Tracheostomy thaum mob ntxiv nyob rau hauv COVID-19 cov neeg mob

Emergency Live | Evidence-based medicine - Is cricoid pressure in ER rapid sequence intubation really efficient?

Tracheostomy thaum mob ntxiv nyob rau hauv COVID-19 cov neeg mob: ib daim ntawv ntsuam xyuas txog cov kev soj ntsuam tam sim no

By Newsroom On Jul 17, 2020

Cov kev kho mob tau ntsib dhau los ntawm kev thov uas tsis tau xav txog, tsis ntev los no. Kev Tiv Thaiv-19 kev kis tus kabmob kis rau kabmob kis tau hloov pauv txoj hauv kev ua yeeb yam. Txhua qhov haujlwm tau dhau los ua qhov nyuaj tshaj li yav dhau los. Cov kws tshawb nrhiav hauv tebchaws Askiv tau ua qhov kev tshawb fawb txog qhov kev tshawb nrhiav tam sim no txog kev cuam tshuam tracheostomy thaum tab tom mob rau cov neeg mob COVID-19.

Raws li peb txhua tus paub, KEVID-19 kis thoob plaws cov ntsws thiab tuaj yeem hloov zuj zus mus rau txoj kev muaj pa ceev heev. [3] Muaj ntau cov neeg mob, xws li mob coronavirus zoo rau cov neeg mob, kev tawm tsam thiab tshuab lub tshuab ua pa yog feem ntau. Cov neeg mob uas xav ua kom muaj cua dim pa ntev, yuav tsum tau kuaj pob txha caj dab kom tau txais txiaj ntsig. [5] Cov txiaj ntsig tau suav nrog kev txiav tawm lub cev thiab tso zis tso quav nyob rau hauv cov neeg uas yuav tsum tau nqus cov hlab pa tso rau hauv Chav Intensive Care Unit. Kev kuaj mob hauv cov neeg mob plab mas ib txwm ua thaum nruab hnub 7 thiab 10 tom qab kev nkag siab. Txawm li cas los xij, ENT UK cov lus qhia tau lees paub qhov kev xav tau ceev faj thaum ua kev mob tracheostomy hauv COVID-19 cov neeg mob. [8] Cov kws tshawb fawb los ntawm cov tsev kawm qib siab hauv tebchaws Askiv tau tshaj tawm cov lus nug hauv qab no txhawm rau txheeb xyuas cov kev coj ua.

Muaj kev paub dhau los hauv KEVID-19 cov neeg mob txhawm rau: qhov peb muaj

Kev kuaj mob tracheostomy tuaj yeem siv rau ntawm kev phais pob txha lossis mus rau thaj tsam, feem ntau nyob ntawm ntug txaj. [7] Txawm li cas los xij, cov ntaub ntawv me me qhia tau tias qhov zoo tshaj plaws mus kom ze thiab tom qab tau tshwm sim los ntawm COVID-19 txoj kev ua pa zoo rau cov neeg mob. Cov chaw nyob hauv Suav teb uas tau kis ntau tshaj plaws los ntawm tus kabmob kis nthuav dav tau tsim kev nkag siab ntau ntxiv txog yuav ua li cas tswj hwm tus neeg mob zoo COVID-19. Lawv cov kev paub dhau los yog tau txais txiaj ntsig rau lwm lub tsev kawm thaum ntxov hauv lub voj voog kis mus thoob ntiaj teb. Tsis yog hais txog kev npaj cov neeg mob txoj hauv kev thiab cov peev txheej saib xyuas kev noj qab haus huv, tab sis kuj suav cov txiaj ntsig. Cov kws tshawb nrhiav tau ua qhov kev tshawb fawb thoob ntiaj teb los ntsuas kev cuam tshuam txog kev mob tracheostomy thaum tsim kev tiv thaiv nyob rau hauv COVID-19 cov neeg mob zoo nyob hauv ENT Cov Neeg phais.

ENT kws phais mob: mob tracheostomy thaum mob ntxiv rau hauv cov neeg mob TSIS-19: txoj kev thiab cov txiaj ntsig

Daim ntawv tshuaj ntsuam no yog Kev Pabcuam Tsim Kev Kawm uas tau txais los ntawm Kev Tshawb Fawb thiab Kev Txhim Kho ntawm King's College Hospital NHS Foundation Trust, London. Cov kws tshawb nrhiav tau tsim cov lus nug online uas muaj cov lus nug hauv qab no:

Nyob lub tebchaws twg / thaj chaw twg koj nyob?
Koj tau ntau npaum li cas cov cua uas tau them los ntawm KEVID-19 hauv koj lub tsev kho mob?
Yog pes tsawg feem pua ntawm cov neeg mob tau txhaj tshuaj tracheostomy?
Qhov nruab nrab ntawm hnub dab tsi yog qhov kuaj mob tracheostomy (piv txwv li, hnub 7 ntawm kev tsim tawm)?
Ntev npaum li cas tom qab tracheostomy yog tus neeg mob tau tso lub tshuab ua pa tawm?
Yuav ua li cas feem pua ntawm cov neeg mob tuag txawm hais tias tracheostomy?
Cov txiaj ntsim tau los ua tau zoo dua nrog ib qho kev qhia tshwj xeeb tracheostomy (piv txwv li, percutaneous vs phais)?

Cov lus nug tau raug nthuav tawm thaum lub Peb Hlis 27, 2020 thiab cov ntaub ntawv tau txais txog txij Lub Plaub Hlis 15, 2020. Cov neeg mob thiab cov pej xeem tsis koom nrog tsim cov kev tshawb fawb no lossis cov ntawv sau.

Daim ntawv tshuaj ntsuam no tau ua tiav los ntawm tag nrho 50 tus neeg teb los ntawm ob lub tebchaws United Kingdom (n = 8) thiab International units (daim duab 1.) Tus naj npawb ntawm cov neeg mob ua pa yog 3403 nrog 68 tus neeg mob ib lub Tsev Kho Mob / Ntseeg (ntau 0-600). Qhov feem pua ntawm cov neeg mob txhaub uas xav tau tracheostomy yog nyob nruab nrab 9.65% (thaj tsam 0% -100%) nrog tus mob tracheostomy ua raws li intubation ntawm qhov txhais tau tias 14.4 hnub (thaj tsam 7-21).

Qhov no tau kos los ntawm 28 tus neeg teb los ntawm 2701 tus neeg mob plab thiab lub tshuab ua pa (daim duab 2). Cov kev vam meej, cov neeg mob tau tso lub cev tom qab txiav tawm ntawm qhov nruab nrab tom qab 7.4 hnub (thaj tsam 1-16 hnub). Txawm hais tias mob tracheostomy rau thaj tsam nruab nrab 13.5% ntawm cov neeg mob tuag (kos los ntawm 14 tus neeg teb los ntawm cov neeg ntawm 1687 cov neeg mob plab thiab lub cev ua pa). Txog rau kev qhia txog tracheostomy thiab cov txiaj ntsig tau tshwm sim, 3 ntawm 50 tus neeg teb tau muab qhov kev xav txog tus mob ua haujlwm. Qhov qhib kev phais mob tau raug pom zoo los ntawm 8 ntawm 50 tus neeg teb. Lwm cov neeg teb (20/50) tau hais txog qhov tsis nyiam, nrog seem 19/50 tsis tuaj yeem pab txhawb.

Qhov kev sojntsuam no txog kev mob tracheostomy thaum tawm hauv KEV PAB-19 cov neeg mob siv li cas?

Cov ntaub ntawv los ntawm Wuhan qhia tias lub sijhawm nruab nrab ntawm kev nkag mus rau hauv tsev kho mob rau kev tuag yog 5 hnub hauv thawj lub hlis ntawm tus kabmob kis, uas txhais tau tias 11 hnub.[14] COVID-19 kev kis thoob qhov txhia chaw tau ua rau qhov kev thov tsis sib xws rau cov kev pabcuam saib xyuas tseem ceeb thiab qhov xav tau rau kev siv lub cev thiab lub tshuab ua pa.[1] Cov neeg uas dhau los ua qhov tseem ceeb xav tau kev tso dej thiab cov tshuab ua pa zoo heev vim tias muaj kev mob ntsws sai. Nws hloov mus ua mob hnyav heev ua pa nyuaj siab syndrome ua rau ua pa tsis ua hauj lwm thiab tuag.[3,12,13]

Cov txheej txheem tam sim no luam tawm los ntawm Asmeskas Academy ntawm Otorhinolaryngology-Lub taub hau thiab caj dab Cov kev phais pom zoo hais tias kev tsim tawm tracheostomy yuav tsum tsis txhob ua ua ntej 14 hnub ntawm kev nkag siab. [15] Qhov tshwm sim ntawm daim ntawv tshuaj ntsuam no yuav qhia tias kwv yees li ntawm 1 ntawm txhua 10 tus neeg mob sab thiab qhov cua uas thov rau daim npog-19 yuav tsum tau mob tracheostomy. Lwm qhov txiaj ntsig yuav xav tau tias cov koog tau siv txoj cai sib xws nrog qee txoj kev pib ua kom txog thaum mob thawj zaug.

Txawm li cas los xij, peb yuav tsum faj seeb txog cov kev pheej hmoo ntawm qhov cua nyob ntev hauv cov neeg uas yuav txiav tawm mis. Cov no suav nrog kev mob plab lig, mob stenosis thiab mob hlab ntsha-hlab pas-esophageal fistula. [5] Nrhiav kev mob mob nyav kuj tseem yuav muaj ntau zuj zus. [16]

Ntau tus neeg mob yuav xav tau lub qhov cua ntev. Qhov no yuav ua rau cov leeg lub plab uas tuaj yeem ua kom ntev lossis tiv thaiv kom tsis pub mis. [17] Cov ntawv ceeb toom ntawm glottic thiab supraglottic o thiab mob plab kuj tseem txwv tsis pub extubation thiab ua kom ntev li qhov kev xav ua haujlwm, ua kom loog thiab tso pa tawm. Qhov no tuaj yeem kov yeej los ntawm kev mob tracheostomy.

Txawm li cas los xij, daim ntawv tshuaj ntsuam no ua tsis tiav los tsim cov txiaj ntsig pom tseeb txog cov txiaj ntsig tracheostomy. Cov lus pom los ntawm cov neeg piav qhia tau piav qhia tias kev cuam tshuam tau coj los ntawm qee kis thiab nyob ntawm kev phais mob hauv ib cheeb tsam. Txwv tsis pub suav nrog tus naj npawb ntawm cov neeg teb txuam nrog KEVID-19 cov neeg mob zoo nyob hauv cov koog tshwj xeeb. Cov kws sau ntawv nthuav tawm lawv txoj kev ris txiaj rau cov neeg uas tau siv sijhawm los teb cov lus nug no los txhawb kev txiav txim siab ntawm cov npoj yaig thoob ntiaj teb.

TSO CAI

Ayman D'Souza: Christ Church, Tsev Kawm Ntawv ntawm Oxford, Oxford, UK

Ricard Simo FRCS (ORL-HNS): Chav Haujlwm ntawm Otorhinolaryngology, Guy's thiab St Thomas 'NHS Foundation Trust, London, UK

Alwyn D'Souza FRCS (ORL-HNS): Chav Saib Xyuas Haujlwm ntawm Otorhinolaryngology, Tsev Kawm Ntawv Tsev Kho Mob Lewisham, London, UK

Francis Vaz FRCS (ORL-HNS): Chav Saib Xyuas Taub Hau thiab Caj Dab, Tsev Kawm Qib Siab Tsev Kawm Qib Siab, London, UK | Lub koom haum ntawm Medical Science, Medway Campus, Canterbury Christ Church University, Kent, UK

Andrew Ua Ntej FRCS (ORL-HNS): Chav Haujlwm ntawm Otorhinolaryngology, Tsev Kawm Ntawv Huab tais Vaj Ntxwv Tsev Kawm Ntawv Tsev Kho Mob, Kent, UK

Kev siv nyiaj noj qab haus huv hauv tebchaws Ltalis: lub nra hnyav rau tsev neeg

Apr 11, 2024

Aviary Alert: Nruab Nrab Virus Evolution thiab Human Risks

Apr 4, 2024

Ib hnub nyob rau hauv daj tiv thaiv endometriosis

Ti 28, 2024

Kev cia siab thiab kev tsim kho tshiab hauv kev sib ntaus tawm tsam Pancreatic Cancer

Ti 27, 2024

Rahul Kanegaonkar FRCS (ORL-HNS): Lub Tsev Kawm Ntawv ntawm Medical Sciences, Medway Campus, Canterbury Christ Church University, Kent, UK

ua tim khawv

Willan J, Vaj Ntxwv AJ, Jeffery K, Bienz N. Cov kev sib tw rau NHS cov tsev kho mob thaum covid-19 muaj kev sib kis. BMJ. 2020; 368: m1117. https: // doi.org/10.1136/bmj.m1117.
https://www.who.int/docs/default-source/coronaviruse/situationreports/20200414-sitrep-85-covid-19.pdf?sfvrsn=7b8629bb_4). Accessed April 14, 2020.
Wu C, Chen X, Cai Y, li al. Txoj kev pheej hmoo txaus ntshai cuam tshuam nrog kev mob ntsws ua pa nyuaj thiab tuag nyob hauv cov neeg mob uas muaj tus kab mob coronavirus 2019 mob ntsws nyob hauv Wuhan. Suav Teb JAMA Int Med. 2020; e200994. https://doi.org/10.1001/jamainternmed. 2020.0994.
Wu Z, McGoogan JM. Cov yam ntxwv ntawm thiab cov tshooj lus tseem ceeb los ntawm tus kab mob coronavirus 2019 (COVID-19) tau tshwm sim nyob rau hauv Suav teb: cov ntsiab lus ntawm tsab ntawv ceeb toom ntawm 72 314 tus neeg mob los ntawm Suav Chaw Tiv Thaiv thiab Tiv Thaiv. JAMA. 2020; 323 (13): 1239–1242. https://doi.org/10.1001/jama.2020.2648
Dempster J. Tracheostomy (Tshooj 35). Hauv: Musheer Hussain S, ed. Logan Turner Cov Kab Mob ntawm Cov Ntshav, caj pas thiab pob ntseg taub hau thiab Caj dab. 11th ed. Boca Raton, IBCE: CRC Xovxwm; Xyoo 2015.
Freeman BD, Borecki IB, Coopersmith CM, Buchman TG. Kev sib raug zoo ntawm lub sijhawm mus kuaj tracheostomy thiab lub sijhawm siv lub tshuab ua pa hauv cov neeg mob loj. Kev Kho Mob Saib Xyuas Crit. 2005; 33 (11): 2513-2520.
Lipton G, Stewart M, McDermid R, li al. Ntau yam kev paub txog tracheostomy. Ann R Coll Surg Engl. 2020; 1: 1-5.
Takhar A, Walker A, Tricklebank S. Kev pom zoo ntawm cov kev taw qhia tswv yim rau kev nyab xeeb tracheostomy thaum lub sijhawm THAWJ-muaj thoob qhov txhia chaw. Eur Koov Otorhinolaryngol. 19. http://dx.doi.org/ 2020 / s10.1007-00405-020-x.
Murthy S, Gomersall CD, Fowler RA. Saib xyuas rau cov neeg mob hnyav uas tau them cov nqi COVID-19. JAMA. 2020; 323 (15): 1499–1500. https://doi.org/10.1001/jama.2020.3633.
https://www.entuk.org/tracheostomy-guidance-during-covid19-pandemic. Accessed April 14, 2020.
https://www.who.int/docs/default-source/coronaviruse/ situation-reports/20200415-sitrep-86-covid-19.pdf?sfvrsn= c615ea20_6. Accessed April 14, 2020.
Guan WJ, Ni Z, Hu Y, li al. Soj ntsuam tus yam ntxwv mob coronavirus 2019 nyob Suav teb. New Eng J Med. 2020; 382: 1708– 1720. https://doi.org/10.1056/NEJMoa2002032.
Chen J, Qi T, Liu L, li al. Soj ntsuam kev loj hlob ntawm cov neeg mob nrog nyob hauv Shanghai, Suav. J Kab Mob. 2020; 80 (5): E1 – E6. https://doi.org/ 10.1016 / j.jinf.2020.03.004.
Leung C. Cov chaw kuaj mob ntawm cov neeg tuag nyob rau hauv tus kabmob tshiab tau kis tus kabmob tshiab hauv Suav teb. Xyuas hauv Medical Virology. 2020; 323 (15): 1499–1500. https://doi.org/10.1002/rmv.2103.
AAO-HNS Txoj Haujlwm Hais Txog. Cov Lus Pom Txog Mob Ntawm Tracheostomy Thaum THAWJ COV LUS QHIA-19 Pandemic https://www.ent.org/content/ tracheostomy- cov lus pom zoo-thaum-covid-19-kis thoob ntiaj teb
Vassilakopoulos T. Kev ua kom lub cev tsis zoo hauv ICU: nws puas yog lub sijhawm los tiv thaiv cov diaphragm? Thorax. 2016; 71 (5): 397-398. https://doi.org/10.1136/thoraxjnl-2016-208354.
Bolton CF. Neuromuscular manifestations ntawm tus kab mob tseem ceeb. Cov leeg nqaij. 2005; 32(2): 140-163.