Recommendations for performing interventions during the COVID-19 pandemic

Coronavirus infection (SARS-CoV-2), is a pandemic disease declared by the World Health Organization (WHO). This disease reports a high risk of contagion, especially by the transmission of aerosols in health care workers. In this scenario, aerosol exposure is increased in various procedures related to the airway, lungs, and pleural space. For this reason, it is important to have recommendations that reduce the risk of exposure and infection with COVID-19. In this document, a team of international specialists in interventional pulmonology elaborated a series of recommendations, based on the available evidence to define the risk stratification, diagnostic methods and technical considerations on procedures such as bronchoscopy, tracheostomy, and pleural procedures among others. As well as the precautions to reduce the risk of contagion when carrying out pulmonary interventions.

Tracheostomy for COVID-19 acute distress respiratory syndrome (ARDS): Are the outcomes different from non-COVID 19 ARDS?

Background: Acute Distress Respiratory Syndrome (ARDS) develops in 42% of patients presenting with COVID19 pneumonia, and 61-81% of those requiring intensive care. Tracheostomy placement is still a subject of controversy due to the poor prognosis of intubated patients and the risk of transmission to health care providers through this highly aerosolizing procedure. In this study we aim to determine the outcomes of tracheostomized patients with ARDS due to COVID-19 and ARDS to non-COVID-19. Methods: We performed a single center retrospective review of patients diagnosed with SARS-CoV-2 and who underwent tracheostomy due to ARDS between January 2020 and November 2020. Patients were identified from our institutional database. Demographics, baseline comorbidities, mortality, intensive care unit (ICU) stay, duration of ventilator requirement, tracheostomy procedure details, complications, and length of stay. Results: The average time from endotracheal intubation to tracheostomy was 25.56 ± 7.58 days and 25.56 ± 6.35 days for SARS-CoV-2 positive and SARS-CoV-2 negative, respectively. In the SARS-CoV-2 positive group, eleven patients (32.4%) were liberated from the ventilator, six (17.6%) were decannulated, and nine (26.5%) remained on MV. In contrast, in the SARS-CoV-2 negative group five patients (27.8%) were liberated from the ventilator, eight (44.4%) were decannulated, and three (16.7%) remained on MV. The median time from tracheostomy to ventilator liberation was 19 days (range 10-41 days) and 32 days (range 24-49 days) for SARS-CoV-2 positive and SARS-CoV-2 negative, respectively. Of patients who were successfully decannulated, the average time to decannulation was 34.17 ± 16.88 days and 42.00 ± 13.01 days for SARS-CoV-2 positive and SARS-CoV-2 negative, respectively. There was no significant difference in mortality between both groups. Conclusions: In patients with ARDS, there are no statistical differences between SARS-CoV-2 positive and SARS-CoV-2 negative patients in terms of mortality, ventilator liberation, and decannulation time.