Tracheostomy lakoko intubation ni awọn alaisan COVID-19

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Tracheostomy lakoko intubation ni awọn alaisan COVID-19: iwadii kan lori iṣe itọju ile-iwosan lọwọlọwọ

By Newsroom On Jul 17, 2020

Awọn iṣẹ ilera ilera ni iriri awọn ibeere airotẹlẹ, laipẹ. COVID-19 ajakaye-arun coronavirus yi ọna ti iṣe ṣiṣẹ. Gbogbo iṣiṣẹ di lile ju ti iṣaaju lọ. Awọn oniwadi ni Ilu Gẹẹsi ṣe iwadii kan lori iṣe adaṣe lọwọlọwọ ti ilowosi tracheostomy lakoko intubation ni awọn alaisan COVID-19.

Gẹgẹbi gbogbo wa ti mọ, COVID-19 ajakaye-arun ni abajade ninu ẹdọforo ati pe o le ni ilọsiwaju kiakia si aisan aarun atẹgun nla. [3] Ọpọlọpọ awọn ipo awọn alaisan, gẹgẹ bi awọn alaisan ti o ni idaniloju coronavirus, gbigbi ati fifa ẹrọ ni a nilo nigbagbogbo. Awọn alaisan wọnyẹn ti o nilo irukerudo gigun, nilo tracheostomy lati ni anfani. [5] Awọn anfani ni mimu ọmu ati ile-igbọn ẹdọforo ni awọn to nilo fun mimu-ọna atẹgun deede ni Ẹka Itọju Itọju. Tracheostomy ni awọn alaisan ti o wa ni abẹrẹ ni a ti ṣe igbagbogbo laarin ọjọ 7 ati 10 ti o tẹle intubation. Sibẹsibẹ, awọn itọnisọna ENT UK mọ iwulo fun iṣọra nigbati o ba n ṣe tracheostomy ni awọn alaisan COVID-19. [8] Awọn oniwadi lati awọn ile-ẹkọ giga ni Ilu Gẹẹsi gbejade iwadi atẹle lati ṣe idanimọ awọn iṣẹ iṣoogun.

Imọye ninu intubation awọn alaisan COVID-19: ohun ti a ni

O le ṣe adaṣe itọju nipa ilana isan ti ṣiṣi tabi lilu, ni igbagbogbo lori ibusun ibusun. Sibẹsibẹ, awọn data kekere fihan ọna ti o dara julọ ati abajade atẹle ni COVID-7 alaisan ti o ni itutu. Awọn agbegbe ni Ilu China eyiti o kọlu pupọ julọ nipasẹ ajakaye-arun naa ni idagbasoke oye ti o dara julọ bi o ṣe le ṣakoso awọn alaisan rere COVID-19 ti o dara julọ. Iriri wọn jẹ anfani fun awọn ile-iṣẹ miiran ni kutukutu ọmọ ajakaye-arun. Kii ṣe ni awọn ofin ti gbero awọn ipa ọna alaisan ati awọn orisun ilera, ṣugbọn tun sọtẹlẹ awọn iyọrisi. Ẹgbẹ awọn oniwadi ṣe iwadi iwadi ti ilu okeere lati ṣe ayẹwo ilowosi tracheostomy lakoko gbigbe inu ni awọn alaisan rere COVID-19 laarin awọn oniwosan ENT.

Awọn oniwosan ENT: tracheostomi lakoko intubation ni awọn alaisan COVID-19: awọn ọna ati awọn abajade

Iwadi yii jẹ Ile-iṣẹ Idagbasoke Iṣẹ ti a gba lati Ẹka Iwadi ati Idagbasoke Ẹka ti Ile-iwosan ti Ile-iwosan NHS Foundation Trust, London. Awọn oniwadi ṣe ifilọlẹ iwe ibeere lori ayelujara ti o ni awọn ibeere wọnyi:

Orile-ede / agbegbe wo ni o ti ipilẹ?
Melo ni awọn alaisan COVID-19 ti o ni afẹfẹ ti ni ni ile-iwosan rẹ?
Kini ogorun ti awọn alaisan inu-inu ti o nilo tracheostomy?
Ni apapọ ọjọ wo ni a ṣe tracheostomy (fun apẹẹrẹ, ọjọ 7 ti intubation)?
Bawo ni pipẹ lẹhin tracheostomy ti a fi gba ọmu alaisan kuro ninu ẹrọ ategun?
Kini idawọle ti awọn alaisan ku laibikita tracheostomy?
Awọn abajade wa dara julọ pẹlu eyikeyi ilana ilana-ọpọlọ pato (fun apẹẹrẹ, percutaneous vs surgery)?

Ti pin iwe ibeere ni Oṣu Kẹta Ọjọ 27, Ọdun 2020 ati gba data titi di Oṣu Kẹrin Ọjọ 15, Ọdun 2020. Awọn alaisan ati ara ilu ko kopa ninu iṣelọpọ ti iwadi yii tabi nkan naa.

Iwadi naa pari nipasẹ apapọ awọn oludahunsi 50 lati United Kingdom mejeeji (n = 8) ati awọn ẹka kariaye (Nọmba 1.) Nọmba ti awọn alaisan ti o fọn mọ jẹ 3403 pẹlu awọn alaisan 68 fun Ẹgbẹ Aabo / igbẹkẹle (sakani 0-600). Oṣuwọn awọn alaisan ti o nba abinibi ti o nilo tracheostomy wa ni apapọ 9.65% (sakani 0% -100%) pẹlu tracheostomy ti o ṣe atẹle intubation ni itumọ ọjọ 14.4 (sakani 7-21).

Eyi ni a fa lati ọdọ awọn oluyẹwo 28 lati 2701 intubated ati awọn alaisan ti o ni fifa (olusin 2). Ni aṣeyọri, awọn alaisan ti yọ ọra postchechestomy ni apapọ lẹhin ọjọ 7.4 (iwọn ọjọ 1-16). Laibikita tracheostomy ni apapọ 13.5% ti awọn alaisan ku (ya lati ọdọ awọn oluṣe 14 lati inu olugbe 1687 intubated ati awọn alaisan ti o ni afẹfẹ). Pẹlu n ṣakiyesi si ilana ilana tracheostomy ati abajade, 3 ninu awọn 50 awọn oludahun ni o fẹran ayanfẹ si ọpọlọ onibajẹ. Ọna iṣẹ-ọna ṣiṣi silẹ ti a ṣe ayanfẹ si 8 ninu 50 awọn idahun. Awọn oludahunran miiran (20/50) ṣalaye boya ààyò, pẹlu iyokù 19/50 ti ko le ṣe alabapin.

Kini iwadi yii lori tracheostomy lakoko intubation ni awọn alaisan COVID-19 gba si?

Data lati Wuhan daba pe akoko agbedemeji lati gbigba ile-iwosan si iku jẹ ọjọ 5 ni awọn oṣu akọkọ ti ajakaye-arun, eyiti o tumọ si ọjọ 11.[14] Ajakaye-arun COVID-19 ti yọrisi ibeere ti ko lẹgbẹ fun awọn iṣẹ itọju to ṣe pataki ati iwulo fun intubation ati fentilesonu ẹrọ.[1] Awọn ti o ni itara nilo intubation ati fentilesonu ilọsiwaju ẹrọ nitori lilọsiwaju iyara ti pneumonia. O wa sinu ńlá ńlá atẹgun mimi aisan ti o yori si ikuna atẹgun ati iku.[3,12,13].

Awọn itọsọna lọwọlọwọ ti a tẹjade nipasẹ Ile-ẹkọ Amẹrika ti Otorhinolaryngology-ori ati ọrùn Isẹ abẹ sọ pe tracheostomy ko yẹ ki o ṣe ṣaaju ọjọ 14 ti intubation. [15] Awọn abajade iwadi yii yoo daba pe o to 1 ninu gbogbo 10 ti o ya sinu ati ti fẹrẹẹgbẹ awọn alaisan COVID-19 nilo tracheostomy. Awọn abajade miiran yoo daba pe awọn sipo n gba imulo kan ti o jọra pẹlu ṣiṣe diẹ ni kutukutu tracheostomy ni igbagbogbo.

Bibẹẹkọ, o yẹ ki a ṣe akiyesi awọn eewu ti o pọju ti fentilesonu gigun ninu awọn ti o le yọ lẹnu. Iwọnyi pẹlu iṣọn ọgbẹ ọgbẹ pẹ, stenosis ati fistula tracheo-esophageal. [5] Itoju itọju aifọkanbalẹ paapaa tun ṣee ṣe lati di apọju diẹ sii. [16]

Awọn alaisan diẹ sii yoo nilo fun igbala gigun. Eyi yoo fa eero-inu iṣan eyiti o le pẹ tabi idiwọ apọju. [17] Awọn ijabọ ti didan ati wiwu wiwu ati ọgbẹ le tun ṣe idiwọ piparẹ ati mu iwulo fun intubation, sedation ati fentilesonu. Eyi le bori nipasẹ tracheostomy.

Bibẹẹkọ, iwadi yii kuna lati fi idi eyikeyi anfani ti o han gbangba nipa ilana tracheostomy. Awọn asọye nipasẹ awọn olukọ ṣalaye pe a mu idasi lori ọran nipasẹ ipilẹ ọran ati igbẹkẹle lori iriri iṣẹ abẹ agbegbe. Awọn idiwọn pẹlu nọmba awọn oludahunsi pẹlu awọn alaisan rere COVID-19 ni ifojusi ni awọn ẹka kan pato. Awọn onkọwe ṣafihan idupẹ nla wọn fun awọn ti o lo akoko lati dahun si iwadi yii lati ṣe atilẹyin ipinnu ipinnu ti awọn ẹlẹgbẹ jakejado agbaye.

ỌMỌRỌ

Ayman D'Souza: Ile ijọsin Kristi, Ile-iwe giga ti Oxford, Oxford, UK

Ricard Simo FRCS (ORL-HNS): Sakaani ti Otorhinolaryngology, Guy's ati St Thomas 'NHS Foundation Trust, London, UK

Alwyn D'Souza FRCS (ORL-HNS): Sakaani ti Otorhinolaryngology, Ile-iwosan University Lewisham, London, UK

Francis Vaz FRCS (ORL-HNS): Ẹka ti Ori ati Isẹ Ọrun, Ile-ẹkọ giga Ile-ẹkọ giga University, London, UK | Institute of Science Sciences, Medway Campus, Canterbury Christ Church University, Kent, UK

Andrew Iwaju FRCS (ORL-HNS): Sakaani ti Otorhinolaryngology, Princess Royal University Hospital, Kent, UK

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