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Introduction: The COVID-19 pandemic necessitated proliferation of telesimulation. This pedagogy may be useful in rural areas to increase procedural adoption and reduce healthcare disparities. Our aim was to determine the current status of surgical simulation education to retool rural practicing Urologists. Method(s): Literature search was performed with a trained librarian for PubMed, EMBASE and Web of Science. Title/ screening were performed to include all studies of surgical simulation involving rural surgical learners to identify simulation education opportunities for practicing rural Urologists. Data was then extracted: simulation event, skills focus, MERSQI score, type/number of learners, learner assessment and event evaluation. Result(s): Seven manuscripts met inclusion criteria. Most were published 2019-2020 and were cross sectional (5/7, 71%). Mean adjusted MERSQI score was 13 (range 6-15.5). A wide range of surgical skills were taught (incl. laparoscopy, cricothyroidotomy, chest tube insertion, damage control laparotomy), but no Urological surgical skills. Two articles described mobile simulation units for rural areas. A total of 232 learners were identified including 69 medical students. One fifth of rural learners were non-medical or non-physicians. Only one study involved faculty, who were general surgeons. Conclusion(s): Telesimulation education for practicing Urologists in rural areas is lacking. Current in-operating room telementoring for rural Urologists requires surgeons to travel and perform their first cases utilizing this new technique on patients. Telesimulation to teach Urological skills in rural areas of the US may increase dissemination of techniques with no patient risk and has significant potential to redress current healthcare disparities.
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BackgroundPenetrating injury of the oropharynx occurs frequently in children, however, anesthetic management is seldom described in such cases.Case presentationA 2-year old child came to the emergency room with a toothbrush impacted in the gingivobuccal sulcus making airway management difficult. We used a simple yet unique approach to secure the airway safely given the lack of pediatric size fibreoptic and videolaryngoscopes in our emergency operation theatre. The patient was kept in Pediatric ICU and watched for any complications and discharged on the 4th postoperative day.ConclusionsThus, ingenious non-invasive techniques to secure the airway can prevent the patient from undergoing surgical tracheostomy.
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OBJECTIVE: To identify factors predictive of 30-day mortality following tracheotomy in patients with COVID-19. METHODS: A retrospective chart review of patients with COVID-19 who underwent tracheotomy at a tertiary medical center between March 2020 and October 2021 was conducted. Univariate and multivariable analyses of factors correlated with 30-day post-tracheotomy mortality were performed. The outcomes of tracheotomies performed in the operating room and at bedside were compared with t-tests and multivariable analysis. RESULTS: One hundred-twenty patients met inclusion criteria, with 48 female patients (40%). Mean age was 59.8 [12.6] years, and the 30-day mortality rate was 18.3%. On univariate analysis, age (odds ratio (OR) = 1.06; P = .015), FiO2 at the time of tracheotomy (OR = 1.06; P < .001), and bedside tracheotomy (OR = 3.21; P = .019) were associated with increased risk of 30-day mortality. After including control variables, increased FiO2 continued to predict increased odds of 30-day mortality (OR = 1.08; P = .02); specifically, patients with FiO2 > 65% were significantly more likely to pass within 30 days than those with FiO2 ≤ 40% (OR = 28.24; P < .001). There was a significant difference in the 30-day mortality rate of bedside tracheotomies (31%) and OR tracheotomies (12%; P = .02), but this association was eliminated on multivariable analysis (OR = 0.95; P = .96). CONCLUSION: Intubated patients with COVID-19 undergoing tracheotomy with FiO2 > 65% have 25 times greater odds of 30-day mortality than those with FiO2 ≤ 40%. There were no differences in outcomes between bedside and OR tracheotomies.
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Objective: The aim of this study was to investigate the effect of percutaneous tracheotomy on mortality and length of stay in the intensive care unit (ICU) for patients with COVID-19-associated acute respiratory distress syndrome (ARDS). Materials and Methods: This study included patients with coronavirus disease-19 (COVID-19-associated) acute respiratory distress syndrome who were treated with invasive mechanical ventilation in a pandemic intensive care unit. Patients admitted to the pandemic intensive care unit between March and July 2021 were retrospectively reviewed. Patients who underwent percutaneous tracheotomy and did not have a tracheotomy during the follow-up were statistically compared in terms of laboratory and clinical characteristics such as mortality and length of stay in the intensive care unit. Results: The study included 102 orotracheally intubated patients diagnosed with COVID-19 acute respiratory distress syndrome. The number of tracheotomized and not-tracheotomized patients was 34 and 68, respectively. The mean age of the patients was 60.39 +/- 14.10 years. The mean time to perform percutaneous tracheotomy was 7.94 +/- 6.11 days. There was no significant difference in mortality rate between the two groups (p=0.298). However, patients who underwent tracheotomy had a longer length of stay in the intensive care unit compared to those who did not (35.00 +/- 24.60 days vs 13.20 +/- 11.69 days, p<0.001). Conclusion: Our study found no statistically significant difference in mortality rate between the two groups in our study. Additionally, the length of stay in the intensive care unit was not better in tracheotomized patients. While tracheotomy has some advantages in other severe lung diseases, its effect on mortality in patients with severe lung disease associated with COVID-19 should be evaluated further in randomized controlled trials.
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Objectives: to understand tracheostomy-related complications in post-COVID-19 patients treated with different oxygen therapy devices and their associated factors. Methods: an observational retrospective study was conducted in adult patients with post-COVID-19 tracheostomy, who were hospitalized at the Respiratory Semi-critical Care Unit of the Bellvitge University Hospital (Barcelona, Spain), from August 2021 to May 2022. The variables were: sociodemographic, clinical, comorbidities, associated with tracheostomy and oxygenation systems, complications. Descriptive analysis was conducted, as well as comparison of variables in order to identify the risk factors associated with said complications. Results: the study included 28 patients;85.7% were male. Their median age was 65.50. The median number of hospitalization days at ICU was 61.5 days. Their main comorbidities: hypertension (42.9%) and diabetes (35.7%). High-flow devices were used by 78.6% of patients;32.1% of them presented complications associated with tracheostomy management. The most frequent complications were the presence of mucous plug (33.3%) and an alteration in consistency of secretions (33.3%). Male patients presented more complications than female patients (88.9% vs.11.1%), as well as patients with a smoking history (66.7% vs. 33.3%, p= 0.028). Patients who were carriers of high-flow devices presented almost no complications (94.7% vs. 5.3%, p= 0.007). Conclusions: the use of oxygen therapy devices incorporating active humidification and temperature control is a useful option in order to reduce those complications associated with the loss of this physiological function of the nasopharyngeal anatomy in patients with tracheostomy. © 2023 DAE Editorial, Grupo Paradigma. All rights reserved.
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Background: Complex mycotic aortic aneurysm (MAA) is a rare and life-threatening disease with a high mortality rate. Open surgical treatment has always been considered as gold standard. However, it carries a high mortality and morbidity rate. Endovascular repair is a feasible option with encouraging results, especially in frail patients. Due to the production lead time, Fenestrated/Branched Endovascular Aortic Repair cannot be proposed in urgent cases. In those cases, an alternate solution could be the use of "Off the shelf" (OTS) fenestrated stent grafts. Objective(s): We aimed to assess the feasibility of OTS fenestrated stent grafts in the acute treatment of a MAA. Method(s): We present the case of a frail 74-year-old woman with an acute MAA undergoing a successful treatment by Zenith t-Branch Thoracoabdominal Endovascular Graft associated with antibiotic therapy. Result(s): Thoraco-abdominal computed tomography (CT) at 1-year follow up showed good result with total exclusion of the thoracic aneurysm and size reduction. No migration of the stent was found, and all branch vessels remained patent. Conclusion(s): OTS endovascular T-branch is a feasible option to treat acute MAA and could be considered in frail patient. Further studies are required to define the place of this strategy in the management of acute MAA.Copyright © 2022
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Relevance. The coronavirus rush, which has appeared since December 2019, has an impact on economic, medical, and social development in all countries of the world. There are still no standard diagnostic and therapeutic plans aimed at limiting this infection. Purpose. To determine the therapeutic role of tracheostomy with patients with coronavirus infection. Material. The prospective study of 100 patients with coronavirus infection was carried out on the basis of State Budgetary Healthcare Institution "Interdistrict Multidisciplinary Hospital" in Nartkala city. When patients were admitted to the clinic, they were randomized into 2 groups depending on the therapy: the first group (comparison, n=50) - patients received traditional therapy in intensive care;the second (main, n=50) group - patients underwent tracheostomy in addition to standard therapy. The average age was 56.2+/-4.8 years. The women's average age was 55 years (55.0%), and the men's - 45 years (45.0%). Methods. Determination of the syndrome of endogenous intoxication, taxation of lipid peroxidation intensification. The local microcirculation was investigated by the apparatus LAKK-02. The activity of the coagulation-lytic blood system was found by thrombelastograph TEG 5000. Results. Early COVID-19 infection demonstrates signs of intoxication, oxidative depression, phospholipase activity, microcirculatory and hemostatic disorders. These changes were the cause of the development of life-threatening complications (neurological, pulmonary, cardiac, etc.). They were associated with the type of treatment. Traditional treatment and the use of mask oxygen turned out to be ineffective, since the homeostasis system disorders remained throughout the investigation period. The inclusion of tracheostomy in traditional therapy makes it possible to quickly improve the course of pathology as it purposefully affects the pathogenetic links of the homeostasis system. Conclusion. The use of tracheostomy in the scheme of standard treatment of coronavirus infection allows improving the effectiveness of general therapy of COVID-19 patients, especially with severe forms.Copyright © 2023, Codon Publications. All rights reserved.
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The outbreak of coronavirus disease 2019 (COVID-19) affects the world. It is highly contagious and spreads quickly. COVID-19 severely increases the medical burden and interferes with our normal work. This article introduces our experience on treat oral cancer patients during the epidemic. The negative impact can be minimized through reasonable and orderly arrangement.Copyright © 2021 The Authors
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Hemodialyzed patients with COVID-19 are at risk for severe complications from acute respiratory distress syndrome, requiring admission to the intensive-care unit for invasive mechanical ventilation. Post tracheotomy stenosis can be a life-threatening condition that commonly occurs after iatrogenic injury secondary to tracheotomy or tracheal intubation. We report a case of a 44-year-old female patient on maintenance haemodialysis who presented a COVID-19-related ARDS that required mechanical ventilation for 4 weeks, followed by a persistent stridor and finally succumbed, 1 month after being discharged from intensive care unit, from a severe respiratory distress due to a tracheal stenosis. Our aim is to highlight the importance of the early recognition and management of post tracheotomy stenosis in patients with persistent respiratory difficulty as stridor after prolonged intubation requiring tracheotomy, in order to improve the prognosis of these patients.
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AIMS: To identify risk factors present in patients with dysphagia in a population of critically ill patients. METHODS: Case series of a cohort of patients recruited in the intensive care unit (ICU) until hospital discharge. Patients who gave consent and met the inclusion criteria were recruited. The Volume-Viscosity clinical examination method was used for the screening of dysphagia. An uni- and bivariate statistical analysis was performed using odds ratio (OR) to detect risk factors for dysphagia. OUTCOMES: 103 patients were recruited from 401 possible. The mean age was 59,33 ± 13,23, men represented 76,7%. The severity of the sample was: APACHE II (12,74 ± 6,17) and Charlson (2,98 ± 3,31). 45,6% of patients showed dysphagia, obtaining significant OR values (p < 0,050) for the development of dysphagia: older age, neurological antecedents, COVID19, long stay in ICU and hospitalization, and the presence of tracheotomy. COVID19 patients represented 46,6% of the sample, so an analysis of this subgroup was performed, showing similar results, with a Charlson risk (OR:4,65; 95% CI:1,31-16,47; p = 0,014) and a hospital stay (OR: 8,50; 95%CI: 2,20-32,83; p < 0,001) On discharge from the ICU, 37,9% of the population still had dysphagia; 12,6% maintained this problem at hospital discharge. CONCLUSIONS: Almost half of our patients developed dysphagia. Clinical severity and the presence of tracheotomy were risk factors. We observed in patients with dysphagia a longer stay in both ICU and hospitalization.
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Background: Guidelines for long-term ventilation agree that tracheotomy has several benefits for patien t treatment . During the coronavirus disease-19 (COVID-19) pandemic it is widely seen as an unsafe procedure with a high risk of infection. To assess the risk, we used a mathematical model and assessed our tracheotomies in COVID-19 patients. Material(s) and Method(s): First, theoretical risk of infectio n durin g tracheotomy was assessed using a Monte-Carlo (MC) simulation of airborne transmission based on the Wells-Riley equation. Second, we evaluated early tracheotomies performed in 16 COVID-19 patients. Tracheotomies were performed by experienced ICU physicians and trainees under supervision. Personal protective equipment (PPE) was used in all procedures. Patients or legal representatives gave informed consent to the procedure. Result(s): Our theoretical model revealed a risk of infection between 0.08 +/- 0.03% and 2.5 +/- 0.8%, depending on the assumptions made. MC simulations showed that the stochastic risk of infection is low to very low, if PPE is correctly used. Patients were a mean of 61 years old (median age 60 +/- 7 years;15/16 male), mean BMI was 31.3 kg/m2 (median 29.6 +/- 6.9 kg/m2). All procedures were percutaneous dilatation tracheotomies (PDT). There was no procedure-related complication or death due to tracheotomy. Overall mortality in COVID-19 patients undergoing tracheotomy was 6 out of 16 (37.5%). No SARS-CoV-2 infections were recorded in 59 tracheotomy-performing healthcare workers (HCW) or other team members. Conclusion(s): The theoretical risk of infections during tracheotomy is low. Technically, tracheotomy in COVID-19 patients is almost identical to patients without COVID-19, the only difference being PPE during the intervention Copyright ©.
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Aims: To identify risk factors present in patients with dysphagia in a population of critically ill patients. Methods: Case series of a cohort of patients recruited in the intensive care unit (ICU) until hospital discharge. Patients who gave consent and met the inclusion criteria were recruited. The Volume-Viscosity clinical examination method was used for the screening of dysphagia. An uni- and bivariate statistical analysis was performed using odds ratio (OR) to detect risk factors for dysphagia. Outcomes: 103 patients were recruited from 401 possible. The mean age was 59,33±13,23, men represented 76,7%. The severity of the sample was: APACHE II (12,74±6,17) and Charlson (2,98±3,31). 45,6% of patients showed dysphagia, obtaining significant OR values (p<0,050) for the development of dysphagia: older age, neurological antecedents, COVID19, long stay in ICU and hospitalization, and the presence of tracheotomy. COVID19 patients represented 46,6% of the sample, so an analysis of this subgroup was performed, showing similar results, with a Charlson risk (OR:4,65;95% CI:1,31-16,47;p=0,014) and a hospital stay (OR: 8,50;95%CI: 2,20-32,83;p<0,001). On discharge from the ICU, 37,9% of the population still had dysphagia;12,6% maintained this problem at hospital discharge. Conclusions: Almost half of our patients developed dysphagia. Clinical severity and the presence of tracheotomy were risk factors. We observed in patients with dysphagia a longer stay in both ICU and hospitalization. © 2022 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC)
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Resumen Objetivos Determinar los factores de riesgo presentes en los pacientes con disfagia en relación con una población de pacientes críticos. Método Serie de casos de una cohorte de pacientes reclutados en la unidad de cuidados intensivos (UCI) hasta el alta hospitalaria. Se reclutaron a aquellos pacientes que dieron su consentimiento y cumplían los criterios de inclusión. El método de exploración clínica Volumen-Viscosidad fue utilizado para la detección de la disfagia. Se realizó un análisis estadístico uni- y bivariante, a través del odds ratio (OR) para detectar los factores de riesgo en la disfagia. Resultados 103 pacientes fueron reclutados de 401 posibles. La media de edad fue de 59,33±13,23;los hombres representaban el 76,7%. La gravedad media fue: APACHE II (12,74±6,17) y Charlson (2,98±3,31). Un 45,6% de los pacientes desarrollaron disfagia, obteniendo valores significativos de OR (p<0,050) para el desarrollo de disfagia: la mayor edad, los antecedentes neurológicos, COVID19, la alta estancia en UCI y hospitalización y la presencia de traqueotomía. Los pacientes COVID19 representaban el 46,6%, por lo que se realizó un análisis de este subgrupo observando resultados similares, con un riesgo de Charlson (OR:4,65;IC95%: 1,31-16,47;p=0,014) y una estancia hospitalaria (OR: 8,50;IC95%: 2,20-32,83;p<0,001). Al alta de UCI, el 37,9% de la población presentaba todavía disfagia, y mantenía este problema al alta hospitalaria el 12,6%. Conclusiones Casi la mitad de nuestros pacientes presentaron disfagia. Fueron factores de riesgo la gravedad clínica y la presencia de traqueotomía. Se observó en estos pacientes una mayor estancia tanto en UCI como en hospitalización. Aims To identify risk factors present in patients with dysphagia in a population of critically ill patients. Methods Case series of a cohort of patients recruited in the intensive care unit (ICU) until hospital discharge. Patients who gave consent and met the inclusion criteria were recruited. The Volume-Viscosity clinical examination method was used for the screening of dysphagia. An uni- and bivariate statistical analysis was performed using odds ratio (OR) to detect risk factors for dysphagia. Outcomes 103 patients were recruited from 401 possible. The mean age was 59,33±13,23, men represented 76,7%. The severity of the sample was: APACHE II (12,74±6,17) and Charlson (2,98±3,31). 45,6% of patients showed dysphagia, obtaining significant OR values (p<0,050) for the development of dysphagia: older age, neurological antecedents, COVID19, long stay in ICU and hospitalization, and the presence of tracheotomy. COVID19 patients represented 46,6% of the sample, so an analysis of this subgroup was performed, showing similar results, with a Charlson risk (OR:4,65;95% CI:1,31-16,47;p=0,014) and a hospital stay (OR: 8,50;95%CI: 2,20-32,83;p<0,001). On discharge from the ICU, 37,9% of the population still had dysphagia;12,6% maintained this problem at hospital discharge. Conclusions Almost half of our patients developed dysphagia. Clinical severity and the presence of tracheotomy were risk factors. We observed in patients with dysphagia a longer stay in both ICU and hospitalization.
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Importance: The number of infections and deaths caused by the global epidemic of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) invasion is steadily increasing daily. In the early stages of outbreak, approximately 15%-20% of patients with coronavirus disease 2019 (COVID-19) inevitably developed severe and critically ill forms of the disease, especially elderly patients and those with several or serious comorbidities. These more severe forms of disease mainly manifest as dyspnea, reduced blood oxygen saturation, severe pneumonia, acute respiratory distress syndrome (ARDS), thus requiring prolonged advanced respiratory support, including high-flow nasal cannula (HFNC), non-invasive mechanical ventilation (NIMV), and invasive mechanical ventilation (IMV). Objective: This study aimed to propose a safer and more practical tracheotomy in invasive mechanical ventilated patients with COVID-19. Design: This is a single center quality improvement study. Participants: Tracheotomy is a necessary and important step in airway management for COVID-19 patients with prolonged endotracheal intubation, IMV, failed extubation, and ventilator dependence. Standardized third-level protection measures and bulky personal protective equipment (PPE) may hugely impede the implementation of tracheotomy, especially when determining the optimal pre-surgical positioning for COVID-19 patients with ambiguous surface position, obesity, short neck or limited neck extension, due to vision impairment, reduced tactile sensation and motility associated with PPE. Consequently, the aim of this study was to propose a safer and more practical tracheotomy, namely percutaneous dilated tracheotomy (PDT) with delayed endotracheal intubation withdrawal under the guidance of bedside ultrasonography without the conventional use of flexible fiberoptic bronchoscopy (FFB), which can accurately determine the optimal pre-surgical positioning, as well as avoid intraoperative damage of the posterior tracheal wall and prevent the occurrence of tracheoesophageal fistula (TEF).
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The COVID-19 pandemic has altered all aspects of the healthcare system's organization and impacted patients with head and neck cancer (HNC) who have experienced delayed diagnosis and treatment. The pandemic resulted in the admission of patients with severe dyspnea and a need for tracheotomy due to extremely advanced HNC. This study's objective was to evaluate the clinical characteristics of two multi-center cohorts, "pre-COVID-19" and "COVID-19", of HNC patients admitted as emergencies for dyspnea. The therapeutic activity of HNC patients in four University Departments of Otolaryngology was studied over two time periods: September-February 2019/2020 and 2020/2021. A group of 136 HNC patients who underwent a tracheotomy in two-time cohorts, pre-COVID-19 (N = 59) and COVID-19 (N = 77), was analyzed. The mean tracheotomies incidence proportion was 1.82 (SD: 1.12) for the pre-COVID-19 and 3.79 (SD: 2.76) for COVID-19 period. A rise in the occurrence of emergency dyspnea was observed in the COVID-19 cohort, and the greatest increase was seen in the centers with the highest limitations on planned surgeries. In the pre-COVID-19 period, 66% of patients presented with symptoms for more than a month in comparison to 78% of patients in the COVID-19 period (p = 0.04). There was a higher incidence of laryngeal and laryngopharyngeal cancer in the COVID-19 period (63% vs. 75%, respectively). The number of tracheotomies performed under general anesthesia dropped in favor of local anesthesia during COVID-19 (64% vs. 56%, respectively) due to extremely advanced HNC. In the COVID-19 cohort, most patients received a telemedicine consultation (N = 55, 71%) in comparison to the pre-COVID-19 period (N = 14, 24%). Reorganization of the referral system, adjustment of treatment capacity for an increased number of HNC, and a reserve for more extensive resection and reconstruction surgeries should be made in the profile of otorhinolaryngological departments, ensuring future HNC treatment is not hampered in case of a new pandemic wave.
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OBJECTIVE: To investigate the characteristics and influencing factors for Stenotrophomonas maltophilia (SMA) infection in Sanya and analyze the drug resistance so as to provide guidance for prevention and control of infection in medical institutions. METHODS: The hospitalization data were collected from the patients with SMA infection who were hospitalized in three tertiary general hospitals of Sanya from 2016 to 2020. The characteristics of SMA infection and influencing factors for respiratory tract and non-respiratory tract SMA infection were retrospectively analyzed, and the result of drug susceptibility testing was observed. RESULTS: A total of 753 case times of patients had SMA infection, including 606 (80.48%) case times of respiratory tract infection and 147 (19.52%) case times of non-respiratory tract infection. The isolation rate was the highest in respiratory medicine department (16.73%), followed by critical care medicine department (15.67%) and neurosurgery department (12.35%). The percentages of the patients with advanced age, complications with hypertension and pulmonary diseases, tracheotomy were the higher in the respiratory tract infection group than in the non-respiratory tract infection group (P < 0.05);while the percentages of the patients with malignant tumors, bacteremia, surgery, urinary tract intubation, low immunity and use of antibiotics and immunosuppressants were the higher in the non-respiratory tract infection group than in the respiratory tract infection group (P < 0.05). The result of drug susceptibility testing showed that the drug resistance rate of the SMA strains to sulfamethoxazole-trimethoprim was only 2.39%, while the drug resistance rate to ceftazidime was as high as 74.50%. CONCLUSION: The major influencing factors for the respiratory tract SMA infection include pulmonary diseases, hypertension, advanced age and tracheotomy;the influencing factors for the non-respiratory tract SMA infection include malignant tumors, low immunity, long-term excessive use of immunosuppressants and broad-spectrum antibiotics, bacteremia, surgery and urinary tract intubation. The SMA strains isolated from the city are highly sensitive to sulfamethoxazole-trimethoprim but are highly resistant to ceftazidime and chloramphenicol. It is necessary for the hospital to reasonably use antibiotics based on the result of drug susceptibility testing.
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Objectives: To analyze changes in tracheotomy practices at the onset of the COVID-19 pandemic, and determine if quality patient care was maintained. Methods: This was a single institution retrospective study that included patients undergoing tracheotomy from May 2019 to January 2021. Patients were divided into two groups, pre-COVID and post-COVID. Only three patients tested positive for COVID-19, and they were excluded from the study. Data were collected from the electronic medical record. Statistical analyses were performed using 2-tailed independent t tests, Wilcoxon Rank Sum tests, Chi-Square tests, and Kaplan-Meier curves. Results: There were 118 patients in the pre-COVID group and 91 patients in the post-COVID group. The main indication for tracheotomy in both groups was prolonged intubation. There were no significant differences in overall length of stay, time to tracheotomy, duration of tracheotomy procedure, or time to initial tracheotomy change between the two groups. Due to protocols implemented at our institution to limit viral transmission, there were significant increases in the percent of tracheotomies performed in the OR (p = .02), and those performed via open technique (p = .04). Additionally, the median time to decannulation significantly decreased in the post-COVID group (p = .02). Conclusion: Several variables regarding the timing of patient care showed no significant differences between groups which demonstrates that quality patient care was maintained. It is important to note that this data was collected early in the Pandemic, and additional trends may become apparent over time. Level of evidence: 4.
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OBJECTIVE. To estimate the effect of tracheostomy on ventilation in patients with COVID-19. MATERIAL AND METHODS. An observational, retrospective, analytical, longitudinal study of a consecutive series of cases was carried out between April 2020 and March 2021. The study included data about different variables, such as age, sex, comorbidities, time of orotracheal intubation, place of surgery, complications and death, ventilatory parameters, blood gas and time of the weaning after tracheostomy. Descriptive statistics were used with measures of central tendency, measures of dispersion and the Wilcoxon test to see differences in the ventilatory parameters. RESULTS. The study was performed on 130 patients admitted to the ICU with intubation to manage their critical condition. From these patients, the study group included 31 who underwent tracheostomy, 25 males (80.64%) with a mean age of 57.1±13.395 years and with 20.52±6.722 days in orotracheal intubation. Among the most frequent comorbidities, we encountered: arterial hypertension (51.6%), obesity (35.4%), diabetes mellitus (22.5%), hypothyroidism (6.4%), asthma (3.2%), pregnancy (3.2%), chronic obstructive pulmonary disease (3.2%) and obstructive sleep apnea syndrome (3.2%). The main complications were bleeding (12.9%) and decannulation (3.2%). The survival rate was 90.32%. Comparing the pre-surgical and postoperative outcomes of the ventilatory parameters and blood gas, statistically significant differences were found only in case of PEEP (p = 0.033), FiO2 (p = 0.001) and O2 saturation (p = 0.001). The average removal of the ventilator was 4.3±2.437 days. CONCLUSION. There were no significant changes in the ventilatory parameters, however, they were sufficient to wean the patients from the ventilation team and discharge them to the internal medicine department to continue their management outside the intensive care unit. [ FROM AUTHOR] Copyright of Romanian Journal of Rhinology is the property of Romanian Rhinologic Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)