Agysérült betegek tracheostomájának dekanülálása bronchoszkópos ellenőrzés mellett@@@Tracheostomy decannulation of patients with brain injury guided by flexible bronchoscope

Bevezetes: Az intenziv terapia teruleten bekovetkezett fejlődes a kritikus allapotu traumas es vascularis eredetű sulyos agyserult betegek eletkilatasait jelentősen javitotta, es novelte a rehabilitacios osztalyra kerulő tracheostomizalt, kanulos betegek szamat. Celkitűzes: A szerzők ismertetik a tracheakanul biztonsagos eltavolitasanak altaluk kidolgozott technikajat a sulyos agyserultek rehabilitacioja soran. Modszer: Prospektiv leiro vizsgalat, amelyet az Orszagos Orvosi Rehabilitacios Intezet sulyos agyserultek rehabilitaciojaval foglalkozo osztalyain folytattak. Eredmenyek: 2013. januar 1. es december 31. kozott 20 betegnel 30 esetben vegeztek bronchoszkopos tracheavizsgalatot dekanulalassal kapcsolatosan. A betegeket kulonboző eredetű agykarosodas miatt kezeltek a rehabilitacios osztalyon: 6 esetben trauma, 5 esetben ischaemias stroke, 3 betegnel agytorzsi verzes, kettőnel kisagyi, egy betegnel bifrontalis verzes volt az alapbetegseg, mig 1-1 beteg eseteben koroki tenyezőkent meningeoma, pneumonia kovetkezteben fellepő tobbszervi elegtelenseg es anoxias agykarosodas szerepelt. A betegek atlageletkora 44 ev (18–80) volt. A vizsgalat soran 13 esetben vegeztek sikeres, szovődmenymentes dekanulalast. A kanulok eltavolitasa atlagosan 62 nap utan tortent. Kovetkeztetesek: A biztonsagos betegellatas erdekeben, a szakteruletek fejlődesehez a kulonboző gyogyitoosztalyoknak is alkalmazkodniuk kell. A sulyos agyserult betegek korai rehabilitacios kezelesenek feltetele a tracheostomaval erkező betegek biztonsagos ellatasa, majd lehetőseg szerinti dekanulalasa. Ehhez a tevekenyseghez a szerzők szuksegesnek tartjak a bronchoszkopiaban jartas szakember bevonasat es helyi protokoll kialakitasat. Orv. Hetil., 2014, 155(28), 1108–1112. | Introduction: Progress in intensive care management of patients with severe brain injury due to trauma or vascular lesion significantly improved the mortality and increased the number of patients with tracheostomy who undergo treatment in rehabilitation departments. Aim: The aim of the authors was to describe the safe tracheostomy decannulation method of patients with brain injury during rehabilitation. Method: A prospective, descriptive study performed at the rehabilitation departments of the National Institute for Medical Rehabilitation in Budapest, Hungary. Results: From January 1 until December 31, 2013, thirty examinations with flexible bronchoscope for tracheostomy decannulation were performed in 20 patients. The patients were admitted to the rehabilitation wards with various brain injuries: 6 patients suffered from trauma, 5 had ischemic stroke, 3 patients had brain stem haemorrhage, 2 patients cerebellar and one patient bifrontal haemorrhage. One patient had menangioma, and one had multiple organ failure and anoxic brain injury caused by pneumonia. The average age of patients was 44 years (range, 18–80 years). During the procedure successful decannulation was performed in 13 patients. Decannulation occurred 62 days after tracheostomy on average. Conclusions: Safe patient care requires that various medical departments keep pace with the development of different specialities. To ensure early rehabilitation of patients with severe brain injury having tracheostomy, safe treatment and, if possible, decannulation should be performed. This procedure requires the involvement of a physician with bronchoscopy skills as well as the development of local protocols. Orv. Hetil., 2014, 155(28), 1108–1112.