S

1
?????????? ???????S?????

• ?as???? a????

G?????? ????d?? MD, FRCPC
2
?st???a t?? µe??d??

• Shelden - 1955 ???t? t?a?e??st?µ?a µe t?????
• Toye/Wenistein - 1969 ???t? ???s? ?d????
  s??µat?? Seldinger
• Caglia - 1985 ?e????? µe p???de?t??? d?ast???
  p?? ?a?????se t?? µ???d?
• Griggs - 1990 ????d?? µe µeta????? d?ast???a
• Fantoni - 1997 ??a?a??????? µ???d??
• Caglia - 1999 ?e????? µe ??a d?ast???a

3
?e?????? ?a? s????t?ta

• ?e p?ast????? d?ast??e??
• ????de?t??? 46.6
• ????? d?ast???a? 31.3
• ????d?? Griggs 17.3
• ??a?a??????? µ???d?? 3.3
• PercuTwist 1.3

4
??de??e??

• ?? ?d?e? µe t?? ?e????????? t?a?e??st?µ?a
• ? ?at????s?

5
??te?de??e??

• ?p???te?
• ?? d??????µe?? a?µ???a???? d???es?
• ?sta??? ??ta?µa ??SS
• ??p??? ???µ??? ? ?a????e?a
• S?et????
• ??µ?d??aµ??? ast??e?a
• FiO2 gt 0.6
• ??at?µ???? a??µa??e?
• ???????µe?? t?a?e??st?µ?a
• ?a?e?? pa??sa???a
• ?pe????sa p??sßas? st?? ae?a????

6
T??t?t?ta - ?p?p?????

• T??t?t?ta 0- 0.6
• ?p?p????? ???? st? 6
• ??ap??s? t?µ?? (3.5)
• ?e??e??e???t??? a?µ???a??a (1.5)
• S?ßa??? ep?p????? (sp???e?)
• ???? t?a?e?a?
• ??a?e????s?fa???? s???????
• ??e?µ????a?a? ?p? t?s?
• ?p????tt?d??? st???s?
• ???? ?????µ?? a?t???a?

7
?a T??a?a
8
??ade?µ??? vs ?e?????????

• ? d?ade?µ??? ???eta? st? ??T µe p??s?p??? ??T
• ?p?? d?ade?µ????
• ?a??te??
• ??sµ?t??? ap?t??esµa
• ????te?? d?ap??s?
• ? ??µ???a??a
• ????? d?af???
• St???s? t?a?e?a?
• T??t?t?ta

9
?p?ß????t??? µ?sa

• ??????s??p??
• ?p???e? d??µa?? ??a t? ?at? p?s? e??a? apa?a?t?t?
• St? ??etta??a ap? 30 t? 1998 ??e? a????e? st?
  80.6 t? 2002
• ??e??e?t?µata
• ?µes? ?pt??? ep?ßeßa?a?s? t?? e?s?d?? t??
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• ep?ßeßa?a?s? t?? s?st?? ????? t?? t?a?e??t?µ??
• ap?f??? ? ???a??? d?ap?st?s? t?a?µat?sµ?? t??
  ?p?s???? t????µat?? t?? t?a?e?a?
• ?e???e?t?µata
• ? a????? eµpe???a? ap? µ????? t?? ?e???st? t??
  ae?a?????
• ? p??a??t?ta ?p??a?µ?a? ?/?a? ?pe??ap??a? ?a? ?
• p??a??t?ta ß??ß?? t?? ß?????s??p??? ap? t??
  ße???a
• ?pe???????f?µa ???s?µ?p??e?ta? ??a e?t?p?sµ?
  ep?fa?e?a??? a??e??? st? ped?? t?? t?a?e??t?µ??
  ?? ep?s?? ?a? t?? ???s?? t?? t?a?e?a? µa?? µe t??
  ??s? t?? ?????e?d??? ???d??? ?a? t?a?e?a???
  ?µ????????.

10
????d?? Griggs
Griggs WM, Worthley LIG, Gilligan JE, et al. A
simple percutaneous tracheostomy technique.
Gynecol Obstet 1990 170543545
11
Portex kit
12
?p?fa?e?a?? a?at?µ?a
13
St?d?a µe??d??
14
St?d?a µe??d??
15
St?d?a µe??d??
16
?p??e?µ??? ??ß?????af?a

• Griggs WM, Worthley LIG, Gilligan JE, et al. A
  simple percutaneous tracheostomy technique.
  Gynecol Obstet 1990 170543545
• Percutaneous Tracheostomy A Practical Handbook.
  Henry G. W. Paw and Andrew R. Bodenham. Cambridge
  University Press .978-1-841-10142-2
• Clinical review percutaneous dilatational
  tracheostomy.Al-Ansari MA, Hijazi MH Crit Care
  2006 Feb, 10202
• Marx, WH, Ciaglia, P, Graniero, KD. Some
  important details in the technique of
  percutaneous dilatational tracheostomy via the
  modified Seldinger technique. Chest
  1996110,762-766
• Is the Method of Modified Percutaneous
  Tracheostomy Without Bronchoscopic Guidance
  Really Simple and Safe? Feyerherd Matthias
  Gründling, Dragan Pavlovic, Sven-Olaf Kuhn and
  Frank Chest 20051283774-3775
• Gregory J. Swanson Robert J. Meleca Joseph
  Bander Robert J. StachlerThe Utility of Chest
  Radiography Following Percutaneous Dilational
  Tracheotomy. Arch Otolaryngol Head Neck Surg, Nov
  2002 128 1253 - 1254.
• Percutaneous dilatational tracheostomy versus
  surgical tracheostomy in critically ill patients
  a systematic review and meta-analysis Anthony
  Delaney, Sean M Bagshaw, and Marek Nalos.
  Critical Care 2006, 10R55