Yoğun Bakımda COVID-19 ve Acil Cerrahi Girişimler
Özet
Yoğun bakımda takip edilen COVID-19 hastalarında gerçekleştirilen acil cerrahi girişimler, hem enfeksiyonun getirdiği sistemik etkiler hem de cerrahi travma nedeniyle yüksek morbidite ve mortalite riski taşımaktadır. COVID-19 hastalarında virüsün ACE-2 reseptörlerine bağlanmasıyla akciğer dışı organlarda da hasar oluşabilmekte; bu durum gastrointestinal kanama, akut kolesistit ve koagülopatiye bağlı intestinal iskemi gibi acil müdahale gerektiren tabloları tetikleyebilmektedir. Cerrahi süreçlerde hem hastanın fizyolojik durumunu optimize etmek hem de sağlık çalışanlarını aerosol ve vücut sıvıları yoluyla bulaşmadan korumak amacıyla kişisel koruyucu ekipman (KKE) kullanımı, negatif basınçlı ameliyathanelerin tercih edilmesi ve minimal personel ile çalışılması gibi katı önlemler alınmalıdır. Akut kolesistitte yüksek riskli hastalarda perkütan kolesistostomi gibi minimal invaziv ve başucunda uygulanabilecek yöntemler tercih edilirken, kritik solunum yetmezliğinde yatak başında uygulanan çift bölgeli ECMO hayat kurtarıcı bir destek sağlayabilmektedir. Genel cerrahi acillerinde konservatif yaklaşımlar öncelikli değerlendirilmekle birlikte, gecikmiş vakalarda cerrahi rezeksiyon kaçınılmaz olmaktadır. Sonuç olarak, bu kritik hastaların yönetimi, mortaliteyi düşürmek amacıyla güncel rehberler ve multidisipliner bir yaklaşım çerçevesinde titizlikle planlanmalıdır.
Emergency surgical interventions performed in COVID-19 patients monitored in the intensive care unit carry a high risk of morbidity and mortality due to both the systemic effects of the infection and surgical trauma. The binding of the COVID-19 virus to ACE-2 receptors can cause damage to extra-pulmonary organs, which may trigger conditions requiring emergency intervention such as gastrointestinal bleeding, acute cholecystitis, and intestinal ischemia secondary to coagulopathy. In surgical processes, strict precautions such as the use of personal protective equipment (PPE), preference for negative pressure operating rooms, and working with minimal staff must be taken to optimize the patient's physiological status and protect healthcare workers from transmission via aerosols and bodily fluids. While minimal invasive and bedside methods like percutaneous cholecystostomy are preferred for acute cholecystitis in high-risk patients, double-lumen ECMO applied at the bedside can provide life-saving respiratory support in severe respiratory failure. Although conservative approaches are prioritized in general surgical emergencies, surgical resection becomes inevitable in delayed cases. Consequently, the management of these critical patients must be meticulously planned within a multidisciplinary approach and current guidelines to minimize mortality.
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