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J Intensive Care Med ; 36(11): 1340-1346, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1367648


Background: A significant number of patients with severe respiratory failure related to COVID-19 require prolonged mechanical ventilation. Minimal data exists regarding the timing, safety, and efficacy of combined bedside percutaneous tracheostomy and endoscopy gastrostomy tube placement in these patients. The safety for healthcare providers is also in question. This study's objective was to evaluate the effectiveness and safety of combined bedside tracheostomy and gastrostomy tube placement in COVID-19 patients. Design and Methods: This is a single arm, prospective cohort study in patients with COVID-19 and acute respiratory failure requiring prolonged mechanical ventilation who underwent bedside tracheostomy and percutaneous endoscopic gastrostomy placement. Detailed clinical and procedural data were collected. Descriptive statistics were employed and time to event curves were estimated and plotted using the Kaplan Meier method for clinically relevant prespecified endpoints. Results: Among 58 patients, the median total intensive care unit (ICU) length of stay was 29 days (24.7-33.3) with a median of 10 days (6.3-13.7) postprocedure. Nearly 88% of patients were weaned from mechanical ventilation postprocedure at a median of 9 days (6-12); 94% of these were decannulated. Sixty-day mortality was 10.3%. Almost 90% of patients were discharged alive from the hospital. All procedures were done at bedside with no patient transfer required out of the ICU. A median of 3.0 healthcare personnel total were present in the room per procedure. Conclusion: This study shows that survival of critically ill COVID-19 patients after tracheostomy and gastrostomy was nearly 90%. The time-to-event curves are encouraging regarding time to weaning, downsizing, decannulation, and discharge. A combined procedure minimizes the risk of virus transmission to healthcare providers in addition to decreasing the number of anesthetic episodes, transfusions, and transfers patients must undergo. This approach should be considered in critically ill COVID-19 patients requiring prolonged mechanical ventilation.

COVID-19 , Tracheostomy , Gastrostomy , Humans , Prospective Studies , SARS-CoV-2
A A Pract ; 14(14): e01371, 2020 Dec 21.
Article in English | MEDLINE | ID: covidwho-992617


Respiratory failure in coronavirus disease 2019 (COVID-19) patients with prolonged endotracheal intubation may require a tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placement to facilitate recovery. Both techniques are considered high-risk aerosol-generating procedures and present a heightened risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for operating room personnel. We designed, simulated, and implemented a portable, continuous negative pressure, operative field barrier system using standard equipment available in hospitals to enhance health care provider safety during high-risk aerosol-generating procedures.

COVID-19/complications , COVID-19/transmission , Endoscopy, Gastrointestinal/methods , Gastrostomy/methods , Minimally Invasive Surgical Procedures/methods , Tracheostomy/methods , Aerosols , Air Pressure , COVID-19/prevention & control , Enteral Nutrition , Filtration , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Male , Middle Aged , Operating Rooms , Patient Isolation
Respir Care ; 65(11): 1773-1783, 2020 11.
Article in English | MEDLINE | ID: covidwho-695569


The COVID-19 pandemic has profoundly affected health care delivery worldwide. A small yet significant number of patients with respiratory failure will require prolonged mechanical ventilation while recovering from the viral-induced injury. The majority of reports thus far have focused on the epidemiology, clinical factors, and acute care of these patients, with less attention given to the recovery phase and care of those patients requiring extended time on mechanical ventilation. In this paper, we review the procedures and methods to safely care for patients with COVID-19 who require tracheostomy, gastrostomy, weaning from mechanical ventilation, and final decannulation. The guiding principles consist of modifications in the methods of airway care to safely prevent iatrogenesis and to promote safety in patients severely affected by COVID-19, including mitigation of aerosol generation to minimize risk for health care workers.

Coronavirus Infections , Device Removal/methods , Gastrostomy , Infection Control , Pandemics , Pneumonia, Viral , Tracheostomy , Ventilator Weaning/methods , Betacoronavirus , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/surgery , Coronavirus Infections/therapy , Critical Care/methods , Critical Care/standards , Gastrostomy/instrumentation , Gastrostomy/methods , Humans , Infection Control/instrumentation , Infection Control/methods , Infection Control/standards , Pneumonia, Viral/complications , Pneumonia, Viral/surgery , Pneumonia, Viral/therapy , Respiration, Artificial/methods , Risk Adjustment , SARS-CoV-2 , Tracheostomy/instrumentation , Tracheostomy/methods