gms | German Medical Science

Objective: Tracheotomy is a well-established method in the airway management of critical ill patients. Especially Percutaneous Dilatational Tracheotomy (PDT) represents an easy-to-learn technique with a low complication rate. However, patients on a neurointensive care unit often require special treatment methods beyond the established general measures for critical ill patients. PDT might negatively influence the course of disease, and in particular lead to irreversible ICP crises.

Method: Almost all PDT (n=289) that were conducted from 5/2005 until 10/2013 were included in this retrospective study. Medical basic data were collected. Blood gas analyses and hemodynamic values were recorded at seven different time points around the procedure (from the beginning up to 12 hours after finishing tracheotomy). Intracerebral brain tissue oxygen (PBrO₂) and intracerebral pressure (ICP) were determined by parenchymal devices in a subset of patients.

Results: Invasive measurement of brain tissue oxygen (n=39) ruled out any cerebral hypoxia in those cases. Intracranial pressure rose temporarily in 24% (23/95) of the cases with a peak of mean ICP (23 mmHg, range 3-68 mmHg) at time-of-cannulation, but no case of ongoing ICP crisis was observed following the tracheotomy. Cerebral perfusion pressure (CPP) remained unaffected in all cases. Severe complications were very rare (1/289), in one case there was an injury of the brachiocephalic trunk. Circulatory parameters (arterial pressure and heart rate) were stable. Mean PCO₂ value increased significantly (U-test: p<0.001) from 35 mmHg (baseline) to 45 mmHg (cannulation), but returned to baseline value postoperatively. Only two patients showed transient hypoxia while mean oxygen partial pressure rose up to 432 mmHg during the procedure. The average time for the procedure was 4:10 min (Range: 1:03 min – 25:00 min). Spearman's rank correlation ruled out any correlations between ICP at time of cannulation and respiratory or circulatory baseline values. ICP during cannulation seems only to depend on baseline ICP.

Conclusions: PDT is a safe procedure for most common neurosurgical diseases with acute cerebral lesions. Not even patients with respiratory insufficiency or circulatory instability did show any cerebral hypoxia or long running cerebral hypertension provoked through PDT.