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在新冠疫情期间,可为非新冠患者维持高质量的气管切开护理。

Quality tracheotomy care can be maintained for non-COVID patients during the COVID-19 pandemic.

作者信息

Tucker Jacqueline, Ruszkay Nicole, Goyal Neerav, Gniady John P, Goldenberg David

机构信息

College of Medicine Pennsylvania State University Hershey Pennsylvania USA.

Department of Otolaryngology-Head and Neck Surgery Penn State Hershey Medical Center Hershey Pennsylvania USA.

出版信息

Laryngoscope Investig Otolaryngol. 2022 Aug 18;7(5):1337-42. doi: 10.1002/lio2.885.

Abstract

OBJECTIVES

To analyze changes in tracheotomy practices at the onset of the COVID-19 pandemic, and determine if quality patient care was maintained.

METHODS

This was a single institution retrospective study that included patients undergoing tracheotomy from May 2019 to January 2021. Patients were divided into two groups, pre-COVID and post-COVID. Only three patients tested positive for COVID-19, and they were excluded from the study. Data were collected from the electronic medical record. Statistical analyses were performed using 2-tailed independent tests, Wilcoxon Rank Sum tests, Chi-Square tests, and Kaplan-Meier curves.

RESULTS

There were 118 patients in the pre-COVID group and 91 patients in the post-COVID group. The main indication for tracheotomy in both groups was prolonged intubation. There were no significant differences in overall length of stay, time to tracheotomy, duration of tracheotomy procedure, or time to initial tracheotomy change between the two groups. Due to protocols implemented at our institution to limit viral transmission, there were significant increases in the percent of tracheotomies performed in the OR ( = .02), and those performed via open technique ( = .04). Additionally, the median time to decannulation significantly decreased in the post-COVID group ( = .02).

CONCLUSION

Several variables regarding the timing of patient care showed no significant differences between groups which demonstrates that quality patient care was maintained. It is important to note that this data was collected early in the Pandemic, and additional trends may become apparent over time.

LEVEL OF EVIDENCE

摘要

目的

分析新型冠状病毒肺炎(COVID-19)大流行开始时气管切开术的实施变化,并确定是否维持了优质的患者护理。

方法

这是一项单机构回顾性研究,纳入了2019年5月至2021年1月接受气管切开术的患者。患者分为两组,COVID前组和COVID后组。仅3例患者COVID-19检测呈阳性,他们被排除在研究之外。数据从电子病历中收集。使用双尾独立t检验、Wilcoxon秩和检验、卡方检验和Kaplan-Meier曲线进行统计分析。

结果

COVID前组有118例患者,COVID后组有91例患者。两组气管切开术的主要指征均为长时间插管。两组在总住院时间、气管切开时间、气管切开手术持续时间或首次气管切开更换时间方面无显著差异。由于我们机构实施了限制病毒传播的方案,手术室进行气管切开术的百分比显著增加(P = 0.02),以及通过开放技术进行气管切开术的百分比显著增加(P = 0.04)。此外,COVID后组拔管的中位时间显著缩短(P = 0.02)。

结论

关于患者护理时机的几个变量在两组之间没有显著差异,这表明维持了优质的患者护理。需要注意的是,这些数据是在大流行早期收集的,随着时间的推移可能会出现其他趋势。

证据级别

4级。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/686d/9575067/3efe14eecfbf/LIO2-7-1337-g002.jpg

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