Öz
Uyanık trakeal entübasyon (UTE), zor hava yolu öngörüldüğü durumların yönetiminde temel bir stratejidir. Özellikle spontan solunumun ve hava yolu reflekslerinin korunmasının kritik olduğu durumlarda kullanılmaktadır. Koronavirüs hastalığı-2019 (COVID-19) pandemisi sırasında aerosol oluşumu ile ilgili endişeler olması sebebiyle güvenliği ön planda tutan yöntemlerle entübasyon yaplmasına eğilim olmuştur. Bununla beraber, şüpheli veya doğrulanmış COVID-19 hastalarında UTE uygulamalarına ilişkin yayımlanmış veriler oldukça sınırlıdır. Bu sistematik derleme, PRISMA 2020 kılavuzu doğrultusunda yapılmıştır. PubMed (MEDLINE) ve Web of Science Core Collection veri tabanlarında, 30 Nisan 2025’e kadar yayımlanan çalışmalar kapsamlı bir şekilde taranmıştır. Doğrulanmış veya şüpheli COVID-19 enfeksiyonu olan ve UTE yapılan 18 yaş ve üzeri hastaları içeren çalışmalar dahil edilmiştir. Olgu sunumları, olgu serileri, gözlemsel çalışmalar ile randomize veya yarı randomize çalışmalar değerlendirmeye alınmıştır. Simülasyon çalışmaları, hayvan deneyleri, derlemeler ve klinik uygulama içermeyen yayınlar dışlanmıştır. Çalışmaların seçimi ve veri çıkarımı birden fazla araştırmacı tarafından bağımsız olarak yapılmış, görüş ayrılıkları uzlaşı yoluyla giderilmiştir. Metodolojik kalite değerlendirmesi, Joanna Briggs Institute Olgu Sunumları için Kritik Değerlendirme Kontrol Listesi kullanılarak yapılmıştır. Dahil edilme kriterlerini karşılayan toplam altı çalışma belirlenmiştir. Tüm UTE girişimleri fiberoptik bronkoskopi kullanılarak gerçekleştirilmiş olup, hiçbir olguda videolaringoskopi bildirilmemiştir. Çoğu olguda topikal lidokain ile lokal anestezi uygulanmış, ancak hiçbir hastada bölgesel sinir bloğu kullanılmamıştır. Hastaların büyük kısmına sedasyon uygulanmıştır. Hastaların çoğuna oksijen desteği sağlanmış ve en sık nazal kanül kullanılmıştır. İşlemlerin büyük bölümü ameliyathanede gerçekleştirilmiş olup, bir çalışmada uygulama ortamı belirtilmemiştir. Hiçbir olguda majör komplikasyon bildirilmemiştir. UTE, zor hava yolu yönetiminde önemli bir yere sahip olmasına rağmen COVID-19 pandemisi sırasında kullanımına ilişkin literatür verileri sınırlıdır. Literatürdeki olgu sayısının azlığı, zor entübasyonun nadirliğinden çok klinik çekinceler veya raporlama azlığına bağlı olabilir. Özellikle pandemi gibi yüksek riskli durumlarda, klinik deneyimlerin daha şeffaf şekilde paylaşılması, gelecekteki uygulamalara rehberlik edebilmek açısından büyük önem taşımaktadır.
Anahtar Kelimeler:
COVID-19, hava yolu yönetimi, trakeal entübasyon
Kaynaklar
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