Starkov Yu G, Lukich K V, Dzhantukhanova S V, Plotnikov G P, Zamolodchikov R D, Zvereva A A
Vishnevsky National Medical Research Center for Surgery, Moscow, Russia.
Khirurgiia (Mosk). 2020(12):16-21. doi: 10.17116/hirurgia202012116.
To summarize an experience of endoscopy-assisted dilatational tracheostomies in patients with COVID-19.
There were 31 endoscopy-assisted dilatational tracheostomies in patients with COVID-19 for the period from April 17 to June 10, 2020 (11 women and 19 men). Mean age of patients was 66.7 years (range 48-87). Tracheostomy was performed using Ciaglia (22) and Griggs (9) techniques. All procedures were carried out at the intensive care unit in elective fashion.
Tracheostomy was performed in 19.8% of ICU patients or 36.9% of all patients on mechanical ventilation within 6.5±2.5 days [min 3, max 11]. There were 22 survivors with tracheostomy (70.9%) that is comparable with survival of patients without mechanical ventilation (79.7%) and slightly higher than in patients on ventilation without tracheostomy (65.4%). No complications during the procedure were noted.
Endoscopy-assisted dilatational tracheostomy is preferred for prolonged mechanical ventilation, including patients with COVID-19. The undeniable advantages of this operation are fewer intraoperative complications due to endoscopic control, and lower risk of tracheal strictures.
总结新型冠状病毒肺炎（COVID-19）患者在内镜辅助下扩张气管切开术的经验。
2020年4月17日至6月10日期间，对31例COVID-19患者实施了内镜辅助下扩张气管切开术（11例女性，19例男性）。患者平均年龄为66.7岁（范围48 - 87岁）。采用Ciaglia技术（22例）和Griggs技术（9例）进行气管切开术。所有手术均在重症监护病房择期进行。
在6.5±2.5天内（最短3天，最长11天），19.8%的重症监护病房患者或36.9%的所有机械通气患者接受了气管切开术。22例气管切开术患者存活（70.9%），这与未接受机械通气患者的生存率（79.7%）相当，略高于未行气管切开术的机械通气患者（65.4%）。术中未观察到并发症。
对于包括COVID-19患者在内的需要长时间机械通气的患者，内镜辅助下扩张气管切开术是首选。该手术不可否认的优点是由于内镜控制术中并发症较少，以及气管狭窄风险较低。
