+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Percutaneous tracheostomy/gastrostomy in brain-injured patients--a minimally invasive alternative



Percutaneous tracheostomy/gastrostomy in brain-injured patients--a minimally invasive alternative



Journal of Trauma 33(3): 435-439



Tracheostomy and gastrostomy are frequent adjunctive procedures required in the management of patients with severe brain injuries to facilitate neurorehabilitation. We therefore evaluated the use of two minimally invasive surgical procedures, percutaneous tracheostomy (PT) and percutaneous endoscopic gastrostomy (PEG), in 27 patients with severe brain injuries. The mean age was 41 +/- 4 years, and 23 (85%) were men. All patients were intubated, and 19 (70%) required mechanical ventilator support on the day of PT/PEG. The endotracheal tubes had been in place for 1 to 21 days (mean, 8.7 +/- 0.8). All patients were stable from their acute brain injury; 13 had intracranial pressure (ICP) monitors in place. The Seldinger technique, as described by Ciaglia, was employed for PT. Following PT, a PEG was inserted by a modification of the Sachs-Vine "push" technique. We were uniformly successful in placing these access tubes. Complications were minor and not clinically significant. Three of 13 patients (23%) with ICP monitors had a transient rise in ICP related to PT and one of these patients developed local subcutaneous emphysema. Another patient experienced a mild cellulitis at the tracheostomy site. Of note, there were no PEG-related complications. In conclusion, PT and PEG are readily learned, minimally invasive procedures. In our experience with patients with severe brain injuries combined PT/PEG is a uniformly safe alternative to gain long-term access to the airway and gut.

Please choose payment method:






(PDF emailed within 1 workday: $29.90)

Accession: 060079167

Download citation: RISBibTeXText

PMID: 1404515


Related references

Percutaneous tracheostomy/gastrostomy in brain injured patients--a minimally invasive alternative. Journal of Trauma 34(6): 916-917, 1993

Minimally invasive surgery. Bedside tracheostomy and gastrostomy. Critical Care Clinics 16(1): 113-130, 2000

Tracheostomy and percutaneous endoscopic gastrostomy in the management of the head-injured trauma patient. American Surgeon 60(3): 180-185, 1994

Impact of percutaneous dilatational tracheostomy in brain injured patients. Clinical Neurology and Neurosurgery 137: 137-141, 2016

Percutaneous transesophageal gastrostomy tube placement: an alternative to percutaneous endoscopic gastrostomy in patients with intra-abdominal metastasis. Gastrointestinal Endoscopy 71(2): 402-406, 2010

Percutaneous tracheostomy: a minimally invasive procedure on the intensive care unit. Swiss Surgery 1996(2): 42-45, 1996

Tracheostomy under jet-ventilation - An alternative approach to ventilating patients undergoing surgically created or percutaneous dilational tracheostomy. Middle East Journal of Anesthesiology 19(4): 803-818, 2008

Image-guided percutaneous ablation of lung malignancies: A minimally invasive alternative for nonsurgical patients or unresectable tumors. Journal of Bronchology and Interventional Pulmonology 21(1): 68-81, 2014

Establishing radiological percutaneous gastrostomy with balloon-retained tubes as an alternative to endoscopic and surgical gastrostomy in patients with tumours of the head and neck or oesophagus. British Journal of Radiology 75(892): 371-377, 2002

Endoscopy-assisted, single trans-gastric trocar, laparoscopic pseudocysto-gastrostomy A minimally invasive alternative for drainage of large pseudocysts. Annali Italiani di Chirurgia 8, 2019

Earlier tracheostomy and percutaneous endoscopic gastrostomy in patients with hemorrhagic stroke: associated factors and effects on hospitalization. Journal of Neurosurgery 2019: 1-7, 2019

The role of percutaneous endoscopic gastrostomy in spinal cord injured patients. Paraplegia 33(7): 416-418, 1995

Percutaneous cholecystolithotomy. A minimally invasive alternative to cholecystectomy and to shock wave lithotripsy. Archives of Surgery 125(9): 1114-1118, 1990

Percutaneous endoscopic gastrostomy reduces total hospital costs in head-injured patients. American Journal of Surgery 176(4): 311-314, 1998

Minimally invasive percutaneous nephrolithotomy: an alternative to retrograde intrarenal surgery and shockwave lithotripsy. World Journal of Urology 31(6): 1555-1561, 2014