Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Sapporo 060-8638, Japan.
Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Auris Nasus Larynx. 2021 Jun;48(3):525-529. doi: 10.1016/j.anl.2021.01.006. Epub 2021 Jan 9.
Involvement in the tracheostomy procedure for COVID-19 patients can lead to a feeling of fear in medical staff. To address concerns over infection, we gathered and analyzed experiences with tracheostomy in the COVID-19 patient population from all over Japan.
The data for health-care workers involved in tracheostomies for COVID-19-infected patients were gathered from academic medical centers or their affiliated hospitals from all over Japan.
Tracheostomies have been performed in 35 COVID-19 patients with a total of 91 surgeons, 49 anesthesiologists, and 49 surgical staff members involved. Twenty-eight (80%) patients underwent surgery more than 22 days after the development of COVID-19-related symptoms (11: 22-28 days and 17: ≥29 days). Thirty (85.7%) patients underwent surgery ≥ 15 days after intubation (14: 15-21 days, 6: 22-28 days, and 10: ≥29 days). Among the total of 189 health-care workers involved in the tracheostomy procedures, 25 used a powered air-purifying respirator (PAPR) and 164 used a N95 mask and eye protection. As a result, no transmission to staff occurred during the 2 weeks of follow-up after surgery.
No one involved in tracheostomy procedures were found to have been infected with COVID-19 in this Japanese study. The reason is thought to be that the timing of the surgery was quite late after the infections, and the surgery was performed using appropriate PPE and surgical procedure. The indications for and timing of tracheostomy for severe COVID-19 patients should be decided through multidisciplinary discussion.
参与 COVID-19 患者的气管切开术可能会使医务人员感到恐惧。为了解决感染问题，我们收集并分析了来自日本各地 COVID-19 患者人群的气管切开术经验。
从日本各地的学术医疗中心或其附属医院收集了参与 COVID-19 感染患者气管切开术的医护人员的数据。
对 35 名 COVID-19 患者进行了气管切开术，共有 91 名外科医生、49 名麻醉师和 49 名外科工作人员参与。28 名（80%）患者在 COVID-19 相关症状出现后 22 天以上接受手术（11 例：22-28 天，17 例：≥29 天）。30 名（85.7%）患者在插管后≥15 天接受手术（14 例：15-21 天，6 例：22-28 天，10 例：≥29 天）。在总共 189 名参与气管切开术的医护人员中，25 人使用了动力空气净化呼吸器（PAPR），164 人使用了 N95 口罩和眼部保护装置。因此，手术后 2 周的随访中没有发生工作人员感染。
在这项日本研究中，没有发现参与气管切开术的人员感染 COVID-19。原因被认为是手术时间在感染后相当晚，并且手术使用了适当的个人防护设备和手术程序。严重 COVID-19 患者的气管切开术的适应证和时机应通过多学科讨论决定。
