David Smith1, Juan Montagne1, Micaela Raices2, Agustín Dietrich1, Indalecio Carboni Bisso3, Marcos Las Heras3, Juan E San Román3, Gustavo García Fornari4, Marcelo Figari5. 1. Department of Thoracic Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina. 2. Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina. Electronic address: micaela.raices@hospitalitaliano.org.ar. 3. Department of Intensive Care Medicine and Critical Pulmonology, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina. 4. Department of Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina. 5. Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina.
Abstract
PURPOSE: COVID-19 has become a pandemic with significant consequences worldwide. About 3.2% of patients with COVID-19 will require intubation and invasive ventilation. Moreover, there will be an increase in the number of critically ill patients, hospitalized and intubated due to unrelated acute pathology, who will present underlying asymptomatic or mild forms of COVID-19. Tracheostomy is one of the procedures associated with an increased production of aerosols and higher risk of transmission of the virus to the health personnel. The aim of this paper is to describe indications and recommended technique of tracheostomy in COVID-19 patients, emphasizing the safety of the patient but also the medical team involved. MATERIALS AND METHODS: A multidisciplinary group made up of surgeons with privileges to perform tracheostomies, intensive care physicians, infectious diseases specialists and intensive pulmonologists was created to update previous knowledge on performing a tracheostomy in critically ill adult patients (>18 years) amidst the SARS-CoV-2 pandemic in a high-volume referral center. Published evidence was collected using a systematic search and review of published studies. RESULTS: A guideline comprising indications, surgical technique, ventilator settings, personal protective equipment and timing of tracheostomy in COVID-19 patients was developed. CONCLUSIONS: A safe approach to performing percutaneous dilational bedside tracheostomy with bronchoscopic guidance is feasible in COVID-19 patients of appropriate security measures are taken and a strict protocol is followed. Instruction of all the health care personnel involves is key to ensure their safety and the patient's favorable recovery.
PURPOSE:COVID-19 has become a pandemic with significant consequences worldwide. About 3.2% of patients with COVID-19 will require intubation and invasive ventilation. Moreover, there will be an increase in the number of critically illpatients, hospitalized and intubated due to unrelated acute pathology, who will present underlying asymptomatic or mild forms of COVID-19. Tracheostomy is one of the procedures associated with an increased production of aerosols and higher risk of transmission of the virus to the health personnel. The aim of this paper is to describe indications and recommended technique of tracheostomy in COVID-19patients, emphasizing the safety of the patient but also the medical team involved. MATERIALS AND METHODS: A multidisciplinary group made up of surgeons with privileges to perform tracheostomies, intensive care physicians, infectious diseases specialists and intensive pulmonologists was created to update previous knowledge on performing a tracheostomy in critically ill adult patients (>18 years) amidst the SARS-CoV-2 pandemic in a high-volume referral center. Published evidence was collected using a systematic search and review of published studies. RESULTS: A guideline comprising indications, surgical technique, ventilator settings, personal protective equipment and timing of tracheostomy in COVID-19patients was developed. CONCLUSIONS: A safe approach to performing percutaneous dilational bedside tracheostomy with bronchoscopic guidance is feasible in COVID-19patients of appropriate security measures are taken and a strict protocol is followed. Instruction of all the health care personnel involves is key to ensure their safety and the patient's favorable recovery.
Authors: Kamran Mahmood; George Z Cheng; Keriann Van Nostrand; Samira Shojaee; Max T Wayne; Matthew Abbott; Darrell Nettlow; Alice Parish; Cynthia L Green; Javeryah Safi; Michael J Brenner; Jose De Cardenas Journal: Ann Surg Date: 2021-08-01 Impact factor: 13.787
Authors: Kathleen D Weiss; Antonio Coppolino; Daniel C Wiener; Ciaran McNamee; Robert Riviello; Ju-Mei Ng; Michael T Jaklitsch; Margaret B Marshall; Matthew M Rochefort Journal: JTCVS Tech Date: 2020-12-07
Authors: Beatrice J Sun; Christopher J Wolff; Hannah M Bechtold; Dwayne Free; Javier Lorenzo; Patrick R Minot; Paul G Maggio; David A Spain; Thomas G Weiser; Joseph D Forrester Journal: Trauma Surg Acute Care Open Date: 2020-12-14