Gambaran Komplikasi Percutaneous Dilatational Tracheostomy (PDT) pada Pasien Kritis di ICU RSUP H. Adam Malik Medan

Abstract

Background: Percutaneous dilatational tracheotomy is one of the procedures in the ICU which is expected to become frequently performed along with the increasing use of ventilators for a long period of time. PDT action in ICU may be indicated in patients with failed extubation, upper airway obstruction, airway protection, access to drain respiratory secretions and to avoid serious oropharyngeal and laryngeal injuries due to prolonged translaryngeal intubation. Several studies explain that the comparison of the number of male tracheostomy patients is greater than female patients but with insignificant comparisons with the average age of the patients who vary. Patients with extensive neurological deficits, patients with chronic obstructive pulmonary disease, postoperative patients and patients with other serious medical illnesses are the patients who generally require long-term mechanical ventilation and require PDT in the ICU. Bronchoscopy guidance can also be used as a tool to detect the exact tracheostomy location so as to minimize damage to the posterior tracheal wall. Tracheostomy complications can be grouped according to several opinions, namely mild and severe complications as well as immediate, early and late complications. The complications that often occur are minor bleeding complications. Objective : To determine the description of percutaneous dilatational tracheostomy complications in critical patients in the ICU of Haji Adam Malik General Hospital, Medan. Method:This research is a retrospective descriptive study with a cross-sectional method. After obtaining approval from the Ethics Committee Of Faculty of Medicine, University of North Sumatera, samples were taken which were all critical patients with tracheostomy in the ICU of Haji Adam Malik General Hospital who were registered in the patient's medical records from January 2022 - December 2022 and met the inclusion criteria. The data that has been collected is analyzed using a computer program and distributed descriptively using a frequency distribution table. Results and conclusions:The total number of critical patients in the ICU who undergo tracheostomy procedures at Haji Adam Malik, General Hospital Medan from January 2022 - December 2022 are 37 patients with the percentage of women (54%) more than men (46%). The highest frequency of patients in the age range of 40-60 years (43%). The most diagnoses of critical patients with tracheostomy in the ICU were endocrine problems, namely 26% and respiratory problems, 21%, gastrointestinal problems (3%) were the rarest in the ICU. The most indicated tracheostomy was failure to wean the ventilator, namely 23 people and the least indication was OSNA, namely 1 person. Tracheostomy time in critical patients in the ICU was mostly done after more than 7 days of ICU stay (84%). Most of the tracheostomy installations in critical patients in the Adam Malik Hospital ICU were performed without the use of bronchoscopy. Complications that occur in tracheostomy patients at ICU Adam Malik Hospital are mild bleeding, subcutaneous emphysema and localized infections which are classified as mild complications. The severe complication that occurred was tracheal injury in 1 patient.