在VV-ECMO支持的肥胖COVID-19患者中,可以安全地进行早期气管切除术
Ian A Tamargo1, Christina Creel-Bulos2, Maria C Callahan1
1Emory University School of Medicine, Atlanta, GA, USA.
早期气管切除似乎对肥胖的COVID-19患者在毒性体外膜氧化 (VV-ECMO) 上是安全的. 在这项回顾性研究中,气管切除术的时间没有影响出血,通风持续时间或死亡率等结果.
科学领域:
- 关键护理医学 关键护理医学
- 肺部病理学 肺部病理学
- 传染性疾病 传染性疾病
背景情况:
- 肥胖是严重COVID-19的重要危险因素,通常导致急性呼吸衰竭 (ARF).
- 需要毒性体外膜氧化 (VV-ECMO) 的COVID-19相关ARF患者可能需要长时间的机械通风.
- 在这种特定的患者群体中,气管切除术的最佳时间仍然不清楚,因为数据有限.
研究的目的:
- 追溯分析COVID-19的肥胖成人患者中气管切除术的安全性和结果,需要VV-ECMO.
- 调查气管切除术时间和临床结果之间的关联,包括出血并发症,通风持续时间和死亡率.
主要方法:
- 在2020年3月至2022年12月期间,对患有COVID-19相关ARDS的肥胖患者进行了VV-ECMO的回顾性队列研究.
- 收集的数据包括患者人口统计,气管切除术时间 (早期或晚期),出血事件,机械通风持续时间,VV-ECMO持续时间,停留时间和死亡率.
- 统计分析以根据气管切除术时间来比较结果.
主要成果:
- 在接受VV-ECMO治疗的62名肥胖患者中,有42人接受了气管切除术;50%的患者进行了早期气管切除术 (14天内进行呼吸器支).
- 整体出血率为29%,其中7%需要外科手术来治疗气管切开部位出血.
- 气管切除术的时间与出血率,机械呼吸或VV-ECMO支持的持续时间,停留时间或死亡率的差异没有显著关联.
结论:
- 在接受VV-ECMO治疗的COVID-19肥胖患者中,可以安全地进行早期气管切除术.
- 气管切除术的临床决策应该保持个性化,考虑到整体患者的个人资料.
- 研究结果表明,早期干预可能是一个可行的选择,而不会影响患者的治疗结果.
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