Tang Yun, Wu Yongran, Zhu Fangfang, Yang Xiaobo, Huang Chaolin, Hou Guo, Xu Wenhao, Hu Ming, Zhang Lu, Cheng Aiguo, Xu Zhengqin, Liu Boyi, Hu Song, Zhu Guochao, Fan Xuepeng, Zhang Xijing, Yang Yadong, Feng Huibin, Yu Lixia, Wang Bing, Li Zhiqiang, Peng Yong, Shen Zubo, Fu Shouzhi, Ouyang Yaqi, Xu Jiqian, Zou Xiaojing, Fang Minghao, Yu Zhui, Hu Bo, Shang You
Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
Front Med (Lausanne). 2020 Dec 17;7:615845. doi: 10.3389/fmed.2020.615845. eCollection 2020.
The outbreak of coronavirus disease 2019 (COVID-19) has led to a large and increasing number of patients requiring prolonged mechanical ventilation and tracheostomy. The indication and optimal timing of tracheostomy in COVID-19 patients are still unclear, and the outcomes about tracheostomy have not been extensively reported. We aimed to describe the clinical characteristics and outcomes of patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia who underwent elective tracheostomies. The multi-center, retrospective, observational study investigated all the COVID-19 patients who underwent elective tracheostomies in intensive care units (ICUs) of 23 hospitals in Hubei province, China, from January 8, 2020 to March 25, 2020. Demographic information, clinical characteristics, treatment, details of the tracheostomy procedure, successful weaning after tracheostomy, and living status were collected and analyzed. Data were compared between early tracheostomy patients (tracheostomy performed within 14 days of intubation) and late tracheostomy patients (tracheostomy performed after 14 days). A total of 80 patients were included. The median duration from endotracheal intubation to tracheostomy was 17.5 [IQR 11.3-27.0] days. Most tracheotomies were performed by ICU physician [62 (77.5%)], and using percutaneous techniques [63 (78.8%)] at the ICU bedside [76 (95.0%)]. The most common complication was tracheostoma bleeding [14 (17.5%)], and major bleeding occurred in 4 (5.0%) patients. At 60 days after intubation, 31 (38.8%) patients experienced successful weaning from ventilator, 17 (21.2%) patients discharged from ICU, and 43 (53.8%) patients had died. Higher 60 day mortality [22 (73.3%) vs. 21 (42.0%)] were identified in patients who underwent early tracheostomy. In patients with SARS-CoV-2 pneumonia, tracheostomies were feasible to conduct by ICU physician at bedside with few major complications. Compared with tracheostomies conducted after 14 days of intubation, tracheostomies within 14 days were associated with an increased mortality rate.
2019年冠状病毒病（COVID-19）的爆发导致大量患者需要长期机械通气和气管切开术，且这一数量还在不断增加。COVID-19患者气管切开术的指征和最佳时机仍不明确，关于气管切开术的结果也尚未有广泛报道。我们旨在描述确诊为严重急性呼吸综合征冠状病毒2（SARS-CoV-2）肺炎且接受择期气管切开术患者的临床特征和结果。这项多中心、回顾性、观察性研究调查了2020年1月8日至2020年3月25日在中国湖北省23家医院重症监护病房（ICU）接受择期气管切开术的所有COVID-19患者。收集并分析了人口统计学信息、临床特征、治疗情况、气管切开手术细节、气管切开术后成功脱机情况及生存状态。对早期气管切开术患者（在插管后14天内进行气管切开术）和晚期气管切开术患者（在14天后进行气管切开术）的数据进行了比较。共纳入80例患者。从气管插管到气管切开术的中位持续时间为17.5[四分位间距11.3 - 27.0]天。大多数气管切开术由ICU医生实施[62例（77.5%）]，采用经皮技术[63例（78.8%）]，在ICU床边实施[76例（95.0%）]。最常见的并发症是气管造口出血[14例（17.5%）]，4例（5.0%）患者发生大出血。插管后60天时，31例（38.8%）患者成功脱机，17例（21.2%）患者从ICU出院，43例（53.8%）患者死亡。早期气管切开术患者的60天死亡率更高[22例（73.3%）对21例（42.0%）]。对于SARS-CoV-2肺炎患者，ICU医生在床边进行气管切开术是可行的，主要并发症较少。与插管14天后进行的气管切开术相比，14天内进行的气管切开术与死亡率增加相关。
