Use of Tracheostomy During the COVID-19 Pandemic American College of Chest Physicians/American Association for Bronchology and Interventional Pulmonology/Association of Interventional Pulmonology Program Directors Expert Panel Report
Use of Tracheostomy During the COVID-19 Pandemic American College of Chest Physicians/American Association for Bronchology and Interventional Pulmonology/Association of Interventional Pulmonology Program Directors Expert Panel Report
复制标题
DOI：
10.1016/j.chest.2020.05.571
复制
发表时间：
2020-10-01
期刊：
影响因子：
9.6
通讯作者：
Murgu, Septimiu
中科院分区：
文献类型：
--
作者：
Lamb, Carla R.;Desai, Neeraj R.;Murgu, Septimiu
背景：气管造口术在2019冠状病毒病（COVID-19）大流行期间的作用仍然未知。本共识声明的目的是检查对COVID-19呼吸衰竭患者进行气管切开术的现有证据，并为医生提供准备，时机和技术方面的指导，同时最大限度地减少对医护人员（HCW）的感染风险。方法：一个小组，包括来自三个专业协会的重症监护医生和介入肺病学家，代表13个具有管理经验的机构。在一系列医疗保健环境中，COVID-19患者提出了关键的临床问题，解决了COVID-19气管切开术的特定主题。文献的系统回顾和一个既定的修改后的德尔菲共识的方法被应用到提供一个可靠的循证共识statement和专家小组report.Results：8个关键问题，对应于14个决策点，被评为小组。对结果进行汇总，得出八项主要建议和五项附加备注，旨在指导医疗保健提供者在COVID-19相关呼吸衰竭患者的气管造口术相关决策过程中。结论：该小组建议对预计需要长期机械通气的患者进行气管造口术。不建议气管切开术的具体时间。目前尚无证据表明，在接受气管造口术评估的确诊COVID-19患者中进行常规重复逆转录聚合酶链反应检测。为了降低HCW感染的风险，我们建议使用最小化雾化的技术进行手术，同时佩戴增强的个人防护设备。本声明中提出的建议可能会随着在这一流行病期间获得更多经验而改变。
BACKGROUND: The role of tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic remains unknown. The goal of this consensus statement is to examine the current evidence for performing tracheostomy in patients with respiratory failure from COVID-19 and offer guidance to physicians on the preparation, timing, and technique while minimizing the risk of infection to health care workers (HCWs).METHODS: A panel including intensivists and interventional pulmonologists from three professional societies representing 13 institutions with experience in managing patients with COVID-19 across a spectrum of health-care environments developed key clinical questions addressing specific topics on tracheostomy in COVID-19. A systematic review of the literature and an established modified Delphi consensus methodology were applied to provide a reliable evidence-based consensus statement and expert panel report.RESULTS: Eight key questions, corresponding to 14 decision points, were rated by the panel. The results were aggregated, resulting in eight main recommendations and five additional remarks intended to guide health-care providers in the decision-making process pertinent to tracheostomy in patients with COVID-19-related respiratory failure.CONCLUSION: This panel suggests performing tracheostomy in patients expected to require prolonged mechanical ventilation. A specific timing of tracheostomy cannot be recommended. There is no evidence for routine repeat reverse transcription polymerase chain reaction testing in patients with confirmed COVID-19 evaluated for tracheostomy. To reduce the risk of infection in HCWs, we recommend performing the procedure using techniques that minimize aerosolization while wearing enhanced personal protective equipment. The recommendations presented in this statement may change as more experience is gained during this pandemic.