Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA.
Otolaryngol Head Neck Surg. 2021 Jun;164(6):1136-1147. doi: 10.1177/0194599820961985. Epub 2020 Nov 3.
The coronavirus disease 2019 (COVID-19) pandemic has led to a global surge in critically ill patients requiring invasive mechanical ventilation, some of whom may benefit from tracheostomy. Decisions on if, when, and how to perform tracheostomy in patients with COVID-19 have major implications for patients, clinicians, and hospitals. We investigated the tracheostomy protocols and practices that institutions around the world have put into place in response to the COVID-19 pandemic.
Protocols for tracheostomy in patients with severe acute respiratory syndrome coronavirus 2 infection from individual institutions (n = 59) were obtained from the United States and 25 other countries, including data from several low- and middle-income countries, 23 published or society-endorsed protocols, and 36 institutional protocols.
The comparative document analysis involved cross-sectional review of institutional protocols and practices. Data sources were analyzed for timing of tracheostomy, contraindications, preoperative testing, personal protective equipment (PPE), surgical technique, and postoperative management.
Timing of tracheostomy varied from 3 to >21 days, with over 90% of protocols recommending 14 days of intubation prior to tracheostomy. Most protocols advocate delaying tracheostomy until COVID-19 testing was negative. All protocols involved use of N95 or higher PPE. Both open and percutaneous techniques were reported. Timing of tracheostomy changes ranged from 5 to >30 days postoperatively, sometimes contingent on negative COVID-19 test results.
Wide variation exists in tracheostomy protocols, reflecting geographical variation, different resource constraints, and limited data to drive evidence-based care standards. Findings presented herein may provide reference points and a framework for evolving care standards.
2019 年冠状病毒病（COVID-19）大流行导致全球需要接受有创机械通气的危重症患者激增，其中一些患者可能受益于气管切开术。关于 COVID-19 患者是否进行、何时进行以及如何进行气管切开术的决策对患者、临床医生和医院都有重大影响。我们调查了世界各地的机构为应对 COVID-19 大流行而制定的气管切开术方案和实践。
从美国和其他 25 个国家/地区的各个机构获得了针对严重急性呼吸综合征冠状病毒 2 感染患者的气管切开术方案（n=59），其中包括来自几个中低收入国家的数据、23 项已发表或协会认可的方案以及 36 项机构方案。
比较文件分析涉及对机构方案和实践的横断面审查。对气管切开术的时机、禁忌证、术前检查、个人防护设备（PPE）、手术技术和术后管理等数据来源进行了分析。
气管切开术的时机从 3 天到 >21 天不等，超过 90%的方案建议在气管切开术前进行 14 天的插管。大多数方案主张在 COVID-19 检测结果为阴性时延迟气管切开术。所有方案都涉及使用 N95 或更高等级的 PPE。均有报道开放和经皮技术。气管切开术的时机变化从术后 5 天到 >30 天不等，有时取决于 COVID-19 检测结果是否为阴性。
气管切开术方案存在广泛差异，反映了地理位置的差异、不同的资源限制以及有限的数据来推动循证护理标准。本文提出的研究结果可能为不断发展的护理标准提供参考点和框架。
