Percutaneous Dilatational tracheostomy and surgical tracheostomy in Imam Khomeini Hospital: report of two cases (case report)

Background: percutaneous dilatational tracheostomy was invented by ciaglia in 1985. With advent of various instruments, various methods such as Fantoni, Grigges and etc, it became a widesepreadly used method of tracheostomy, especially in intensive care unit wards. In our country this was began in 2005, along with many work shops conducted by anesthesiology department of Tehran University of Medical sciences, with help of specialist from Turin University from ITALY. Case report: In this report two patients who underwent percutaneous dilatational tracheostomy are presented, and are compared with patients who had undergo surgical tracheostomy. Their long and short term complications such as bleeding, injury extents, and recovery was studied and presented. Conclusion: Tracheostomy is an opening in front of neck, in to the trachea, through which breathing is made possible. Percutaneous Dilatational Ttracheostomy (PDT) is a method of tracheostomy, in which the need for surgery and transfer of patient to operation room is alleviated. Dispite various benefits, PDT has a few short term and long term drawbacks, which are cartilage fracture, injury to vital structures, perforation of posterior wall, sever bleeding displacement of tube, tracheo-esophageal fistula and trache-oinnominate fistula. Incidence of these complications are lower than surgical tracheostomy. Global reports, especialllly from countries with large scale experiences present a different statistic regarding its success as an alternative method for patients with long surveillance and under mechanical ventilation

Clinical Course Teaching in Transport of Critically Ill Patients: Small Group Methods

Critically ill patient transfer is potentially risky and may be lead to morbidity and mortality. Physicians' skill is very important for safe transport. We want to evaluate the effect of clinical course teaching on the promotion of physicians' abilities in the transport of critically ill patients. In an interventional study, 320 interns, male and female, were taught about patient transfer in two groups include in one day clinical course as the small group system (n=160) and other group the lecture base learning (n=160). In the clinical course, each participant under observation of an anesthesiologist in the operation room and ICU was acquainted with mask ventilation, intubation and learned to work with a defibrillator, infusion pump, portable ventilator and pulse oximeter. In lecture group, the anesthesiologist explained the topics by video and dummy. At the end of education course, the interns’ abilities were evaluated based on checklist method and scored by the project colleague in all educational items. Three hundred twenty interns, 122 males, and 198 females; were enrolled, two groups. The clinical course training caused improvements in the interns’ knowledge and abilities in intubation and use of the defibrillator and portable ventilator vs.lecture group significantly (P<0.005). The males were better than females in laryngoscopy, but the progress of the females was significantly better than males (P=0.003). The rate of adverse events was reduced significantly after clinical course teaching (P=0.041) Clinical course teaching could promote interns' clinical competencies in the transport of critically ill patients