To explore the application of standard operating procedure of percutaneous dilatation tracheotomy in patients with severe neuropathy.

Medical records of 56 patients who underwent ultrasound localization combined with fiberoptic bronchoscope-guided PDT in ICU 1 of Beijing Tiantan Hospital, Capital Medical University from September 2019 to March 2021 were retrospectively collected, and they were divided into the pre-SOP implementation group (19 cases, September 2019 to February 2020) and the post-SOP implementation group (37 cases, March 2020 to March 2021). Two groups patients with baseline data (age, sex, body mass index), the proportions of the main diagnosis, brain tumors, cerebrovascular disease, the types of artificial airway, artificial airway indwelling time, Glasgow coma scale (GCS), total length of hospital stay, calm analgesic drug use time, operation time, mechanical ventilation, vital signs parameters were compared.

There were no significant differences in baseline data and surgical difficulty between the two groups, but the implementation of SOP significantly shortened the time of sedative and analgesic drugs [25 (24, 28) min vs 32 (28, 33) min, P＜0.001], and the operation time [7 (6, 8) min vs 10 (8, 14) min, P＜0.001] and duration of mechanical ventilation [40 (40, 50) min vs 70 (60, 80) min, P＜0.001], the incidence of adverse events, such as tachycardia (0 vs 21.1%, P=0.004), hypotension (0 vs 26.3%, P=0.001), hypertension (0 vs 21.1%, P=0.004) and hypoxemia (0 vs 15.8%, P=0.013) were also significantly decreased, with statistically significant differences.

For PDT guided by ultrasound and fiberoptic bronchoscope in neurocritical patients, SOP can help shorten the length of anesthesia and operation, reduce the adverse events and avoid aggravating of secondary cerebral ischemia and hypoxia.