Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA.
Department of Surgery, University of South Florida, Tampa, FL, USA.
Am Surg. 2023 May;89(5):1955-1965. doi: 10.1177/00031348211054711. Epub 2021 Nov 8.
This review explores the current body of evidence pertaining to tracheostomy placement in COVID-19 seropositive patients and summarizes the research by tracheostomy indications, timing, and procedure. Literature review was performed in accordance with the 2020 PRISMA guidelines and includes 12 papers discussing protocols for adult patients seropositive for COVID-19. The studies demonstrated high mortality rates after tracheostomy, especially in geriatric patients, and suggested a multifactorial determination of whether to perform a tracheostomy. There was inconclusive data regarding wait time between testing seropositive, tracheostomy, and weaning off of ventilation. COVID-19 generally reaches highest infectivity between days 9 and 10; furthermore, high early mortality rates seen in COVID-19 may confound mortality implicated by tracheostomy placement. Due to the aerosol-generating nature of tracheostomy placement, management and maintenance, techniques, equipment, and personnel should be carefully considered and altered for COVID-19 patients. With surgical tracheostomy, literature suggested decreased usage of electrocautery; with percutaneous tracheostomy, single-use bronchoscope should be used. The nonemergent exchange of tracheostomy should be done only after the patient tested negative for COVID-19. Placement of tracheostomy should only be considered in COVID-19 patients who are no longer transmissible, with rigorous attention to safety precautions. Understanding procedures for airway maintenance in a respiratory disease like COVID-19 is imperative, especially due to current shortages in ventilators and PPE. However, because of a lack of available data and its likelihood of change as more data emerges, we lack complete guidelines for tracheostomy placement in COVID-19 seropositive patients, and those existing will likely evolve with the disease.
这篇综述探讨了 COVID-19 血清阳性患者行气管切开术的现有证据，并总结了气管切开术的适应证、时机和操作的研究。文献综述符合 2020 年 PRISMA 指南，并包括 12 篇讨论 COVID-19 血清阳性成人患者方案的论文。这些研究表明，气管切开术后死亡率很高，尤其是老年患者，并提示需要综合多种因素来决定是否进行气管切开术。关于检测血清阳性、气管切开术和脱机之间的等待时间，数据尚无定论。COVID-19 通常在第 9 天至第 10 天达到最高传染性；此外，COVID-19 中早期高死亡率可能会混淆气管切开术导致的死亡率。由于气管切开术置管具有气溶胶生成的特性，因此应仔细考虑并改变 COVID-19 患者的管理和维护、技术、设备和人员。对于手术气管切开术，文献表明应减少使用电烙术；对于经皮气管切开术，应使用一次性支气管镜。只有在 COVID-19 患者检测结果为阴性后，才可进行非紧急的气管切开管更换。只有在 COVID-19 患者不再具有传染性时，才应考虑行气管切开术，并严格注意安全预防措施。了解 COVID-19 等呼吸道疾病的气道维护程序至关重要，尤其是由于目前呼吸机和个人防护设备短缺。然而，由于缺乏可用数据，而且随着更多数据的出现，数据可能会发生变化，我们缺乏 COVID-19 血清阳性患者气管切开术的完整指南，而且现有的指南可能会随着疾病的发展而演变。
