UNASSIGNED:全球流行的严重急性呼吸道综合症冠状病毒2型(SARS-CoV-2)入侵导致的感染和死亡人数每天都在稳步增加。在爆发的早期阶段,大约15%-20%的2019年冠状病毒病患者(COVID-19)不可避免地发展为重症和危重疾病,尤其是老年患者和有多种或严重合并症的患者。这些更严重的疾病主要表现为呼吸困难,血氧饱和度降低,重症肺炎,急性呼吸窘迫综合征(ARDS),因此需要长时间的高级呼吸支持,包括高流量鼻插管(HFNC),无创机械通气(NIMV),有创机械通气(IMV)。
UNASSIGNED:本研究旨在为有创机械通气的COVID-19患者提出一种更安全,更实用的气管切开术。
UNASSIGNED:这是一项单中心质量改进研究。
未经证实:气管切开术是COVID-19患者气管插管时间延长的必要且重要的气道管理步骤,IMV,拔管失败,和呼吸机依赖。标准化的三级防护措施和笨重的个人防护装备(PPE)可能会极大地阻碍气管切开术的实施,特别是在确定表面位置模糊的COVID-19患者的最佳术前定位时,肥胖,短颈部或有限的颈部延伸,由于视力障碍,与PPE相关的触觉和运动性降低。因此,这项研究的目的是提出一种更安全,更实用的气管切开术,即经皮扩张气管切开术(PDT),在床旁超声引导下延迟气管插管退出,而无需常规使用柔性纤维支气管镜(FFB),可以准确地确定最佳的手术前定位,以及避免术中损伤气管后壁,防止气管食管瘘(TEF)的发生。
UNASSIGNED: The number of infections and deaths caused by the global epidemic of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) invasion is steadily increasing daily. In the early stages of outbreak, approximately 15%-20% of patients with coronavirus disease 2019 (COVID-19) inevitably developed severe and critically ill forms of the disease, especially elderly patients and those with several or serious comorbidities. These more severe forms of disease mainly manifest as dyspnea, reduced blood oxygen saturation, severe pneumonia, acute respiratory distress syndrome (ARDS), thus requiring prolonged advanced respiratory support, including high-flow nasal cannula (HFNC), non-invasive mechanical ventilation (NIMV), and invasive mechanical ventilation (IMV).
UNASSIGNED: This
study aimed to propose a safer and more practical tracheotomy in invasive mechanical ventilated patients with COVID-19.
UNASSIGNED: This is a single center quality improvement
study.
UNASSIGNED: Tracheotomy is a necessary and important step in airway management for COVID-19 patients with prolonged endotracheal intubation, IMV, failed extubation, and ventilator dependence. Standardized third-level protection measures and bulky personal protective equipment (PPE) may hugely impede the implementation of tracheotomy, especially when determining the optimal pre-surgical positioning for COVID-19 patients with ambiguous surface position, obesity, short neck or limited neck extension, due to vision impairment, reduced tactile sensation and motility associated with PPE. Consequently, the aim of this
study was to propose a safer and more practical tracheotomy, namely percutaneous dilated tracheotomy (PDT) with delayed endotracheal intubation withdrawal under the guidance of bedside ultrasonography without the conventional use of flexible fiberoptic bronchoscopy (FFB), which can accurately determine the optimal pre-surgical positioning, as well as avoid intraoperative damage of the posterior tracheal wall and prevent the occurrence of tracheoesophageal fistula (TEF).