Otorhinolaryngology Unit, Ospedali Riuniti Padova Sud "Madre Teresa Di Calcutta" Hub Covid Hospital Monselice (Padova)-ULSS 6 Euganea, Padua, Italy.
Anaesthesia and Intensive Care Unit, Ospedali Riuniti Padova Sud "Madre Teresa Di Calcutta" Hub Covid Hospital Monselice (Padova)-ULSS 6 Euganea, Padua, Italy.
Eur Arch Otorhinolaryngol. 2020 Aug;277(8):2403-2404. doi: 10.1007/s00405-020-06068-7. Epub 2020 May 26.
The indications and timing for tracheostomy in patients with SARS CoV2-related are controversial.
In a recent issue published in the European Archives of Otorhinolaryngology, Mattioli et al. published a short communication about tracheostomy timing in patients with COVID-19 (Coronavirus Disease 2019); they reported that the tracheostomy could allow early Intensive Care Units discharge and, in the context of prolonged Invasive Mechanical Ventilation, should be suggested within 7 and 14 days to avoid potential tracheal damages. In this Letter to the Editor we would like to present our experience with tracheostomy in a Hub Covid Hospital.
8 patients underwent open tracheostomy in case of intubation prolonged over 14 days, bronchopulmonary overlap infections, and patients undergoing weaning. They were followed up and the number and timing of death were recorded.
Two patients died after tracheostomy; the median time between tracheostomy and death was 3 days. A negative prognostic trend was observed for a shorter duration of intubation.
In our experience, tracheostomy does not seem to influence the clinical course and prognosis of the disease, in the face of possible risks of contagion for healthcare workers. The indication for tracheostomy in COVID-19 patients should be carefully evaluated and reserved for selected patients. Although it is not possible to define an optimal timing, it is our opinion that tracheostomy in a stable or clinically improved COVID-19 patient should not be proposed before the 20th day after orotracheal intubation.
关于 SARS CoV2 相关患者进行气管切开术的适应证和时机仍存在争议。
在最近发表在《欧洲耳鼻喉科学档案》上的一期文章中，Mattioli 等人发表了一篇关于 COVID-19（2019 年冠状病毒病）患者气管切开术时机的短通讯；他们报告说，气管切开术可以允许患者更早地从重症监护病房出院，并且在长时间进行有创机械通气的情况下，应在 7 至 14 天内建议进行气管切开术，以避免潜在的气管损伤。在这篇给编辑的信中，我们将介绍我们在一家新冠病毒医院进行气管切开术的经验。
8 名患者因插管时间超过 14 天、支气管-肺部重叠感染以及正在脱机的患者而行开放式气管切开术。对他们进行了随访，并记录了死亡的人数和时间。
2 名患者在气管切开术后死亡；气管切开术和死亡之间的中位时间为 3 天。我们观察到，插管时间越短，预后呈负向趋势。
在我们的经验中，气管切开术似乎并不能影响疾病的临床过程和预后，尽管这可能会对医护人员造成感染的风险。COVID-19 患者进行气管切开术的适应证应仔细评估，并保留给选定的患者。虽然无法确定最佳时机，但我们认为，对于稳定或临床改善的 COVID-19 患者，在经口气管插管后 20 天之前不应该建议进行气管切开术。
