Effect of Precoetaneous dilatation tracheotomy usage without fiber optic bronchoscope guidance on the patients candidate for tracheostomy and admitted to the intensive care unit on reduction of postoperative complications

Study is done as prospective without blinding on 80 patients with age of at least 18 years candidate for tracheostomy and admitted to the intensive care unit (ICU) at Shahid rajaee hospital during 2106-2017. Patients with great thyroid, undesirable anatomy and Placket disorder are excluded. At first, patient is placed in hyperextension position and intended site is sterile in alcohol with chlorhexidine 2%. The site between the rings 2 and 3 of chips is marked with betadine. With a scalpel, the size of 1.5 cm horizontal incision is created and is pierce with a needle in gauge of fourteen linked to syringe 10 cc content of 2 cc distilled water. The Syringe and needle are exited and Plastic cannula is placed in trachea. Then, guide wire is entered into trachea about 10 cm via plastic cannula and is passed a plastic dilator 14 french over guide wire. Plastic dilator is exited and after entering white dilator and passing rhino dilator to the skin level into trachea and then exiting rhino dilator via metal guide wire, tracheostomy tube in suitable size is placed into trachea. metal guide wire and white dilator are exited and after bilateral symmetry lung sound and confirming tracheostomy tube site into trachea, Orotracheal tube is exited. After one hour, chest x-ray is taken. Rate of Bleeding, loss of oxygen saturation less than 90%, exiting or rupture of trachea tube, incidence of pneumothorax and Subcutaneous emphysema, incorrect embedding tracheostomy tube and related death are assessed in patients to 24 hours.

Vice Chancellor for Research, Qazvin University of Medical Sciences