COVID-19 呼吸衰竭患者行气管切开术：多学科、多中心的时机、技术和结局数据。
Tracheostomy for COVID-19 Respiratory Failure: Multidisciplinary, Multicenter Data on Timing, Technique, and Outcomes.
机构信息
Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University, Durham, NC.
Department of Medicine, Division of Pulmonary and Critical Care, University of California, San Diego, CA.
出版信息
Ann Surg. 2021 Aug 1;274(2):234-239. doi: 10.1097/SLA.0000000000004955.
OBJECTIVE
The aim of this study was to assess the outcomes of tracheostomy in patients with COVID-19 respiratory failure.
SUMMARY BACKGROUND DATA
Tracheostomy has an essential role in managing COVID-19 patients with respiratory failure who require prolonged mechanical ventilation. However, limited data are available on how tracheostomy affects COVID-19 outcomes, and uncertainty surrounding risk of infectious transmission has led to divergent recommendations and practices.
METHODS
It is a multicenter, retrospective study; data were collected on all tracheostomies performed in COVID-19 patients at 7 hospitals in 5 tertiary academic medical systems from February 1, 2020 to September 4, 2020.
RESULT
Tracheotomy was performed in 118 patients with median time from intubation to tracheostomy of 22 days (Q1-Q3: 18-25). All tracheostomies were performed employing measures to minimize aerosol generation, 78.0% by percutaneous technique, and 95.8% at bedside in negative pressure rooms. Seventy-eight (66.1%) patients were weaned from the ventilator and 18 (15.3%) patients died from causes unrelated to tracheostomy. No major procedural complications occurred. Early tracheostomy (≤14 days) was associated with decreased ventilator days; median ventilator days (Q1-Q3) among patients weaned from the ventilator in the early, middle and late groups were 21 (21-31), 34 (26.5-42), and 37 (32-41) days, respectively with P = 0.030. Compared to surgical tracheostomy, percutaneous technique was associated with faster weaning for patients weaned off the ventilator [median (Q1-Q3): 34 (29-39) vs 39 (34-51) days, P = 0.038]; decreased ventilator-associated pneumonia (58.7% vs 80.8%, P = 0.039); and among patients who were discharged, shorter intensive care unit duration [median (Q1-Q3): 33 (27-42) vs 47 (33-64) days, P = 0.009]; and shorter hospital length of stay [median (Q1-Q3): 46 (33-59) vs 59.5 (48-80) days, P = 0.001].
CONCLUSION
Early, percutaneous tracheostomy was associated with improved outcomes compared to surgical tracheostomy in a multi-institutional series of ventilated patients with COVID-19.
目的
本研究旨在评估 COVID-19 呼吸衰竭患者行气管切开术的结局。
背景资料概要
对于需要长时间机械通气的 COVID-19 呼吸衰竭患者，气管切开术在治疗中起着至关重要的作用。然而，关于气管切开术如何影响 COVID-19 结局的数据有限，且传染性传播风险方面存在不确定性，导致推荐和实践存在差异。
方法
这是一项多中心回顾性研究；在 2020 年 2 月 1 日至 2020 年 9 月 4 日期间，从 5 个三级学术医疗系统的 7 家医院对所有行气管切开术的 COVID-19 患者进行了数据收集。
结果
118 例患者接受了气管切开术，中位气管切开术距插管时间为 22 天（Q1-Q3：18-25）。所有气管切开术均采用措施尽量减少气溶胶生成，78.0%采用经皮技术，95.8%在负压室床边进行。78 例（66.1%）患者成功脱机，18 例（15.3%）患者死于与气管切开术无关的原因。未发生重大手术并发症。早期（≤14 天）行气管切开术与呼吸机使用天数减少相关；成功脱机患者的呼吸机使用天数（Q1-Q3）分别为 21 天（21-31）、34 天（26.5-42）和 37 天（32-41），P=0.030。与外科气管切开术相比，经皮技术与患者更快脱机相关[中位（Q1-Q3）：34 天（29-39）比 39 天（34-51），P=0.038]；呼吸机相关性肺炎发生率更低（58.7%比 80.8%，P=0.039）；出院患者的 ICU 住院时间更短[中位（Q1-Q3）：33 天（27-42）比 47 天（33-64），P=0.009]；住院时间更短[中位（Q1-Q3）：46 天（33-59）比 59.5 天（48-80），P=0.001]。
结论
在一项多机构接受机械通气的 COVID-19 患者系列中，与外科气管切开术相比，早期经皮气管切开术与结局改善相关。
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