危重症COVID-19患者经皮扩张气管切开术机构协议的制定：初步经验
Development of an institutional protocol for percutaneous dilatational tracheostomy in critically ill COVID-19 patients: Initial experience.
作者信息
Damarla Haritha, Pangasa Neha, Hirolli Divya, Jha Parthadeep, Garg Heena, Khan Tazeen, Soni Lipika, Maitra Souvik, Anand Rahul K, Ray Bikash R, Baidya Dalim K
机构信息
Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
出版信息
J Anaesthesiol Clin Pharmacol. 2022 Jul;38(Suppl 1):S102-S106. doi: 10.4103/joacp.joacp_495_21. Epub 2022 Jun 15.
BACKGROUND AND AIMS
Percutaneous dilatational tracheostomy (PDT) may improve the outcome in critically ill COVID-19 patients on mechanical ventilation. However, the timing of performing tracheostomy may be controversial, and it is an aerosol-generating procedure with a potential risk of viral exposure to healthcare workers.
MATERIAL AND METHODS
An operational protocol for performing PDT was made and subsequently followed in a designated COVID-19 ICU. Critically ill adult patients on mechanical ventilators who underwent PDT were included in this retrospective cohort study. Case files were retrospectively reviewed and patient characteristics, clinical outcome, and procedure-related details were noted.
RESULTS
Forty-one patients were included in the analysis. The median age was 49 (39-67) years, and 41.5% of patients were females. The median duration of mechanical ventilation before tracheostomy was 10 (8-16) days, and the median (IQR) PaO/FiO ratio on the day of PDT was 155 (125-180) mm Hg. Further, 48.8% of patients had transient desaturation to SpO2 <90%, and 41.5% survived to ICU discharge. None of the health care providers involved in PDT developed any symptoms of COVID 19.
CONCLUSION
This descriptive study demonstrates the feasibility, implementation, and apparent safety of the PDT protocol developed at our institution.
背景与目的
经皮扩张气管切开术（PDT）可能改善接受机械通气的重症 COVID-19 患者的预后。然而，气管切开术的实施时机可能存在争议，并且它是一种产生气溶胶的操作，对医护人员存在病毒暴露的潜在风险。
材料与方法
制定了一份实施 PDT 的操作方案，并随后在指定的 COVID-19 重症监护病房（ICU）中遵循。本回顾性队列研究纳入了接受 PDT 的机械通气成年重症患者。对病例档案进行回顾性审查，并记录患者特征、临床结局和与操作相关的细节。
结果
41 例患者纳入分析。中位年龄为 49（39 - 67）岁，41.5%的患者为女性。气管切开术前机械通气的中位持续时间为 10（8 - 16）天，PDT 当天的中位（IQR）PaO/FiO 比值为 155（125 - 180）mmHg。此外，48.8%的患者出现 SpO2 短暂降至<90%，41.5%的患者存活至从 ICU 出院。参与 PDT 的医护人员均未出现 COVID-19 的任何症状。
结论
这项描述性研究证明了我们机构制定的 PDT 方案的可行性、实施情况及明显的安全性。
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