Department of Otorhinolaryngology Head and Neck Surgery, St George's Hospital NHS Foundation Trust, London, UK.
Department of Critical Care, St George's Hospital NHS Foundation Trust, London, UK.
Eur Arch Otorhinolaryngol. 2021 Feb;278(2):313-321. doi: 10.1007/s00405-020-06126-0. Epub 2020 Jun 17.
Traditional critical care dogma regarding the benefits of early tracheostomy during invasive ventilation has had to be revisited due to the risk of COVID-19 to patients and healthcare staff. Standard practises that have evolved to minimise the risks associated with tracheostomy must be comprehensively reviewed in light of the numerous potential episodes for aerosol generating procedures. We meet the urgent need for safe practise standards by presenting the experience of two major London teaching hospitals, and synthesise our findings into an evidence-based guideline for multidisciplinary care of the tracheostomy patient.
This is a narrative review presenting the extensive experience of over 120 patients with tracheostomy, with a pragmatic analysis of currently available evidence for safe tracheostomy care in COVID-19 patients.
Tracheostomy care involves many potentially aerosol generating procedures which may pose a risk of viral transmission to staff and patients. We make a series of recommendations to ameliorate this risk through infection control strategies, equipment modification, and individualised decannulation protocols. In addition, we discuss the multidisciplinary collaboration that is absolutely fundamental to safe and effective practise.
COVID-19 requires a radical rethink of many tenets of tracheostomy care, and controversy continues to exist regarding the optimal techniques to minimise risk to patients and healthcare workers. Safe practise requires a coordinated multidisciplinary team approach to infection control, weaning and decannulation, with integrated processes for continuous prospective data collection and audit.
由于 COVID-19 对患者和医护人员的威胁，传统的重症监护中关于早期气管切开术在有创通气中有益的观点必须重新审视。为了最大限度地降低与气管切开术相关的风险，已经发展了一些标准实践，必须根据潜在的大量气溶胶产生程序对这些标准实践进行全面审查。我们通过介绍两家主要的伦敦教学医院的经验，满足了安全实践标准的迫切需求，并将我们的发现综合为多学科气管切开患者护理的循证指南。
这是一篇叙述性综述，介绍了超过 120 例气管切开患者的丰富经验，并对 COVID-19 患者安全气管切开护理的现有证据进行了务实分析。
气管切开护理涉及许多潜在的气溶胶产生程序，可能会对工作人员和患者造成病毒传播的风险。我们通过感染控制策略、设备改装和个体化拔管方案提出了一系列建议来减轻这种风险。此外，我们还讨论了安全有效实践绝对必需的多学科协作。
COVID-19 需要对许多气管切开护理的原则进行彻底的重新思考，关于如何最大限度地降低患者和医护人员风险的最佳技术仍存在争议。安全实践需要协调多学科团队的感染控制、脱机和拔管方法，同时进行持续的前瞻性数据收集和审核的综合流程。
