| Abstract | Ciljevi: Ciljevi istraživanja su prikazati učestalost komplikacija poslije traheotomija u COVID Jedinici intenzivnog liječenja KBC-a Split, usporediti perkutanu i kiruršku metodu i usporediti rezultate s rezultatima drugih studija.
Ispitanici i metode: U studiju su uključeni svi ispitanici koji su traheotomirani za vrijeme hospitalizacije u COVID jedinici intenzivnog liječenja u razdoblju od ožujka 2020. godine do ožujka 2022 godine. Od njih ukupno 47, 28 postupaka (60%) je obavljeno perkutanom, a 19 postupaka (40%) kirurškom metodom. Podaci su prikupljeni analizom otpusnih pisama iz arhive Klinike za anesteziologiju, reanimatologiju i intenzivno liječenje dostupnih u bolničkom informatičkom sustavu. Razdiobu kvantitativnih podataka smo testirali Kolmogorov – Smirnov testom. Povezanost kvalitativnih podataka proveli smo Hi kvadrat testom. Razliku kvantitativnih podataka između dvije ispitivane skupine napravili smo Mann – Whitney testom. Rezultate smo interpretirali na razini značajnosti P<0,05.
Rezultati: Od ukupnog broja ispitanika, njih 34 (72%) nije imalo komplikacije, a njih 13 (28%) je imalo komplikacije. Neki od potonjih su imali višestruke komplikacije, pa je ukupna incidencija 34%. Krvarenje je najčešća komplikacija koja se javila u 10,5% slučajeva, prolazak zraka pored kanile u 6%, pojava granulacijskog tkiva u 4% i opstrukcija kanile također u 4% slučajeva. Infekcija, traheomalacija, nekroza i subkutani emfizem javile su se u po jednog bolesnika, pa je incidencija svake od njih 2%. Nije bilo statistički značajne razlike između dviju metoda. Od ispitivanih parametara (dob, veličina tubusa, broj pronacija, dan traheotomije, pokušaji odvajanja od respiratora, pojava otežane intubacije i ishod), samo je broj prethodnih pokušaja odvajanja od respiratora imao povezanost s pojavom komplikacija na razini značajnosti od 92%.
Zaključci: Komplikacije poslije traheotomija u COVID JIL-u KBC-a Split javile su se u 28% bolesnika. Nema značajne razlike u incidenciji komplikacija između perkutane i kirurške metode traheotomije. Dob, veličina tubusa, dan traheotomije, ishod i broj pronacija u našem istraživanju nisu u direktnoj vezi s pojavom komplikacija. Postoji značajna povezanost između broja prethodnih pokušaja odvajanja od respiratora i pojave komplikacija. Uzorak nije dovoljno velik da zaključimo može li se neka od komplikacija povezati s perkutanom odnosno kirurškom metodom. |
| Abstract (english) | Objectives: The aim of our research is to determine incidence of complications following tracheostomy in COVID-19-ICU at University Hospital of Split, compare percutaneous with surgical method and compare results with the results of other research projects.
Subjects and methods: Study included all patients that received tracheostomy during their COVID-19-ICU stay form March 2020 to March 2022. Out of 47 procedures, 28 (60%) of them were percutaneous and 19 (40%) were sugical tracheostomies. Data was collected by analyzing patients' discharge letters from the archive of the Department of anesthesiology, resuscitation and intensive care which is available in hospital's informatic system. Distribution of quantitative data was tested with Kolmogorov – Smirnov test. Relation of the qualitative data was tested by Chi-square test. Difference of the quantitative data between two groups was made with Mann – Whitney test. Results were interpreted with the statistical significance P<0.05. Results: From all patients included, 34 (72%) of them had no complications and 13 (28%) had complicatons. Some of the latter had multiple complications, so the total incidence is 34%. Bleeding was the most common complication which occured in 10.5% of the cases, cuff leak in 6%, granulation tissue formation in 4% and tracheal tube obstruction also in 4% of the cases. Infection, traheomalacia, necrosis and subcutaneous emphysema each occured in one patient, which makes incidence for every of them 2%. There was no significant difference between the two methods. From all parameters included (age, endotracheal tube size, number of prone positions, day of tracheostomy, number od weaning attempts, difficult intubation and outcome), only the number of weaning attempts had a correaltion with the occurrence of complications with a statistical significance of 92%.
Conclusions: Complications after tracheostomy in COVID-19-ICU at University Hospital of Split occur in 28% of the patients. There is no significant difference between the percutaneous and surgical method of tracheostomy. Age, endotracheal tube size, day of tracheostomy, outcome and number of prone positions in our study are not in a direct correlation with complications occurrence. There is a significant correlation between number of weaning attempts and occurrence of complications. Sample size is not big enough to to correlate certain complications with a certain method. |
