Department of Intensive Care Medicine, Peninsula Health, Melbourne, Victoria.
Monash University, Peninsula Clinical School, Melbourne, Victoria, Australia.
ANZ J Surg. 2022 Jul;92(7-8):1614-1625. doi: 10.1111/ans.17814. Epub 2022 Jun 2.
Tracheostomy is a commonly performed procedure in patients with coronavirus disease 2019 (COVID-19) receiving mechanical ventilation (MV). This review aims to investigate the occurrence of SARS-CoV-2 transmission from patients to healthcare workers (HCWs) when tracheostomies are performed.
This systematic review used the preferred reporting items for systematic reviews and meta-analysis framework. Studies reporting SARS-CoV-2 infection in HCWs involved in tracheostomy procedures were included.
Sixty-nine studies (between 01/11/2019 and 16/01/2022) reporting 3117 tracheostomy events were included, 45.9% (1430/3117) were performed surgically. The mean time from MV initiation to tracheostomy was 16.7 ± 7.9 days. Location of tracheostomy, personal protective equipment used, and anaesthesia technique varied between studies. The mean procedure duration was 14.1 ± 7.5 minutes; was statistically longer for percutaneous tracheostomies compared with surgical tracheostomies (mean duration 17.5 ± 7.0 versus 15.5 ± 5.6 minutes, p = 0.02). Across 5 out of 69 studies that reported 311 tracheostomies, 34 HCWs tested positive for SARS-CoV-2 and 23/34 (67.6%) were associated with percutaneous tracheostomies.
In this systematic review we found that SARS-CoV-2 transmission to HCWs performing or assisting with a tracheostomy procedure appeared to be low, with all reported transmissions occurring in 2020, prior to vaccinations and more recent strains of SARS-CoV-2. Transmissions may be higher with percutaneous tracheostomies. However, an accurate estimation of infection risk was not possible in the absence of the actual number of HCWs exposed to the risk during the procedure and the inability to control for multiple confounders related to variable timing, technique, and infection control practices.
气管切开术是 COVID-19 患者接受机械通气（MV）时经常进行的一种手术。本综述旨在调查气管切开术时 SARS-CoV-2 从患者传播给医务人员（HCWs）的情况。
本系统综述使用了系统评价和荟萃分析的首选报告项目框架。纳入了报告涉及气管切开术的 HCWs 感染 SARS-CoV-2 的研究。
共纳入 69 项研究（2019 年 11 月 1 日至 2022 年 1 月 16 日），共报告 3117 例气管切开术事件，其中 45.9%（1430/3117）为手术切开。从 MV 开始到气管切开术的平均时间为 16.7±7.9 天。研究之间气管切开术的位置、使用的个人防护设备和麻醉技术有所不同。平均手术时间为 14.1±7.5 分钟；与手术气管切开术相比，经皮气管切开术的手术时间明显较长（平均时间 17.5±7.0 与 15.5±5.6 分钟，p=0.02）。在 69 项报告了 311 例气管切开术的研究中，有 5 项研究报告了 34 例 HCWs 检测出 SARS-CoV-2 阳性，其中 23/34（67.6%）与经皮气管切开术有关。
在本系统综述中，我们发现，在气管切开术期间或协助进行该手术的 HCWs 中，SARS-CoV-2 传播给医务人员的风险似乎较低，所有报告的传播都发生在 2020 年，在接种疫苗和最近的 SARS-CoV-2 株之前。经皮气管切开术的传播风险可能更高。然而，由于无法确定在手术过程中实际接触风险的 HCWs 数量，也无法控制与手术时机、技术和感染控制实践相关的多种混杂因素，因此无法准确估计感染风险。
