М.С. Бутра, А.Р. Сакович
УЗ «4-я городская клиническая больница им. Н. Е. Савченко», УО «Белорусский государственный медицинский университет»
В настоящее время продолжается дискуссия о сроках и методах проведения трахеостомии у пациентов, инфицированных Ковид-19 и нуждающихся в проведении искусственной вентиляции легких (ИВЛ). Объектом исследования стали 182 пациента с Ковид-19, находившихся на искусственной вентиляции легких. На начальном этапе выполнения трахеостомий у Ковид-19 инфицированных пациентов имели место осложнения в виде интра и послеоперационных кровотечений (диффузных) на фоне продолжающегося титрования гепарина (12 случаев из 26, – 46,1 %). В 75,8 % случаев трахеостомия была выполнена в срок от 3 до 14 дней нахождения на ИВЛ, в 24,2 % случаев – в сроки более 14 суток нахождения на ИВЛ. Показания к трахеостомии, включая сроки и способ ее выполнения, у пациентов с Ковид-19, находящихся на ИВЛ, должны учитывать клинико-лабораторные показатели тяжести состояния и вероятность благоприятного прогноза, наличие ресурсов безопасности для медработников, участвующих в проведении операции и ведении послеоперационного периода, а также возможности постоянного динамического наблюдения за пациентом.
ключевые слова: Ковид-19, искусственная вентиляция легких, интубация, трахеостомия, кровотечение
Modern aspects of tracheostomy in Covid-19 infected patients
M.S. Butra, A.R. Sakovich
Currently, there is ongoing discussion about the timing and methods of tracheostomy in patients infected with Covid-19 and in need of artificial lung ventilation. The object of the study was 182 patients with Covid-19 who were on artificial lung ventilation. At the initial stage of tracheostomy, Covid-19 infected patients had complications in the form of intra- and postoperative bleeding (diffuse) against the background of continued titration of heparin (12 cases out of 26, – 46.1 %). In 75.8 % of cases, tracheostomy was performed within 3 to 14 days of being on artificial lung ventilation, in 24.2 % of cases – within 14 days of being on artificial lung ventilation. Indications for tracheostomy, including the timing and method of its implementation, in patients with Covid-19 who are on artificial lung ventilation should take into account the clinical and laboratory indicators of the severity of the condition and the likelihood of a favorable prognosis, the availability of safety resources for health workers involved in the operation and management of the postoperative period, as well as the possibility of constant dynamic monitoring of the patient.
keywords: Covid-19, artificial lung ventilation, intubation, tracheostomy, bleeding
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References
1. Tiffany, N. Chao. Tracheotomy in ventilated patients with covid-19 / N. Tiffani [et al.] // Annals of Surgery. – 2020.
2. Mattioli, F. Tracheostomy in the COVID-19 pandemic / F. Mattioli [et al.] // Eur Arch Otorhinolaryngol. – 2020.
3. McGrath, A. Tracheostomy in the COVID-19 era: global and multidisciplinary guidance / A. McGrath [et al.] // The Lancet. Respiratory medicine. – 2020. – Vol. 8(7). – Р. 717–725.
4. Martin-Villares, C. Outcome of 1890 tracheostomies for critical COVID - 19 patients: a national cohort study in Spain / C. Martin-Villares [et al.] // Eur Arch Otorhinolaryngol. – 2021.
5. Аviles-Jurando, F. X. Timing, Complications, and Safety of Tracheotomy in Critically Ill Patients With COVID-19 / F. X. AvilesJurando [et al.] // JAMA Otalaryngol Head Neck Surg. – 2020.
6. Ferro, A. Systematic review and meta-analysis of tracheostomy outcomes in COVID-19 patients / A. Ferro [et al.] // Oral Maxillofac Surgery. – 2021.
7. Wolfer, R. Virological assessment of hospitalized patients with covid-19 / R. Wolfer [et al.] // Nature. – 2020.
8. COVIDTrach collaborative. COVIDTrach: a prospective cohort study of mechanically ventilated patients with COVID-19 undergoing tracheostomy in the UK COVIDTrach collaborative / COVIDTrach collaborative // Surg Interv Health Technol. – 2021.
Поступила 21.12.2021 г.
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