UMass Memorial Medical Center, Worcester, MA, USA.
12262University of Massachusetts Medical School, Worcester, MA, USA.
J Intensive Care Med. 2021 Dec;36(12):1507-1512. doi: 10.1177/08850666211043436. Epub 2021 Oct 29.
The benefits of percutaneous dilational tracheostomy (PDT) placement have been well documented in patients requiring prolonged mechanical ventilation. However, the data regarding the benefit of PDT in coronavirus-2019 (COVID-19) patients are scarce. The objective of this study is to evaluate the outcomes of a cohort of 37 patients who underwent tracheostomy as part of their COVID-19 care. Retrospective data from a series for 37 patients undergoing tracheostomy was collected using chart review. Primary outcomes included 30 and 60 day mortality, weaning rate, and decannulation rate. Secondary outcomes collected included admission demographics, comorbidities, and procedural information. Thirty-seven (37) patients requiring prolonged mechanical ventilation due to COVID-19. Of these 37 patients, 35 were alive 60 days post-PDT placement, 33 have been weaned from mechanical ventilation and 18 have been decannulated. The low mortality and high decannulation rates in this cohort in is a promising development in the care of critically ill COVID-19 patients. Of note, all participating physicians underwent routine polymerase chain reaction (PCR) testing for infection with the severe acute respiratory syndrome coronavirus-2 virus and no physician contracted COVID-19 as a result of their involvement. Overall, this case series describes the modified PDT technique used by our team and discusses the feasibility and potential benefit to PDT placement in COVID-19 patients requiring long-term mechanical ventilation.
经皮扩张气管切开术(PDT)在需要长时间机械通气的患者中已被证明具有诸多益处。然而,关于 COVID-19 患者中 PDT 益处的数据却很少。本研究旨在评估接受气管切开术作为 COVID-19 治疗一部分的 37 例患者的结局。通过病历回顾收集了接受气管切开术的 37 例患者的系列回顾性数据。主要结局包括 30 天和 60 天死亡率、撤机率和拔管率。收集的次要结局包括入院人口统计学、合并症和程序信息。由于 COVID-19 需要长时间机械通气的 37 例患者。在这 37 例患者中,有 35 例在 PDT 放置后 60 天存活,33 例已从机械通气中撤机,18 例已拔管。该队列中死亡率低且拔管率高,这是危重症 COVID-19 患者治疗的一个有希望的进展。值得注意的是,所有参与的医生都接受了常规聚合酶链反应(PCR)检测以感染严重急性呼吸综合征冠状病毒-2 病毒,并且没有医生因参与而感染 COVID-19。总体而言,该病例系列描述了我们团队使用的改良 PDT 技术,并讨论了在需要长期机械通气的 COVID-19 患者中进行 PDT 放置的可行性和潜在益处。