经皮扩张气管切开术（PDT）以其创伤小、安全性高的特点，目前已成为气管切开的主流术式。为了充分暴露气管，在围手术期需将患者摆放成肩部垫高、颈部过伸的体位，但由此可能引起颅内压（ICP）升高进而对患者的远期神经功能预后产生不利影响。本文通过回顾1例脑死亡患者在急性脑损伤后2周左右接受PDT的围手术期ICP监测数据，观察到自气管切开手术体位摆放完毕至恢复初始体位期间，ICP始终较基线水平升高3~5 mmHg，虽然这一现象与患者预后之间似乎并无明显关联，但仍然提示对理想的ICP管理产生一定程度的负面影响。尽管早期气管切开具有提高患者舒适性、减少镇静药物使用等优点，但如何平衡神经重症患者经皮气管切开的操作时机并避免因ICP升高引起的神经系统继发性损伤，仍有待未来大样本量的临床研究予以明确。

Percutaneous dilatational tracheotomy (PDT), characterized by its minimal invasiveness and high safety profile, has become the mainstream technique for tracheotomy. To achieve adequate tracheal exposure, the procedure requires positioning the patient with shoulder elevation and neck hyperextension. However, this specific maneuver may increase intracranial pressure (ICP), which could potentially lead to adverse effects on long-term neurological outcomes. This case report presents the perioperative ICP monitoring data of a brain-death patient who underwent PDT approximately two weeks after acute brain injury. Our observations indicated that ICP remained persistently elevated by approximately 3-5 mmHg above the baseline from the establishment of the surgical position until the patient was returned to the initial supine position. Although this ICP elevation did not appear to directly influence the outcome in this particular case (given the patient's brain-death status), it nonetheless suggests a potential compromise to optimal ICP management. While early tracheostomy offers benefits such as enhanced patient comfort and reduced sedation requirements, balancing the timing of PDT in neurocritically ill patients against the risk of procedure-related ICP elevation and secondary neurological injury warrants further investigation through large-scale clinical studies.