Service ORL, Centre hospitalier intercommunal de Créteil, Université Paris Est, 40, avenue de Verdun, 94000 Créteil, France.
Service ORL, AP-HP, Hôpital Cochin AP-HP, Université Paris centre, 27, rue du Faubourg-St.-Jacques, 75014 Paris, France.
Eur Ann Otorhinolaryngol Head Neck Dis. 2021 Dec;138(6):443-449. doi: 10.1016/j.anorl.2021.03.002. Epub 2021 Mar 4.
To analyse tracheostomies after intubation for SARS-Cov-2 infection performed by otorhinolaryngologists in 7 university hospitals in the Paris area of France during the month March 24 to April 23, 2020.
A multicentre retrospective observational study included 59 consecutive patients. The main goals were to evaluate the number, characteristics and practical conditions of tracheostomies, and the COVID-19 status of the otorhinolaryngologists. Secondary goals were to analyse tracheostomy time, decannulation rate, immediate postoperative complications and laryngotracheal axis status.
Tracheostomy indications were for ventilatory weaning and extubation failure in 86% and 14% of cases, respectively. The technique was surgical, percutaneous or hybrid in 91.5%, 3.4% and 5.1% of cases, respectively. None of the operators developed symptoms consistent with COVID-19. Postoperative complications occurred in 15% of cases, with no significant difference between surgical and percutaneous/hybrid techniques (P=0.33), although no complications occurred after percutaneous or hybrid tracheostomies. No procedures or complications resulted in death. The decannulation rate was 74.5% with a mean tracheostomy time of 20±12 days. In 55% of the patients evaluated by flexible endoscopy after decannulation, a laryngeal abnormality was found. On univariate analysis, no clinical features had a significant influence on tracheostomy time, decannulation rate or occurrence of laryngeal lesions.
The main findings of the present retrospective study were: absence of contamination of the surgeons, heterogeneity of practices between centres, a high rate of complications and laryngeal lesions whatever the technique, and the specificities of the patients.
分析 2020 年 3 月 24 日至 4 月 23 日期间，法国巴黎地区 7 所大学附属医院的耳鼻喉科医生对因 SARS-CoV-2 感染行气管插管后的气管切开术。
这是一项多中心回顾性观察性研究，纳入了 59 例连续患者。主要目标是评估气管切开术的数量、特征和实际情况，以及耳鼻喉科医生的 COVID-19 状况。次要目标是分析气管切开时间、拔管率、术后即刻并发症和喉气管轴位。
气管切开术的指征分别为通气脱机和拔管失败，占 86%和 14%。手术、经皮和混合技术分别占 91.5%、3.4%和 5.1%。所有术者均未出现符合 COVID-19 的症状。术后并发症发生率为 15%，手术和经皮/混合技术之间无显著差异（P=0.33），尽管经皮或混合气管切开术无并发症发生。无任何手术或并发症导致死亡。拔管率为 74.5%，平均气管切开时间为 20±12 天。在拔管后接受软性内镜评估的 55%患者中，发现存在喉部异常。单因素分析显示，无临床特征对气管切开时间、拔管率或发生喉部病变有显著影响。
本回顾性研究的主要发现是：术者未发生感染；各中心的操作实践存在差异；无论采用何种技术，并发症和喉部病变的发生率均较高，且患者具有特殊性。
