Early ventilator liberation and decreased sedation needs after tracheostomy in patients with COVID-19 infection.
Early ventilator liberation and decreased sedation needs after tracheostomy in patients with COVID-19 infection.
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DOI：
10.1136/tsaco-2020-000591
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发表时间：
2021
影响因子：
2
通讯作者：
Idrovo JP
中科院分区：
文献类型：
--
作者：
Carmichael H;Wright FL;McIntyre RC;Vogler T;Urban S;Jolley SE;Burnham EL;Firth W;Velopulos CG;Idrovo JP
自2019冠状病毒病（COVID-19）大流行开始以来，鉴于高死亡率以及对感染传播给提供者的担忧，已发布的气管切开术指南通常建议将手术推迟到插管的最初几周之后。目前尚不清楚COVID-19感染患者的气管造口术是否有助于呼吸机脱机，文献中尚未报道长期结局。这是一项回顾性研究，研究对象是在单中心三级学术转诊重症监护病房接受COVID-19感染的患者的气管切开术结局。患者在床边接受经皮气管切开术;该手术在有限的人员配置下进行，以降低疾病传播的风险。2020年3月1日至6月30日期间，共有206名COVID-19感染患者需要机械通气，26名患者在首次插管后平均25±5天接受了气管切开术。总体而言，81%的气管切开患者在术后平均9±6天脱离呼吸机，54%的患者在术后平均21±10天出院前拔管。术后一周，镇静和止痛药物的需求显著减少。住院死亡率为15%。在气管切开术幸存者中，68%出院到医院。由于长期依赖呼吸机，COVID-19相关呼吸衰竭患者的管理可能具有挑战性。在我们的初步经验中，该人群的气管切开术后结局令人鼓舞，从呼吸机中解放出来的时间短，出院前拔管率高，死亡率与其他适应症的气管切开术相似。该队列中撤机的障碍可能是高镇静需求和呼吸机不同步。第五级-治疗/护理管理。
Since the outset of the coronavirus disease 2019 (COVID-19) pandemic, published tracheostomy guidelines have generally recommended deferral of the procedure beyond the initial weeks of intubation given high mortality as well as concerns about transmission of the infection to providers. It is unclear whether tracheostomy in patients with COVID-19 infection facilitates ventilator weaning, and long-term outcomes are not yet reported in the literature. This is a retrospective study of tracheostomy outcomes in patients with COVID-19 infection at a single-center academic tertiary referral intensive care unit. Patients underwent percutaneous tracheostomy at the bedside; the procedure was performed with limited staffing to reduce risk of disease transmission. Between March 1 and June 30, 2020, a total of 206 patients with COVID-19 infection required mechanical ventilation and 26 underwent tracheostomy at a mean of 25±5 days after initial intubation. Overall, 81% of tracheostomy patients were liberated from the ventilator at a mean of 9±6 days postprocedure, and 54% were decannulated prior to hospital discharge at a mean of 21±10 days postprocedure. Sedation and pain medication requirements decreased significantly in the week after the procedure. In-hospital mortality was 15%. Among tracheostomy survivors, 68% were discharged to a facility. The management of patients with COVID-19 related respiratory failure can be challenging due to prolonged ventilator dependency. In our initial experience, outcomes post-tracheostomy in this population are encouraging, with short time to liberation from the ventilator, a high rate of decannulation prior to hospital discharge, and similar mortality to tracheostomy performed for other indications. Barriers to weaning ventilation in this cohort may be high sedation needs and ventilator dyssynchrony. Level V—Therapeutic/care management.
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DOI：
10.1056/nejmoa1301372
发表时间：
2013-10-03
期刊：
The New England journal of medicine
影响因子：
--
作者：
Pandharipande PP;Girard TD;Jackson JC;Morandi A;Thompson JL;Pun BT;Brummel NE;Hughes CG;Vasilevskis EE;Shintani AK;Moons KG;Geevarghese SK;Canonico A;Hopkins RO;Bernard GR;Dittus RS;Ely EW;BRAIN-ICU Study Investigators
通讯作者：
BRAIN-ICU Study Investigators
影响因子：
76.2
作者：
McGrath, Brendan A.;Brenner, Michael J.;Feller-Kopman, David J.
通讯作者：
Feller-Kopman, David J.
影响因子：
9.6
作者：
Lamb, Carla R.;Desai, Neeraj R.;Murgu, Septimiu
通讯作者：
Murgu, Septimiu
影响因子：
2.6
作者：
Shah, Rahul K.;Lander, Lina;Roberson, David W.
通讯作者：
Roberson, David W.
DOI：
10.1001/jama.2020.6775
发表时间：
2020-01-01
期刊：
JAMA, Journal of the American Medical Association
影响因子：
--
作者：
Richardson, Safiya;Hirsch, Jamie S.;,
通讯作者：
,