PhD Program in Clinical and Experimental Medicine, 208968University of Modena and Reggio Emilia, Reggio Emilia, Italy.
Otolaryngology Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy.
Ear Nose Throat J. 2021 Apr;100(2_suppl):116S-119S. doi: 10.1177/0145561320965196. Epub 2020 Oct 9.
Patients with acute respiratory failure due to coronavirus disease 2019 (COVID-19) have a high likelihood of needing prolonged intubation and may subsequently require tracheotomy. Indications and timing for performing tracheotomy in patients affected by severe COVID-19 pneumonia are still elusive. The aim of this study is to analyze the role of tracheotomy in the context of this pandemic. Moreover, we report the timing of the procedure and the time needed to complete weaning and decannulation in our center.
This retrospective, observational cohort study included adults (≥18 years) with severe COVID-19 pneumonia who were admitted to the intensive care unit (ICU) of the tertiary care center of Reggio Emilia (Italy). All patients underwent orotracheal intubation with invasive mechanical ventilation, followed by percutaneous or open surgical tracheotomy. Indications, timing of the procedure, and time needed to complete weaning and decannulation were reported.
Forty-four patients were included in the analysis. Median time from orotracheal intubation to surgery was 7 (range 2-17) days. Fifteen (34.1%) patients died during the follow-up period (median 22 days, range 8-68) after the intubation. Weaning from the ventilator was first attempted on median 25th day (range 13-43) from orotracheal intubation. A median of 35 (range 18-79) days was required to complete weaning. Median duration of ICU stay was 22 (range 10-67) days. Mean decannulation time was 36 (range 10-77) days from surgery.
Since it is not possible to establish an optimal timing for performing tracheotomy, decision-making should be made on case-by-case basis. It should be adapted to the context of the pandemic, taking into account the availability of intensive care resources, potential risks for health care workers, and benefits for the individual patient.
因 2019 年冠状病毒病（COVID-19）导致急性呼吸衰竭的患者极有可能需要长时间插管，随后可能需要进行气管切开术。严重 COVID-19 肺炎患者行气管切开术的适应证和时机仍不明确。本研究旨在分析气管切开术在本次大流行中的作用。此外，我们报告了我院的手术时机以及完成脱机和拔管所需的时间。
这是一项回顾性、观察性队列研究，纳入了入住意大利雷焦艾米利亚三级保健中心重症监护病房（ICU）的严重 COVID-19 肺炎成人（≥18 岁）患者。所有患者均接受经口气管插管和有创机械通气，随后行经皮或开放性外科气管切开术。报告了适应证、手术时机以及完成脱机和拔管所需的时间。
44 例患者纳入分析。从经口气管插管到手术的中位时间为 7 天（范围 2-17 天）。15 例（34.1%）患者在插管后随访期间（中位时间 22 天，范围 8-68 天）死亡。从经口气管插管开始尝试脱机的中位时间为第 25 天（范围 13-43 天）。完成脱机的中位时间为 35 天（范围 18-79 天）。ICU 中位住院时间为 22 天（范围 10-67 天）。从手术开始到拔管的中位时间为 36 天（范围 10-77 天）。
由于无法确定行气管切开术的最佳时机，应根据具体情况做出决策。决策应适应大流行的背景，考虑到 ICU 资源的可用性、医护人员的潜在风险以及对个体患者的获益。
