Artikel
Comparison of ICP-monitoring values in standard and a modified Griggs' treacheostomy technique
Vergleich der Ergebnisse des ICP-Monitorings bei konventioneller und modifizierter Tracheotomie-Technik nach Griggs
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Autoren
Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
To evaluate a modified Griggs’ dilatational tracheostomy technique in neurosurgical patients, and to compare it with the standard technique of Griggs et al.
Methods
Bedside tracheostomy was performed in 46 neurosurgical patients. In 10 patients (group 1) the standard Griggs' technique was used, in 36 patients (group 2) a modified technique. In group 2 the original technique of Griggs et al. was modified as follows: The head of bed was elevated to 30°, the head was not reclined or only moderately, and, to overcome this space limitation, the skin incision was made larger (2 - 3 cm). This larger skin incision permitted dissection to the trachea and palpation of the tracheal rings. Afterwards, the original puncture-dilatational technique was completed. Intracerebral pressure (ICP), end-tidal CO2 (ETCO2), and cerebral perfusion pressure (CPP) were assessed in all patients.
Results
In group 1, a mean rise of ICP of 9 (0 – 18) mmHg above baseline values was observed, whereas in group 2, a mean rise of ICP of 5 (0 – 15) mmHg above baseline values was seen. Similarly, the rise of ETCO2 was larger in group 1 in comparison with group 2. All patients maintained CPP above 60 mmHg during the procedure.
Conclusions
With the described modifications, bedside dilatational tracheostomy can safely be performed in critically ill neurosurgical patients, who are at risk of ICP increase. It seems, that the described modifications of the original technique of Griggs et al. lead to reduced elevation of ICP during the procedure, thus, potentially reducing morbidity.