Creating Time for LGBT+ Disabled Youth: Co-production Outside Chrononormativity

This article explores how ‘chrononormative' constructions of time shape research and offers an approach to co-production and research involvement that draws on insights from trans, queer, and disability studies. The article presents early reflections on an NIHR School for Social Care–funded research study, approved prior to but developed under the context of the Covid-19 pandemic, investigating personal support, sexuality, and gender in young disabled adults' lives. This project has been supported by a Participatory Advisory Group (PAG) of LGBT+ young disabled adults and we reflect on how engagement with the PAG has shaped our understanding of debates around time and involvement in co-production discourse. Our engagement with trans, queer, and disability theory allows us to think about the constraints on time that such involvement has pushed against as we have sought to account for the diverse needs of the body-minds of the PAG in pandemic times. We suggest that this may speak to opening up the diversity and accessibility of co-production across other research contexts and intend this piece to encourage these conversations. The article thus offers a critical exploration of themes of time, embodiment, and identity in the way in which co-production is enacted in funded research. © The Author(s) 2023.

Safety and efficacy of a novel percutaneous tracheostomy protocol adapted to patients with COVID-19

Introduction and rationale: Many patients with COVID-19 admitted to the intensive care units require prolonged mechanical ventilation. Tracheostomy has been avoided due to increased risk of aerosolization especially during tracheal dilation resulting in increased risk for personnel infection. We describe our novel protocol to prevent exposure during percutaneous tracheostomy.Methods: Patients with COVID-19, on mechanical ventilation requiring prolonged mechanical ventilation were evaluated for bed-side percutaneous tracheostomy. The procedure was performed under bronchoscopic guidance and using a disposable bronchoscope. The scope was secured in position 1 cm from the end of the endotracheal tube with tape at the insertion site to allow the bronchoscopist to withdraw the ETT/bronchoscope en-bloc to the appropriate location in the trachea for adequate visualization during the procedure. Once the puncture point was identified, an expiratory pause was performed during which the trachea was punctured, a guide wire was placed, the anterior wall was dilated, and a tracheostomy was advanced and placed in the trachea. The time of the expiratory pause, any desaturation, complication and personnel conversion were measured.Results: A total of 18 percutaneous tracheostomies were performed. The total time of the expiratory pause, tracheal puncture to tracheostomy placement was thirty seconds to sixty seconds. There was no evidence of desaturation during the procedure, and there were no cases of staff conversion to positive COVID-19 status up to 14 days post procedure.Conclusions: we conclude that expiratory pause during percutaneous tracheostomy is safe, and importantly, may play significant role in decreasing aerosolization and staff exposure in patients with COVID-19 respiratory failure.

Respiratory disease, and treatment / thematic poster session one-person bronchoscopy in COVID-19 patients on mechanical ventilation is safe and decreases exposure rate to hospital personnel

Introduction and rationale:Many patients with COVID-19 are admitted to the intensive care units and require bronchoscopy for bilateral pulmonary infiltrates. Historically, the bronchoscopist is accompanied with a technician and a nurse for the procedure. Fear of increasing personnel exposure has been concerning. We present our protocol to prevent exposure during bronchoscopy.Methods:Patients with COVID-19, on mechanical ventilation requiring bronchoscopy were selected between March 2020 and October 2020. Instead of having the whole bronchoscopy team involved, and need for decontamination of equipment post procedure, a disposable bronchoscope was used, and the bronchoscopist was the only person to perform the procedure.Results:A total of 94 bronchoscopies were performed mostly for the evaluation of non-resolving or worsening infiltrates and respiratory failure. All procedures were completed with a single operator in the room, and the use of topical anesthesia through the ETT. The procedure time was less than five minutes, there was no desaturation, no immediate complications, and all procedures were performed with the recommended safety precautions including masks and contact protection garment. Importantly, there was no operator conversion to positive COVID-19 status.Conclusion:we conclude that in patients with Covid-19 receiving mechanical ventilation, oneperson bronchoscopy procedure is highly effective, safe and decreases staff exposure to COVID-19 .

Respiratory disease, and treatment / thematic poster session role of bronchoalveolar lavage in COVID-19 infection

Introduction: Mortality due to Coronavirus Disease 2019 (COVID-19) is nearly 50% in the intensive care unit (ICU).1,5 There is limited evidence on the role of bronchoalveolar lavage (BAL) to guide appropriate therapy in critically ill COVID-19 infection.2,3,4 We present our experience on the role of BAL identifying bacterial co-infection and to confirm diagnosis of COVID-19 in the ICU. Methods: This is an IRB approved, retrospective study of critically ill COVID-19 patients from March 2020 through July 2020. Critical illness was defined by: hypoxemia requiring >40% oxygen, septic shock or severe organ failure. COVID-19 was detected using reverse transcriptase polymerase chain reaction (rTPCR) performed on nasopharyngeal (NP) swab, BAL, or Mini-BAL. The Halyard Sampling Catheter was used at the time of intubation by respiratory therapists (RT) for mini-BAL. Bronchoscopic BAL was performed by physicians using a disposable bronchoscope. Results: 102 Patients were included. Mean age was 65±15 years with 56% males. 57% were African American, 33% Caucasian, and 9% Hispanic. Hypertension was present in 81% while 68% had BMI >30, and 48% had diabetes. 71% required mechanical ventilation for a median duration of 6 days. Median ICU length of stay was 10 days (range 1-51). Of 72 patients requiring intubation, mini-BAL was performed in 41 (57%) while bronchoscopic BAL was obtained in 8 (11%). 24 out of 49 (49%) had positive cultures. Staphylococcus aureus was identified in 15 of 24;53% of which were methicillin resistant. Other bacterial cultures are presented in Figure 1. Bacterial pneumonia was present <48hours post intubation in 6 of 24 patients. Mortality for those requiring intubation was 38% but increased to 46% with bacterial co-infection. Due to limited reagent availability, COVID-19 testing was not performed on all BAL specimens. Two patients in this cohort had imaging and clinical presentation consistent with COVID-19 but had negative NP swabs. BAL confirmed COVID-19 in both cases. Conclusion: The majority of critically ill COVID-19 patients were obese, African American males with hypertension. Most required mechanical ventilation and culture proven bacterial pneumonia was present in 8% within 48 hours of intubation. BAL provided critical information on bacterial coinfection which contributed to increased mortality in COVID-19. Furthermore, BAL may have a limited role in confirming COVID-19 when NP swab is negative. We recommend that all patients with critical COVID-19 undergo BAL at the time of intubation as identification and treatment of concomitant bacterial pneumonia may impact survival. .