新型冠状病毒肺炎患者的改良经皮气管切开术
Modified percutaneous tracheostomy in patients with COVID-19.
作者信息
Sun Beatrice J, Wolff Christopher J, Bechtold Hannah M, Free Dwayne, Lorenzo Javier, Minot Patrick R, Maggio Paul G, Spain David A, Weiser Thomas G, Forrester Joseph D
机构信息
Department of Surgery, Stanford University, Stanford, California, USA.
Anesthesiology, Stanford University, Stanford, California, USA.
出版信息
Trauma Surg Acute Care Open. 2020 Dec 14;5(1):e000625. doi: 10.1136/tsaco-2020-000625. eCollection 2020.
BACKGROUND
Patients hospitalized with COVID-19 are at risk of developing hypoxic respiratory failure and often require prolonged mechanical ventilation. Indication and timing to perform tracheostomy is controversial in patients with COVID-19.
METHODS
This was a single-institution retrospective review of tracheostomies performed on patients admitted for COVID-19 between April 8, 2020 and August 1, 2020 using a modified percutaneous tracheostomy technique to minimize hypoxia and aerosolization.
RESULTS
Twelve tracheostomies were performed for COVID-related respiratory failure. Median patient age was 54 years (range: 36-76) and 9 (75%) were male. Median time to tracheostomy was 17 days (range: 10-27), and 5 (42%) patients had failed attempts at extubation prior to tracheostomy. There were no intraprocedural complications, including hypoxia. Post-tracheostomy bleeding was noted in two patients. Eight (67%) patients have been discharged at the time of this study, and there were four patient deaths unrelated to tracheostomy placement. No healthcare worker transmissions resulted from participating in the tracheostomy procedure.
CONCLUSIONS
A modified percutaneous tracheostomy is feasible and can be safely performed in patients infected with COVID-19.
LEVEL OF EVIDENCE
Level V, case series.
背景
新冠肺炎住院患者有发生低氧性呼吸衰竭的风险，常需要长时间机械通气。对于新冠肺炎患者，气管切开术的指征和时机存在争议。
方法
这是一项单机构回顾性研究，对2020年4月8日至2020年8月1日因新冠肺炎入院的患者实施气管切开术，采用改良经皮气管切开术技术以尽量减少低氧血症和气溶胶形成。
结果
因新冠肺炎相关呼吸衰竭实施了12例气管切开术。患者中位年龄为54岁（范围：36 - 76岁），9例（75%）为男性。气管切开术的中位时间为17天（范围：10 - 27天），5例（42%）患者在气管切开术前拔管尝试失败。术中无并发症，包括低氧血症。2例患者术后出现出血。在本研究时，8例（67%）患者已出院，有4例患者死亡，与气管切开术的实施无关。参与气管切开术操作未导致医护人员感染。
结论
改良经皮气管切开术是可行的，可在新冠肺炎感染患者中安全实施。
证据级别
V级，病例系列。
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