COVID-19 Pandemisi Sürecinde Yoğun Bakım Ünitesinde Perkütan Trakeostomi Yönetimi

Abstract

Öz Amaç: Coronavirus hastalığı 2019 (COVID-19), uzun süreli mekanik ventilasyon gerektiren kritik hastalarda dramatik bir artışa yol açmıştır. Bu hastaların çoğu, uzun süreli entübasyon süreleri, solunum yetmezliği ve uzatılmış ventilatör desteği gereksinimi nedeniyle trakeostomiye ihtiyaç duymaktadır. Gereç ve Yöntem: Uzun süreli mekanik ventilasyona ihtiyaç duyan kritik COVID-19 hastalarının yer aldığı retrospektif bir analiz gerçekleştirildi. Birincil amacımız COVID-19 hastalarında trakeostomi yapma deneyimimizi sunmaktır. Ultrason rehberliğinde perkütan trakeostomi, tüm hastalarda yatak başında gerçekleştirildi. Bulgular: Tüm perkütan trakeostomiler komplikasyon olmaksızın başarıyla gerçekleştirildi. Trakeostomi işlemi, entübasyondan ortalama 14 gün sonra gerçekleştirildi. Hastaların ortalama yaşı 71 olup, çoğunda hipertansiyon, diyabet mellitus ve obezite gibi altta yatan komorbiditeler mevcuttu. Sonuç: 17 COVID-19 hastasında ultrason rehberliğinde yapılan perkütan trakeostomi deneyimimiz, bu yöntemin kritik hasta grubunda güvenli ve etkili bir yaklaşım olduğunu göstermiştir.

Keywords

• : COVID-19
• ultrason rehberliğinde
• perkütan trakeostomi

The Management of Percutan Tracheostomy in Intensive Care Unit During COVID -19 Pandemic

Abstract

Abstract Aim; Coronavirus disease 2019 (COVID-19) has led to a dramatic increase in critically ill patients requiring prolonged mechanical ventilation. Many of these patients require tracheostomies due to prolonged intubation times, respiratory failure, and the need for prolonged ventilatory support. Material and Method; A retrospective analysis was performed on critically ill COVID- 19 patients who were admitted to our ICU and required prolonged mechanical ventilation. Our primery outcome is presenting our experience for performing tracheostomy in COVID-19 patients. Ultrasound guided percutaneous tracheostomy was performed at the bedside in all patients. Results; All percutaneous tracheostomies were performed successfully without complications. The tracheostomy procedure was performed on an average of 14 days after intubation. The mean age of the patients was 71 years, and most had underlying comorbidities such as hypertension, diabetes mellitus, and obesity. Conclusion; Our experience with ultrasound-guided percutaneous tracheostomy in 17 COVİD 19 patients demonstrated that this method is a safe and effective approach in critically ill patients.

Keywords

• Covid 19
• ultrasound-guided
• percutaneous tracheostomy

References

1. 1. Pascarella G, Strumia A, Piliego C, et al. COVID-19 diagnosis and management: a comprehensive review. J Intern Med. 2020;288(2):192-206.
2. 2. McGrath BA, Brenner MJ, Warrillow SJ, et al. Tracheostomy in the COVID-19 era: global and multidisciplinary guidance. Lancet Respir Med. 2020;8(7):717-25.
3. 3. Sommer DD, Engels PT, Weitzel EK, et al. Recommendations from the CSO-HNS taskforce on performance of tracheotomy during the COVID-19 pandemic. J Otolaryngol Head Neck Surg. 2020;49(1):23.
4. 4. Adly A, Youssef TA, El-Begermy MM, Younis HM. Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review. Eur Arch Otorhinolaryngol. 2018;275(3):679-90.
5. 5. Esteban A, Anzueto A, Alía I, et al. How is mechanical ventilation employed in the intensive care unit? An international utilization review. Am J Respir Crit Care Med. 2000;161(5):1450-8.
6. 6. Chee VW, Khoo ML, Lee SF, Lai YC, Chin NM. Infection control measures for operative procedures in severe acute respiratory syndrome-related patients. Anesthesiology. 2004;100(6):1394-8.
7. 7. Mishra P, Jedge P, Yadav KV, et al. Outcome of Tracheostomy in COVID-19 Patients. Indian J Otolaryngol Head Neck Surg. 2023;75(2):404-8.
8. 8. Tien HC, Chughtai T, Jogeklar A, Cooper AB, Brenneman F. Elective and emergency surgery in patients with severe acute respiratory syndrome (SARS). Can J Surg. 2005;48(1):71-4.

9. 9. Wei WI, Tuen HH, Ng RW, Lam LK. Safe tracheostomy for patients with severe acute respiratory syndrome. Laryngoscope. 2003;113(10):1777- 9.
10. 10. Ahmed N, Hare GM, Merkley J, Devlin R, Baker A. Open tracheostomy in a suspect severe acute respiratory syndrome (SARS) patient: brief technical communication. Can J Surg. 2005;48(1):68-71.
11. 11. Gobatto ALN, Besen BAMP, Tierno PFGMM, et al. Ultrasound-guided percutaneous dilational tracheostomy versus bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients (TRACHUS): a randomized noninferiority controlled trial. Intensive Care Med. 2016;42(3):342-51.
12. 12. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707-10.
13. 13. Tay JK, Khoo ML, Loh WS. Surgical Considerations for Tracheostomy During the COVID-19 Pandemic: Lessons Learned From the Severe Acute Respiratory Syndrome Outbreak. JAMA Otolaryngol Head Neck Surg. 2020;146(6):517-8.
14. 14. Iftikhar IH, Teng S, Schimmel M, Duran C, Sardi A, Islam S. A Network Comparative Meta-analysis of Percutaneous Dilatational Tracheostomies Using Anatomic Landmarks, Bronchoscopic, and Ultrasound Guidance Versus Open Surgical Tracheostomy. Lung. 2019;197(3):267-75.
15. 15. Menegozzo CAM, Sorbello CCJ, Santos-Jr JP, Rasslan R, Damous SHB, Utiyama EM. Safe ultrasound-guided percutaneous tracheostomy in eight steps and necessary precautions in COVID-19 patients. Rev Col Bras Cir. 2022;49:e20223202.