DOI QR코드

DOI QR Code

COVID-19 시대에 중환자실 전담의사 감독 하에 두경부 전문의에 의해 시행된 기관절개술에 대한 후향적 분석 연구

Tracheostomy Performed by a Head and Neck Surgeon Under the Supervision of an Intensive Care Unit Specialists in the COVID-19 Era: A Retrospective Analysis

  • 한원호 (국립암센터 외과) ;
  • 이윤임 (국립암센터 이비인후과-두경부외과) ;
  • 백선화 (단국대학교 의과대학 내과학교실) ;
  • 석준걸 (단국대학교 의과대학 내과학교실)
  • Han, Won Ho (Department of Surgery, National Cancer Center) ;
  • Lee, Yun Im (Department of Internal Medicine, Dankook University College of Medicine) ;
  • Baek, Sunhwa (Department of Otorhinolaryngology-Head and Neck Surgery, National Cancer Center) ;
  • Seok, Jungirl (Department of Otorhinolaryngology-Head and Neck Surgery, National Cancer Center)
  • 투고 : 2022.03.15
  • 심사 : 2022.05.20
  • 발행 : 2022.08.31

초록

Background and Objectives Tracheostomy is a relatively safe procedure, and the recent emergence of COVID-19 has raised the need to perform tracheostomy immediately in the bed of an intensive care unit (ICU) rather than an operating room. The purpose of this study was to determine the occurrence of complications related to surgical tracheotomy performed in the ICU by an ENT specialist. Materials and Method From March 2019 to January 2022, a total of 101 patients underwent tracheostomy in the ICU. Demographics and complications were classified according to postoperative period. Results Within 24 hours after the procedure, bleeding events were confirmed in 2 patients (2.0%) with mild bleeding. One case (1.0%) of ventricular fibrillation occurred shortly after the procedure. There were no complications from 24 hours to 1 week after procedure. After one week, 4 patients (4.5%) had a local infection, and 3 patients (3.4%) had a tube obstruction. During all follow-up periods, there were no serious side effects such as death, major vascular injury, pneumothroax. No complications were observed throughout the entire period in 6 COVID-19 patients. Conclusion The number of complications of surgical tracheotomy in the ICU performed by a specialist was lower than in previous studies, and there were no complications that delayed treatment or endangered life. The ENT training hospitals should provide sufficient training opportunities for residents to perform surgical tracheostomy and strive to minimize complications associated with the procedure and pre- and post-operative management under the detailed guidance and supervision of specialists.

키워드

참고문헌

  1. Jin YJ, Kim SD. Tracheostomy in COVID-19 pandemic era. Korean J Otorhinolaryngol-Head Neck Surg 2021;64(9):613-8. https://doi.org/10.3342/kjorl-hns.2021.00591
  2. Jin YJ, Han SY, Park B, Park IS, Kim JH, Choi HG. Mortality and cause of death in patients with tracheostomy: Longitudinal follow-up study using a national sample cohort. Head Neck 2021;43(1):145-52. https://doi.org/10.1002/hed.26471
  3. Park MH, Suh GJ, Kwon WY, Seo JS. Effects and complications of tracheostomies done by emergency physicians. J Korean Soc Emerg Med 2010;21(2):234-40.
  4. Park SJ, Shin MJ, Kim J, Lee JC. A case of carotid artery rupture during tracheostomy. J Clin Otolaryngol Head Neck Surg 2020;31(1):107-10. https://doi.org/10.35420/jcohns.2020.31.1.107
  5. Cho KH, Lim DH, Lee KS, Paik SH, Yang HS, Kim CG. A tracheotomy in the intensive care unit. Korean J Head Neck Oncol 2002;18(1):71-5.
  6. Shin HI, Jang KI, Kim KM, Nam IC. Comparison of surgical tracheostomy and percutaneous dilatational tracheostomy in intensive care unit patients. Korean J Otorhinolaryngol-Head Neck Surg 2019;62(5):288-93. https://doi.org/10.3342/kjorl-hns.2018.00836
  7. Korean Bronchoesophagological Society Guideline Task Force; Nam IC, Shin YS, Jeong WJ, Park MW, Park SY, Song CM, et al. Guidelines for tracheostomy from the Korean Bronchoesophagological Society. Clin Exp Otorhinolaryngol 2020;13(4):361-75. https://doi.org/10.21053/ceo.2020.00353
  8. Wease GL, Frikker M, Villalba M, Glover J. Bedside tracheostomy in the intensive care unit. Arch Surg 1996;131(5):552-4; discussion 554-5.
  9. Perfeito JA, Mata CA, Forte V, Carnaghi M, Tamura N, Leao LE. Tracheostomy in the ICU: Is it worthwhile? J Bras Pneumol 2007;33(6):687-90. https://doi.org/10.1590/S1806-37132007000600012
  10. Epstein SK. Anatomy and physiology of tracheostomy. Respir Care 2005;50(4):476-82.
  11. Morris LL, Whitmer A, McIntosh E. Tracheostomy care and complications in the intensive care unit. Crit Care Nurse 2013;33(5):18-30. https://doi.org/10.4037/ccn2013518
  12. Han SH, Kim YS, Kwon SK. Respiratory tract bacterial colonization in long-term tracheostomized pediatric patients: Comparison between sites and two different timepoints. J Korean Soc Laryngol Phoniatr Logop 2021;32(1):29-34. https://doi.org/10.22469/jkslp.2021.32.1.29
  13. Epstein SK. Late complications of tracheostomy. Respir Care 2005;50(4):542-9.
  14. Upadhyay A, Maurer J, Turner J, Tiszenkel H, Rosengart T. Elective bedside tracheostomy in the intensive care unit. J Am Coll Surg 1996;183(1):51-5.
  15. Cohen O, Shnipper R, Yosef L, Stavi D, Shapira-Galitz Y, Hain M, et al. Bedside percutaneous dilatational tracheostomy in patients outside the ICU: A single-center experience. J Crit Care 2018;47:127-32. https://doi.org/10.1016/j.jcrc.2018.06.020
  16. Vargas M, Sutherasan Y, Antonelli M, Brunetti I, Corcione A, Laffey JG, et al. Tracheostomy procedures in the intensive care unit: an international survey. Crit Care 2015;19(1):291. https://doi.org/10.1186/s13054-015-1013-7
  17. Johnson-Obaseki S, Veljkovic A, Javidnia H. Complication rates of open surgical versus percutaneous tracheostomy in critically ill patients. Laryngoscope 2016;126(11):2459-67. https://doi.org/10.1002/lary.26019
  18. Massick DD, Yao S, Powell DM, Griesen D, Hobgood T, Allen JN, et al. Bedside tracheostomy in the intensive care unit: A prospective randomized trial comparing open surgical tracheostomy with endoscopically guided percutaneous dilational tracheotomy. Laryngoscope 2001;111(3):494-500. https://doi.org/10.1097/00005537-200103000-00021
  19. Cho YJ, Lim JH, Lee YJ, Nam IC. Severe complication of percutaneous dilatational tracheostomy. J Korean Soc Laryngol Phoniatr Logop 2016;27(1):54-7. https://doi.org/10.22469/jkslp.2016.27.1.54
  20. Al-Ansari MA, Hijazi MH. Clinical review: Percutaneous dilatational tracheostomy. Crit Care 2006;10(1):202. https://doi.org/10.1186/cc3900