Ebook Principles and practice of percutaneous tracheostomy: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Principles and practice of percutaneous tracheostomy: Part 2
Ebook Principles and practice of percutaneous tracheostomy: Part 2
cfiopttfBalloon Facilitated Percutaneous Tracheostomy» 0 o o 0Christian ByhahnINTRODUCTIONAll minimally invasive techniques of tracheostomy have two i Ebook Principles and practice of percutaneous tracheostomy: Part 2independent steps in common: dilatation of pretracheal tissues and the anterior tracheal wall, and the cannula insertion performed in subsequent order. Only translaryngeal tracheostomy (TLT) is different in that dilatation is achieved with the tracheostomy cannula Itself. However, TLT is performed i Ebook Principles and practice of percutaneous tracheostomy: Part 2n retrograde, "reverse*', fashion, i.e. from inside the trachea to the outside, and is technically quite sophisticated when compared to antegrade techEbook Principles and practice of percutaneous tracheostomy: Part 2
niques. The Griggs technique was reported to have significant major perioperative complications, whereas the Blue Rhino technique showed less severe bcfiopttfBalloon Facilitated Percutaneous Tracheostomy» 0 o o 0Christian ByhahnINTRODUCTIONAll minimally invasive techniques of tracheostomy have two i Ebook Principles and practice of percutaneous tracheostomy: Part 2 risks. The more manipulation is posed to the airway, the higher is the risk of airway injury; bleeding, creating false passages or entirely loosing the airway. Therefore, it seemed desirable to develop an antegrade tracheostomy technique that combines tracheal dilatation and cannula placement in on Ebook Principles and practice of percutaneous tracheostomy: Part 2e single step.Shortly before his death 111 2000 at the age of 88 years, the pioneer of modern percutaneous tracheostomy. Pasquale Ciaglia. came up witEbook Principles and practice of percutaneous tracheostomy: Part 2
h anidea of balloon facilitated percutaneous tracheostomy (BFPT). an innovative one-step technique. His preliminary visions were further refined by MicfiopttfBalloon Facilitated Percutaneous Tracheostomy» 0 o o 0Christian ByhahnINTRODUCTIONAll minimally invasive techniques of tracheostomy have two i Ebook Principles and practice of percutaneous tracheostomy: Part 2 adopted from radiologists who are using balloon dilation for a variety of interventional procedures for almost ages. This technique utilizes a means of dilatation tliat does not require entry into the trachea by downward pressure using a hard dilatational device, which theoretically could decrease Ebook Principles and practice of percutaneous tracheostomy: Part 2the risk of posterior tracheal wall injuries.APPARATUS AND THE PROCEDUREBFPT combines dilatation and cannula placement in one single step. First, a 15Ebook Principles and practice of percutaneous tracheostomy: Part 2
-20 nun longitudinal or horizontal skin incision has to be made. Like with any other minimally-invasive technique, the trachea is then punctured undercfiopttfBalloon Facilitated Percutaneous Tracheostomy» 0 o o 0Christian ByhahnINTRODUCTIONAll minimally invasive techniques of tracheostomy have two i Ebook Principles and practice of percutaneous tracheostomy: Part 2assed over the guidewire.The heart of BFPT IS a device that can be divided into two portions: the distal portion of thehttps://khothuvien .comBalloon Fadlitated Percutaneous Tracheostomy 81assembly holds a deflated balloon, while the proximal portion is armed with the tracheostomy cannula (Fig. 10.1 Ebook Principles and practice of percutaneous tracheostomy: Part 2). In 2003. Michael Zgoda reported on his initial experience with BFPT in four dogs? After skin incision, tracheal puncture and guidewire placement, tEbook Principles and practice of percutaneous tracheostomy: Part 2
he puncture channel is predilated with a 14-French punch dilator taken from a Blue Rhino kit. Thereafter, the BFPT device holding a 50 mm long, deflatcfiopttfBalloon Facilitated Percutaneous Tracheostomy» 0 o o 0Christian ByhahnINTRODUCTIONAll minimally invasive techniques of tracheostomy have two i Ebook Principles and practice of percutaneous tracheostomy: Part 2 solution to create a pressure of five atmosphere (Fig. 10.2). Such pressure exerted on live tissue results in immediate ischemia. Subsequently, tissue looses its elastic properties. The balloon is left inflated for about 30 seconds, and. lubricated with saline solution, entirely passed down into th Ebook Principles and practice of percutaneous tracheostomy: Part 2e trachea thereafter. The puncture canal essentially enlarges with the balloon by outward radial pressure. The proximal portion of the BFPT device thaEbook Principles and practice of percutaneous tracheostomy: Part 2
t carried the tube is introduced in the trachea, thereby the cannula IS placed. The last step IS to deflate the balloon by evacuating the saline solutcfiopttfBalloon Facilitated Percutaneous Tracheostomy» 0 o o 0Christian ByhahnINTRODUCTIONAll minimally invasive techniques of tracheostomy have two i Ebook Principles and practice of percutaneous tracheostomy: Part 2rified byFig. 10.1: Balloon dilatation percutaneous tracheostomy kitFig. 10.2: Balloon facilitated percutaneous tracheostomy. An angiopasty balloon IS inflated at 5 atm to create a tracheal Sterna. After balloon deflation the device IS advanced further into the trachea and the tracheostomy cannula p Ebook Principles and practice of percutaneous tracheostomy: Part 2aced therebybronchoscopy. The ventilator IS then connected to the tracheostomy tube and the orotracheal tube is removed.Like almost any other inventioEbook Principles and practice of percutaneous tracheostomy: Part 2
n, the BFPT device underwent various modifications, both in design and technique Itself, on its way from the animal laboratory to the bedside/ 10ne recfiopttfBalloon Facilitated Percutaneous Tracheostomy» 0 o o 0Christian ByhahnINTRODUCTIONAll minimally invasive techniques of tracheostomy have two i Ebook Principles and practice of percutaneous tracheostomy: Part 2 concern was the potential risk of bronchial injury if the device was introduced relatively too deep in smaller persons. Therefore. Zgoda successfully tested a technique of deflating the balloon before pushing it down the trachea. Ischemic preconditioning of the cervical tissues makes the dilated st Ebook Principles and practice of percutaneous tracheostomy: Part 2oma stay open long enough to introduce the cannula, even if the blood flow has returned in the meantime. It takes about seconds before previously ischEbook Principles and practice of percutaneous tracheostomy: Part 2
emic tissue retrieves Its elastic properties and such the ability to contract - enough time to advance the cannula.In the meantime, a couple of cases cfiopttfBalloon Facilitated Percutaneous Tracheostomy» 0 o o 0Christian ByhahnINTRODUCTIONAll minimally invasive techniques of tracheostomy have two i Ebook Principles and practice of percutaneous tracheostomy: Part 2ation of82 Principles and Practice of Percutaneous Tracheostomyrhe balloon was required to enhance the quality of dilatation. A reason tor this could have been different elastic properties of the cervical tissues, i.e. fat or muscle have little resistance to five atmosphere of balloon pressure and i Ebook Principles and practice of percutaneous tracheostomy: Part 2s dilated instantly, while the cervical fascia is tougher and thus more difficult to dilate. Uneven resistance alongside of the inflated balloon can cEbook Principles and practice of percutaneous tracheostomy: Part 2
reate an hour-glass effect that results in uneven pressure distribution within the balloon. The operator, in nun. measures an overall balloon pressurecfiopttfBalloon Facilitated Percutaneous Tracheostomy» 0 o o 0Christian ByhahnINTRODUCTIONAll minimally invasive techniques of tracheostomy have two i Ebook Principles and practice of percutaneous tracheostomy: Part 2 pressure at a particular point (i.e. fascia) results in insufficient dilation and thus inability to introduce the cannula. Using a halloon with higher rated burst pressure (e.g. 10 15 atmosphere) could be an option to solve this problem.Another technical problem of BFPT IS balloon rupture before fu Ebook Principles and practice of percutaneous tracheostomy: Part 2ll dilation is achieved. Zgoda. in laboratory' investigations, could show that the balloon typically bursts at the narrowest portion of the hour-glassEbook Principles and practice of percutaneous tracheostomy: Part 2
, which, in turn. IS typically the site of the least degree of dilatation. When tills happened in one patient, attempted removal of the ruptured ballocfiopttfBalloon Facilitated Percutaneous Tracheostomy» 0 o o 0Christian ByhahnINTRODUCTIONAll minimally invasive techniques of tracheostomy have two i Ebook Principles and practice of percutaneous tracheostomy: Part 2 procedure has therefore been developed. Zgoda demonstrated during induced balloon ruptures in cadavers, that advancement of the dev ice into the airway to exploit the loading dilator to further dilate the stoma and allow balloon catheter removal was successfill. The wire remained in place and allow Ebook Principles and practice of percutaneous tracheostomy: Part 2ed placement of another device and successfill tracheostomy.One of the important clinical considerations related to this procedure is temporary occlusEbook Principles and practice of percutaneous tracheostomy: Part 2
ion of trachea with the balloon for about al least for 15 seconds. Thus in the susceptible patients apnea for such period may evoke life-threatening hcfiopttfBalloon Facilitated Percutaneous Tracheostomy» 0 o o 0Christian ByhahnINTRODUCTIONAll minimally invasive techniques of tracheostomy have two i Ebook Principles and practice of percutaneous tracheostomy: Part 2balloon dilatational tracheostomy using the ciaglia Blue Dolphin Set (ciaglia Blue Dolphin Balloon Percutaneous I racheoslomy Introducer, Cook Critical Care. Bloomington. IN, USA) in 20 patients from a cardiosurgical intensive care unit. The surgical time was 3.3 = 1.9 min. No significant bleeding o Ebook Principles and practice of percutaneous tracheostomy: Part 2r tracheal wall injury was observed; however, there were two complications. One patient developed single tracheal ring cartilage fracture and other suEbook Principles and practice of percutaneous tracheostomy: Part 2
bcutaneous emphysema during the balloon dilatation. The study concluded that balloon dilatational tracheostomy is feasible, easy, and safe in the handcfiopttfBalloon Facilitated Percutaneous Tracheostomy» 0 o o 0Christian ByhahnINTRODUCTIONAll minimally invasive techniques of tracheostomy have two i Ebook Principles and practice of percutaneous tracheostomy: Part 2ved feasible and technically simple A few published cases in patients mainly continued these findings. Nevertheless, large and comparative clinical trials need to be conducted before a final statement regarding clinical impact of this novel technique can be made.REFERENCES1 Ambesh SP. Pandcy CK. Sri Ebook Principles and practice of percutaneous tracheostomy: Part 2vastava s. Agarwal A. Singh DK. PeiL'utaiUKKis tiaelieuUomv with single dilatation technique: A prospective, randomized comparison of Ciaslia blue rhiEbook Principles and practice of percutaneous tracheostomy: Part 2
no versusClrộịgsguides ire dilating liicvepi;. Ar-e-.’.h AnaJg 2002:95:17.ĨÒ 45.2bikkers BG. Bricdc IS. Vcrwicl J.V1. Ct al. Percutaneous tracheostomyGọi ngay
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