The Koronavirusny infection of 2019 (COVID-19) is a global pandemic. Now more than 200 million cases are diagnosed. Though most of patients with COVID-19 does not need a maintenance therapy, the acute respiratory distress syndrome at which patients need carrying out invasive IVL develops in 10–15% of cases. Artificial ventilation at patients with the coronavirus causing an acute respiratory syndrome (SARS-CoV-2) of heavy degree is characterized by the prolonged intubation and is connected with mortality worldwide at least at the level of 50–67%.
Based on past experience of maintaining patients with an acute respiratory syndrome (SARS) in 2003, the procedures which are followed by formation of aerosol such as intubation of a trachea and tracheostomy, are connected with high risk of transfer of the SARS-CoV-2 virus to health workers. The American academy of otolaryngology and LOR-surgery order to anesthesiologists "to avoid holding procedures of a tracheostomy to patients with positive test for COVID-19 or to patients with suspicion on COVID-19" in view of high risk of infection. In these methodical manuals based on limited clinical data carrying out a tracheostomy within 2–3 weeks after an intubation is not recommended; it is offered to carry out this procedure preferably to patients with negative takes of testing for COVID-19 and also to refuse the transdermal dilyatatsionny tracheostomy (TDT) in favor of an open tracheostomy.
Early carrying out a tracheostomy to patients with COVID-19 can be useful therefore specialists from the USA developed the new equipment which is modification of the ChDT standard procedure which is characterized by the improved visualization and ventilation at minimal risks of an aerolization and SARS-CoV-2 broadcast to health workers. The description of technical aspects of the procedure, early outcomes of the disease of patients is provided in this article and preliminary estimate of safety of use of the developed new equipment is given.
The system analysis of all patients who are on hospitalization in intensive care unit and an intensive care (ORIT) at the Lengonsky New York university during the period from March 10 to April 15, 2020 at which was was carried out COVID-19 with capture of a smear from a pharynx and the subsequent its check by method polymerase chain reaction with the return transcriptase (PTsR) is confirmed. Besides, at these patients heavy respiratory insufficiency developed owing to what there was a need for artificial ventilation of the lungs.
ChDT was carried out at the patient's bed conditions of chamber of an intensive care. Before an entrance to chamber each health worker, according to the package of measures accepted officially, put on individual means of protection (SIZ): a medical hat, N95 mask, a surgical mask, the protective screen for the person, a dressing gown and two pairs of gloves. Between members of the team of doctors the following roles were distributed: 1 — carrying out a bronkhoskopiya; 2 — imposing of a tracheostoma; 3 — manipulations with the fan, administration of drugs for sedation and management of an endotracheal tube. The patient was placed lying on spin, in standard situation for carrying out a transdermal tracheostomy. Before the procedure to the patient the sedative drugs and muscle relaxants were administered.
For definition of anatomic reference points, vascular structures and an injection site of a tube (between the first and second tracheal ring) a front part of a neck was investigated ultrasonic / doplerovskim by the device with the linear sensor. Before the procedure the maximum preoksigenation was executed. The endotracheal phone (ETT) was picked up from the holder, the bronchoscope was entered near ETT and advanced to the level of phonatory bands. Then the bronchoscope was advanced further phonatory bands and set to position before ETT. Having installed the fan in a waiting mode, authors emptied a cuff of ETT and advanced ETT further in a distal part of a trachea. Then the cuff of ETT was again the fan was inflated and started. After that the ChDT procedure began. The needle and a catheter were entered into respiratory tracts under direct direct vision. Then the napravitel was entered into respiratory tracts and moved ahead kaudalny ETT. After the napravitel reached the necessary site, the small superficial skin section 0.5 cm long then expansion of fabrics was carried out was made. Before introduction of a tracheostomy tube the fan was installed in a waiting mode again, and the cuff of ETT was emptied.
Straight vision at extraction of ETT was made until ETT was in close proximity to the site of a tracheostomy. The transdermal tracheostomy tube was entered into a trachea, the cuff was inflated, bronchoscopic control and sanitation was carried out.
Authors consider that the equipment of a transdermal tracheostomy developed by them, most likely, is safe and effective for patients with the diagnosis of COVID-19 and also safe for health workers.