Ntchito zachipatala zakumana ndi zosayembekezereka posachedwapa. COVID-19 mliri wa coronavirus wasintha njira yochitira. Kuchita kulikonse kumakhala kovuta kuposa kale. Ofufuzawo ku UK adachita kafukufuku pazomwe zimachitika pakadali pano kuchitapo kanthu kwa tracheostomy panthawi yolowerera kwa odwala a COVID-19.

Monga tonse tikudziwa, mliri wa COVID-19 umabweretsa chibayo ndipo umatha kupita patsogolo ku matenda oopsa opumira. [3] Odwala ambiri, monga coronavirus positive odwala, intubation ndi makina mpweya wabwino amafunikira pafupipafupi. Odwala omwe amafunikira mpweya wabwino kwa nthawi yayitali, amafunikira tracheostomy kuti apindule. [5] Zopindulitsa zimaphatikizapo kuyamwa ndi chimbudzi cha m'mapapo mwa iwo omwe amafunidwa nthawi zonse mu Chipinda Chachangu cha odwala. Tracheostomy mu odwala omwe akhazikika nthawi zambiri imachitika pakati pa tsiku la 7 mpaka 10 kutsatira. Komabe, malangizo a ENT UK adazindikira kufunikira kwa kusamala mukamachita tracheostomy mu odwala a COVID-19. [8] Ofufuza ochokera m'mayunivesite ku UK adasindikiza kafukufuku wotsatirawa kuti adziwe zomwe zimachitika pakachipatala.

Zomwe takumana nazo mu odwala COVID-19: zomwe tili nazo

Tracheostomy imatha kuchitika kudzera mwa njira ya opaleshoni yotseguka kapena pang'onopang'ono, nthawi zambiri pafupi ndi bedi. [7] Komabe, zowerengeka zochepa zimawonetsa njira yoyenera komanso zotsatira zotsatirapo za odwala omwe ali ndi COVID-19. Madera aku China omwe adakhudzidwa kwambiri ndi mliriwu adayamba kudziwa bwino momwe angayendetsere odwala omwe ali ndi COVID-19. Zomwe akuchita zimapindulitsa mabungwe ena kumayambiriro kwa mliri. Osangokhala mukukonzekera njira za odwala komanso zothandizira zaumoyo, komanso kulosera zotsatira. Gulu lofufuzawo lidachita kafukufuku wapadziko lonse kuti awone momwe alumikizidwe a tracheostomy pa nthawi ya intubation mu COVID-19 odwala omwe ali ndi pakati pa ENT Surgeons.

 

Madokotala a opaleshoni a ENT: tracheostomy panthawi yolowerera mu odwala a COVID-19: njira ndi zotsatira

Kafukufukuyu ndi ntchito ya Development Development yomwe idachokera ku Research and Development department of King's College Hospital NHS Foundation Trust, London. Ofufuzawo anayambitsa mafunso azotsatira pa intaneti omwe amakhala ndi mafunso otsatirawa:

1. Mukukhala kudera liti?
2. Ndi odwala angati omwe adakwaniritsidwa omwe mudakhala nawo kuchipatala?
3. Kodi ndi kuchuluka peresenti iti ya odwala omwe akufuna kuti afunikire tracheostomy?
4. Pafupifupi patsiku liti lomwe tracheostomy inachitika (mwachitsanzo, tsiku la 7 la makulidwe)?
5. Patadutsa nthawi yayitali bwanji tracheostomy wodwala atasiya kuyamwa?
6. Ndi odwala angati omwe anamwalira ngakhale anali tracheostomy?
7. Zotsatira zinali bwino ndi njira ina iliyonse ya tracheostomy (mwachitsanzo, percutaneous vs opaleshoni)?

Mafunso amafunsidwa pa Marichi 27, 2020 ndipo deta idavomerezedwa mpaka pa Epulo 15, 2020. Odwala komanso anthu onse sanatenge nawo gawo popanga kafukufukuyu kapena nkhaniyi.

Kafukufukuyu adamalizidwa ndi anthu 50 omwe anafunsidwa kuchokera ku United Kingdom (n = 8) ndi mayunitsi apadziko lonse (Chithunzi 1.) Chiwerengero cha odwala omwe adalandira mpweya wokwanira anali 3403 ndi odwala 68 pa chipatala chilichonse cha chipatala / Trust (osiyanasiyana 0-600). Chiwerengero cha odwala omwe akhazikika omwe amafunikira tracheostomy anali pafupifupi 9.65% (osiyanasiyana 0% -100%) omwe anali ndi tracheostomy yochitika pambuyo poti agwiritse ntchito masiku 14.4 (masamba 7-21).

Izi zidapangidwa kuchokera kwa anthu 28 omwe amafunsidwa kuchokera kwa 2701 odwala omwe adalowa mkati ndi mpweya (Chithunzi 2). Bwino, odwala aletsa positi tracheostomy pafupifupi pambuyo masiku 7.4 (masiku 1-16). Ngakhale tracheostomy pafupifupi 13.5% ya odwala amwalira (ochokera kwa 14 omwe amayankhidwa kuchokera pagulu la anthu 1687 omwe adalowa mkatikati ndi odwala makilidwe). Ponena za njira ya tracheostomy ndi zotulukapo, 3 mwa 50 omwe amafunsidwa adakondwera ndi tracheostomy yokhazikika. Opaleshoni yotseguka inakondedwa ndi 8 mwa 50 omwe adayankha. Ena omwe anafunsidwa (20/50) sananene kuti angakonde, pomwe 19/50 yatsala sangathe kupereka.

 

Kodi kafukufukuyu pa tracheostomy pa nthawi yomwe makulidwe a COVID-19 adatenga chiyani?

Zambiri kuchokera ku Wuhan zikuwonetsa kuti nthawi yapakatikati kuyambira pakugonekedwa kuchipatala mpaka imfa inali masiku 5 m'miyezi yoyamba ya mliriwu, zomwe zikutanthauza kuti masiku 11.[14] Mliri wa COVID-19 wapangitsa kuti pakhale kufunikira kosayerekezeka kwa chithandizo chamankhwala chofunikira komanso kufunikira kwa intubation ndi mpweya wabwino wamakina.[1] Omwe amakhala ovuta kwambiri amafunikira intubation ndi makina otsogola mpweya wabwino chifukwa chakukula msanga kwa chibayo. Amakhala pachimake choopsa kupuma mavuto matenda omwe amachititsa kulephera kupuma ndi imfa.[3,12,13]

Malangizo aposachedwa ndi American Academy of Otorhinolaryngology-Head ndi Khosi Opaleshoni amalimbikitsa kuti tracheostomy sayenera kuchitidwa asanafike masiku 14 a makulitsidwe. [15] Zotsatira za kafukufukuyu zikuwonetsa kuti pafupifupi munthu m'modzi pa 1 aliwonse odwala COVID-10 amafunikira tracheostomy. Zotsatira zina zingafotokoze kuti magawo akutenga dongosolo lofananira ndikumayamba pang'ono tracheostomy pafupipafupi.

Komabe, tiyenera kudziwa zoopsa zomwe zingakhalepo chifukwa choleka kuyamwa kwa nthawi yayitali kwa iwo omwe achotsedwa. Izi zikuphatikiza ndi zilonda zam'mbuyo zam'mimba, stenosis ndi tracheo-esophageal fistula. [5] Matenda osamalira odwala omwe ali ndi vuto lalikulu atha kukhala ochulukirachulukira. [16]

Odwala ambiri amafunika kupuma mokwanira. Izi zimapangitsa kuyipa kwa minofu komwe kumatenga nthawi yayitali kapena kuletsa kuyamwa. [17] Malipoti a kusokonekera komanso kutupa kwa m'mimba ndi zotupa zimathanso kuletsa kutalikirana ndi kupititsa nthawi yayitali ya kufunikira, kutsekeka ndi mpweya wabwino. Izi zitha kugonjetsedwa ndi tracheostomy.

Komabe, kafukufukuyu adalephera kukhazikitsa phindu lililonse lomveka la tracheostomy njira. Ndemanga za omwe amafunsidwa adafotokozera kuti kuchitapo kanthu kunatengedwa pamilandu malinga ndi momwe zimakhalira ndikudalira luso la opaleshoni wamba. Zolepheretsa zimaphatikizapo kuchuluka kwa omwe anafunsidwa ndi odwala omwe ali ndi COVID-19 omwe amakhala ndi zigawo zina. Olembawa akuwonetsa kuthokoza kwawo kwakukulu kwa iwo omwe apatula nthawi kuti ayankhe kafukufukuyu kuti athandizire kusankha komwe anzawo akuchita padziko lonse lapansi.

 

AUTHORS

Ayman D'Souza: Christ Church, Yunivesite ya Oxford, Oxford, UK

Ricard Simo FRCS (ORL-HNS): Dipatimenti ya Otorhinolaryngology, Guy's ndi St Thomas 'NHS Foundation Trust, London, UK

Alwyn D'Souza FRCS (ORL-HNS): Dipatimenti ya Otorhinolaryngology, University Hospital Lewisham, London, UK

Francis Vaz FRCS (ORL-HNS): Dipatimenti ya Opaleshoni Mutu ndi Khosi, University College Hospital, London, UK | Institute of Medical Science, Campus ya Medway, Canterbury Christ Church University, Kent, UK

Andrew Asanafike FRCS (ORL-HNS): Dipatimenti ya Otorhinolaryngology, Chipatala cha Princess Royal University, Kent, UK

Rahul Kanegaonkar FRCS (ORL-HNS): Institute of Medical Sayansi, Campway Campus, Canterbury Christ Church University, Kent, UK

 

ZOKHUDZA

1. Willan J, King AJ, Jeffery K, Bienz N. Zovuta zaku zipatala za NHS panthawi ya mliri wa covid-19. BMJ. 2020; 368: m1117. https: // doi.org/10.1136/bmj.m1117.
2. https://www.who.int/docs/default-source/coronaviruse/situationreports/20200414-sitrep-85-covid-19.pdf?sfvrsn=7b8629bb_4). Accessed April 14, 2020.
3. Wu C, Chen X, Cai Y, et al. Zovuta zomwe zimachitika chifukwa cha kupuma kwapakati pa matenda ndi kupweteka kwa odwala omwe ali ndi matenda a coronavirus 2019 chibayo ku Wuhan. China JAMA Int Med. 2020; e200994. https://doi.org/10.1001/jamainternmed. 2020.0994.
4. Wu Z, McGoogan JM. Makhalidwe ofunikira komanso ofunikira kuchokera ku matenda a coronavirus 2019 (COVID-19) ku China: chidule cha lipoti la milandu 72 314 yochokera ku China Center for Disease Control and Prevention. JAMA. 2020; 323 (13): 1239–1242. https://doi.org/10.1001/jama.2020.2648
5. Dempster J. Tracheostomy (Chaputala 35). Mu: Musheer Hussain S, ed. Matenda a Logan Turner's a Mphuno, Throat ndi Mutu wa Khutu ndi Opaleshoni ya Khosi. 11th. Boca Raton, FL: CRC Press; 2015.
6. Freeman BD, Borecki IB, Coopersmith CM, Buchman TG. Chibale pakati pa tracheostomy nthawi ndi nthawi yama makina mpweya wabwino mwa odwala omwe akudwala kwambiri. Crit Care Med. 2005; 33 (11): 2513-2520.
7. Lipton G, Stewart M, McDermid R, et al. Multispecialty tracheostomy. Ann R Coll Surg Engl. 2020; 1: 1-5.
8. Takhar A, Walker A, Tricklebank S. Malangizo a malangizo othandiza a tracheostomy otetezedwa pa mliri wa COVID-19. Eur Arch Otorhinolaryngol. 2020. http://dx.doi.org/ 10.1007 / s00405-020-05993-x.
9. Murthy S, Gomersall CD, Fowler RA. Kusamalira odwala omwe amadwala kwambiri COVID-19. JAMA. 2020; 323 (15): 1499-1500. https://doi.org/10.1001/jama.2020.3633.
10. https://www.entuk.org/tracheostomy-guidance-during-covid19-pandemic. Accessed April 14, 2020.
11. https://www.who.int/docs/default-source/coronaviruse/ situation-reports/20200415-sitrep-86-covid-19.pdf?sfvrsn= c615ea20_6. Accessed April 14, 2020.
12. Guan WJ, Ni Z, Hu Y, et al. Makhalidwe azachipatala a matenda a coronavirus 2019 ku China. Watsopano Eng J Med. 2020; 382: 1708- 1720. https://doi.org/10.1056/NEJMoa2002032.
13. Chen J, Qi T, Liu L, et al. Kupita patsogolo kwamankhwala kwa odwala omwe ali ku Shanghai, China. J Dziwani. 2020; 80 (5): E1-E6. https://doi.org/ 10.1016 / j.jinf.2020.03.004.
14. Leung C. Zokhudza matenda aimfa mu mliri wapano wa coronavirus ku China. Ndemanga mu Medical Virology. 2020; 323 (15): 1499-1500. https://doi.org/10.1002/rmv.2103.
15. Mbiri ya AAO-HNS. Malangizo a Tracheostomy Pa COVID-19 Mliri https://www.ent.org/content/ tracheostomy -cebiso-nthawi-covid-19-mliri
16. Vassilakopoulos T. Kuwonongeka kwa minofu kukuwonongeka ku ICU: kodi ndi nthawi yoteteza diaphragm? Thorax. 2016; 71 (5): 397-398. https://doi.org/10.1136/thoraxjnl-2016-208354.
17. Bolton CF. Mawonetseredwe a neuromuscular a matenda oopsa. Mitsempha ya Minofu. 2005;32(2):140-163.

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SOURCE

Fufuzani Zotsatira

University of Oxford 

Guy's ndi St Thomas 'NHS Foundation Trust

Chipatala cha University of Lewisham

Chipatala cha University College

Chipatala cha Princess Royal University

MedCampus Canterbury Christ Church University