Problemy s traheostomičeskimi kanûlâmi u pacientov s COVID-19 - pričiny i sposoby rešeniâ

Patients with severe lung injury due to COVID-19 are often in need of mechanical ventilation. Due the predicted length invasive respiratory support, tracheostomy is commonly indicated improve patient comfort, reduce for sedation and allow safer airway care [7] [8] [15]. In this article we report two clinical cases patients COVID-19, who suffered cardiac arrest problems canula placement. The first case regarding a 74-year-old patient, was transported CT from ICU. Problems occurred elevator, where specialist were forced switch bag ventilation, when oxygen supply ran out. As result, an episode desaturation 80% registered. Upon arriving ICU, connected ventilator, however ventilation ineffective: peak pressure more than 40 cmH2O tidal volume less 100 ml. Debridement trachea performed, position cannula secured no effect. While preparing oropharyngeal intubation, patient's saturation dropped 70%, haemodynamics unstable (BP 76/40), ECG showed bradycardia 30 bpm, which quickly turned asystole. Cardiopulmonary resuscitation performed intubated, effective. total time around 2 minutes, ROSC achieved sinus rhythm registered on ECG. 6 hours after signs acute coronary syndrome registered, received treatment accordingly. Despite complications, condition improved he transferred therapeutics ward later discharged home neurological impairment. second presents similar situation alternate outcome. A 32-year-old ICU distress. His worsened soon percutaneous dilatational performed. On day 9 75% not possible block cannula. rapid demise condition, removed intubated. After bronchoscopy, re-tracheostomy During procedure, it noted that standard displaced at angle posterior wall trachea. replaced by armored following hours, hypoxemia observed, as well subcutaneous emphysema face upper body. Applying thoracic X-ray, left-side pneumothorax diagnosed, urgently drained. days intensive gradually improved, effective distress fading. Neurologically responsive, able perform simple tasks. Unfortunately, 15th worsened: his fever spiked 39-40,2C, CRP 149, ARDS progression vasopressors administered hemodynamic instability. An 88% noted. It assumed had been displaced, proven bronchoscopy. Later day, while turning side, monitor 5 minutes until ROSC. then removed, inadequate intubated ventilated through IT tube. status closely monitored. Without unconscious (coma), non-responsive, hyporeflexive little response pain stimuli. weeks regarded vegetative state (GCS -6).