[Application of modified percutaneous rotating dilative tracheostomy with fiberoptic bronchoscope in critical patients of ICU: a control study for four kinds of tracheostomy].

Objective To investigate the clinical application of modified percutaneous rotating dilative tracheostomy with fiberoptic bronchoscope (MPRDT-FOB) in critical patients of intensive care unit (ICU) by comparing it with percutaneous dilative tracheostomy (PDT), modified percutaneous dilative tracheostomy (MPDT), and percutaneous dilative tracheostomy with fiberoptic bronchoscope (PDT-FOB). Methods A prospective control study was conducted. 240 critical patients underwent tracheotomy admitted to ICU of Mudanjiang Medical University Hongqi Hospital from February 2011 to November 2016 were enrolled, and they were randomly divided into four groups with 60 patients in each group. The patients in PDT group received traditional Portex method for tracheotomy. The patients in MPDT group received PDT method first, in the process of puncture and expansion, the trachea catheter was always retained in situ, and then retreated to the puncture site about 16-18 cm from incisor after withdrawal of the dilator. The patients in PDT-FOB group received PDT with fiberoptic bronchoscope. The patients in MPRDT-FOB group received PDT-FOB combined with MPDT, in bronchoscope expansion incision, and was replaced with rotary expander to the anterior wall of the trachea. The duration of operation, the size of incision, blood loss during operation, and the rate of disposable success, as well as the incidence of perioperative and long-term complications among four kinds of tracheostomy were compared. Results Compared with PDT and PDT-FOB, the duration of operation in MPDT and MPRDT-FOB was significantly shortened (minutes: 6.57±3.59, 7.09±2.55 vs. 12.20±2.01, 10.13±2.37), the size of incision was significantly diminished (cm: 1.20±1.00, 1.20±0.90 vs. 1.59±1.18, 1.32±1.24), and the amount of blood loss during operation was significantly decreased (mL: 6.81±2.19, 6.60±1.99 vs. 10.28±3.68, 8.11±2.96, all P 0.05). Conclusions It was proved that MPRDT-FOB to be a time-saving, easy-to-operate way with few complication. Moreover, it was able to deal with the problems of the tracheal wall injury or perforation, tracheoesophageal fistula, and hypoxia. Hence, it was better than PDT, MPDT, and PDT-FOB. Key words: Modified percutaneous rotating dilative tracheostomy with fiberoptic bronchoscope; Modified percutaneous dilative tracheostomy; Percutaneous dilative tracheostomy with fiberoptic bronchoscope; Percutaneous dilative tracheostomy; Intensive care unit; Critical patient