新型コロナウイルス（SARS–CoV–2）陽性患者に対し外科的気管切開術を施行した経験(Surgical tracheostomy for a patient positive for the novel coronavirus (SARS–CoV–2): a case report)

(Hiroshi Fukuma), 福間 博; (Shintaro Yanagi), 柳 新太郎; (Yuki Narumi), é³´æµ· 雄気; (Daisuke Nemoto), æ ¹æœ¬ 大資; (Shingo Adachi), 安達 晋吾; (Shota Nakao), 中尾 彰太; (Tetsuya Matsuoka), 松岡 哲也

We performed tracheostomy in a 69–year–old male patient with severe acute respiratory syndrome coronavirus–2 (SARS–CoV–2) infection. He presented with complaints of fever and malaise for the past 10 days. Chest radiographs taken at a local hospital on the previous day revealed pneumonia, and the RT–PCR test for SARS–CoV–2 was positive; therefore, the patient was admitted to our hospital. On the 5th day of hospitalization maintenance of oxygenation was found difficult; therefore, oral endotracheal intubation was performed. However, his respiratory conditions deteriorated rapidly; hence, veno–venous extracorporeal membrane oxygenation was initiated 12 hours after endotracheal intubation. The sputum had caused a narrowing of the endotracheal tube, and so tracheostomy was performed on the 15th day. Bedside surgery was performed in a physically isolated intensive care unit but considering the high–risks associated with aerosol exposure, appropriate personal protective equipment was used. The patient was managed under general anesthesia using muscle relaxants, but the use of ventilator was discontinued from the beginning of the surgery over concerns of aerosol generation. This report focuses on infection control, the timing of surgery, and intraoperative management followed by a discussion based on the review of available literature.