Son JeongA, Hyun Seungji, Yu Woo Sik, Jung Joonho, Haam Seokjin
Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea.
J Chest Surg. 2023 Mar 5;56(2):128-135. doi: 10.5090/jcs.22.117. Epub 2023 Feb 16.
Pneumonia caused by severe acute respiratory syndrome coronavirus 2 can cause acute respiratory distress syndrome, often requiring prolonged mechanical ventilation and eventually tracheostomy. Both procedures occur in isolation units where personal protective equipment is needed. Additionally, the high bleeding risk in patients with extracorporeal membrane oxygenation (ECMO) places a great strain on surgeons. We investigated the clinical characteristics and outcomes of percutaneous dilatational tracheostomy (PDT) in patients with coronavirus disease 2019 (COVID-19) supported by ECMO, and compared the outcomes of patients with and without ECMO.
This retrospective, single-center, observational study included patients with severe COVID-19 who underwent elective PDT (n=29) from April 1, 2020, to October 31, 2021. The patients were divided into ECMO and non-ECMO groups. Data were collected from electronic medical records at Ajou University Hospital in Suwon, Korea.
Twenty-nine COVID-19 patients underwent PDT (24 men [82.8%] and 5 women [17.2%]; median age, 61 years; range, 26-87 years; interquartile range, 54-71 years). The mean procedure time was 17±10.07 minutes. No clinically or statistically significant difference in procedure time was noted between the ECMO and non-ECMO groups (16.35±7.34 vs. 18.25±13.32, p=0.661). Overall, 12 patients (41.4%) had minor complications; 10 had mild subdermal bleeding from the skin incision, which was resolved with local gauze packing, and 2 (6.9%) had dislodgement. No healthcare provider infection was reported.
Our PDT approach is safe for patients and healthcare providers. With bronchoscopy assistance, PDT can be performed quickly and easily even in isolation units and with acceptable risk, regardless of the hypo-coagulable condition of patients on ECMO.
严重急性呼吸综合征冠状病毒2引起的肺炎可导致急性呼吸窘迫综合征，常需长时间机械通气，最终可能需要气管切开术。这两种操作均在需要使用个人防护设备的隔离病房进行。此外，体外膜肺氧合（ECMO）患者的高出血风险给外科医生带来了巨大压力。我们调查了接受ECMO支持的2019冠状病毒病（COVID-19）患者经皮扩张气管切开术（PDT）的临床特征和结局，并比较了有ECMO和无ECMO患者的结局。
这项回顾性、单中心观察性研究纳入了2020年4月1日至2021年10月31日期间接受择期PDT的重症COVID-19患者（n=29）。患者分为ECMO组和非ECMO组。数据收集自韩国水原市阿朱大学医院的电子病历。
29例COVID-19患者接受了PDT（24例男性[82.8%]和5例女性[17.2%]；中位年龄61岁；范围26 - 87岁；四分位间距54 - 71岁）。平均手术时间为17±10.07分钟。ECMO组和非ECMO组之间在手术时间上未观察到临床或统计学上的显著差异（16.35±7.34 vs. 18.25±13.32，p = 0.661）。总体而言，12例患者（41.4%）出现轻微并发症；10例患者皮肤切口有轻度皮下出血，通过局部纱布填塞得以解决，2例（6.9%）出现气管套管移位。未报告医护人员感染情况。
我们的PDT方法对患者和医护人员是安全的。在支气管镜辅助下，即使在隔离病房，且无论接受ECMO治疗的患者存在低凝状态，PDT也能快速、轻松地进行，且风险可接受。
