Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital d'Instruction des Armées Sainte-Anne, Toulon, France; Elément Militaire de Réanimation du Service de Santé des Armées EMRSSA, Mulhouse, France.
Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital d'Instruction des Armées Sainte-Anne, Toulon, France; Elément Militaire de Réanimation du Service de Santé des Armées EMRSSA, Mulhouse, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2020 Sep;137(4):263-268. doi: 10.1016/j.anorl.2020.06.016. Epub 2020 Jun 28.
The main objective was to demonstrate the feasibility of percutaneous tracheostomy performed under difficult conditions by military ENT physicians during their deployment in the military intensive care field hospital of the French Military Medical Service in Mulhouse to confront the exceptional COVID-19 pandemic. The secondary objective was to assess reliability and safety for patient and caregivers, with a risk of iatrogenic viral contamination.
A single-center retrospective study was conducted between March 25 and April 25, 2020, in 47 COVID-19 patients requiring prolonged mechanical ventilation. The inclusion criterion was having undergone percutaneous tracheostomy.
Eighteen consecutively included patients had successfully undergone percutaneous tracheostomy despite unfavorable anatomical conditions (short neck: 83.3%, overweight or obese: 88.9%). Median time to completion was 11 days after intubation, with an average duration of 7minutes. The procedure was technically compliant in 83.3% of cases, and considered easy (on self-assessment) in 72.2%, with 2 minor per-procedural complications. No crossover to surgery was required. There was only 1 major post-procedural complication (late hemorrhage).
This study showed the feasibility of percutaneous tracheostomy by an ENT physician under COVID-19 biohazard conditions. The technique was fast, easy and safe and met safety requirements for patient and staff.
本研究的主要目的是展示在法国军队医疗服务部在米卢斯军事重症监护野战医院部署期间，耳鼻喉科医生在困难条件下进行经皮气管切开术的可行性，以应对 COVID-19 大流行这一特殊情况。次要目的是评估患者和医护人员的可靠性和安全性，因为存在医源性病毒污染的风险。
这是一项于 2020 年 3 月 25 日至 4 月 25 日在一家中心进行的回顾性单中心研究，共纳入 47 例需要长时间机械通气的 COVID-19 患者。纳入标准为接受经皮气管切开术。
尽管存在不利的解剖条件（短颈：83.3%；超重或肥胖：88.9%），但仍有 18 例连续纳入的患者成功接受了经皮气管切开术。中位置管后时间为 11 天，平均用时 7 分钟。83.3%的病例手术技术符合要求，72.2%的病例认为手术简单（自我评估），有 2 例围手术期轻微并发症。无一例需要转为手术。仅发生 1 例术后严重并发症（迟发性出血）。
本研究表明，在 COVID-19 生物危害条件下，耳鼻喉科医生可以进行经皮气管切开术。该技术快速、简单、安全，符合患者和医护人员的安全要求。
