Pauli Nina, Eeg-Olofsson Måns, Bergquist Henrik
Department of Otorhinolaryngology Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden.
Laryngoscope Investig Otolaryngol. 2021 Apr 7;6(3):446-452. doi: 10.1002/lio2.560. eCollection 2021 Jun.
The aim of this study was to analyze the timing of tracheotomy and the duration of mechanical ventilation and stay in the intensive care unit (ICU) in patients with COVID-19 infection. Furthermore, we aimed to investigate tracheotomy complications and mortality.
Consecutive patients with COVID-19 infection admitted to the Department of Infectious Diseases in Gothenburg, Sweden were identified. Medical records were retrieved and retrospectively assessed.
One hundred eighty-eight patients with COVID-19 infection requiring hospital care were identified. Of these, 116 patients were critically ill and intubated, and 55 patients underwent tracheotomy. The mean time from endotracheal intubation to tracheotomy was 12 days (range 5-28 days). There was a correlation between the timing of tracheotomy and the duration of mechanical ventilation, where a shorter time between intubation and tracheotomy was correlated with a shorter duration of mechanical ventilation ( .58, < .001), and a correlation was identified between the timing of tracheotomy and the duration of ICU stay ( .52, < .001). Perioperative hypoxemia was registered in 9% of tracheotomies performed, whereas postoperative bleeding was observed in 27% of cases, the majority of which were minor.
This retrospective cohort study indicates that early tracheotomy is related to a reduced need for mechanical ventilation and a shorter duration of stay in the ICU in severe cases of COVID-19 disease. Complications during and after tracheotomy in this specific cohort included risk perioperative hypoxia and postoperative bleeding. Prospective randomized controlled trials would be of value to confirm these findings.
4, Case series.
本研究旨在分析新型冠状病毒肺炎（COVID-19）感染患者的气管切开时机、机械通气时间及在重症监护病房（ICU）的住院时间。此外，我们还旨在调查气管切开的并发症及死亡率。
确定瑞典哥德堡传染病科收治的连续COVID-19感染患者。检索病历并进行回顾性评估。
共确定188例需要住院治疗的COVID-19感染患者。其中，116例患者病情危重并接受了气管插管，55例患者接受了气管切开术。从气管插管到气管切开的平均时间为12天（范围5-28天）。气管切开时机与机械通气时间之间存在相关性，插管与气管切开之间的时间越短，机械通气时间越短（r = 0.58，P < 0.001），并且气管切开时机与ICU住院时间之间也存在相关性（r = 0.52，P < 0.001）。在进行的气管切开术中，9%记录有围手术期低氧血症，而27%的病例观察到术后出血，其中大多数为少量出血。
这项回顾性队列研究表明，在COVID-19重症病例中，早期气管切开与机械通气需求减少及ICU住院时间缩短有关。该特定队列气管切开术中及术后的并发症包括围手术期低氧血症风险和术后出血。前瞻性随机对照试验对于证实这些发现将具有重要价值。
4，病例系列。
