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1.
J Intensive Care Med ; 37(5): 641-646, 2022 May.
Article in English | MEDLINE | ID: covidwho-1218276

ABSTRACT

BACKGROUND: To compare the safety and efficacy of percutaneous ultrasound guided gastrostomy (PUG) tube placement with traditional fluoroscopic guided percutaneous gastrostomy tube placement (PRG). METHODS: A prospective, observational, non-randomized cohort trial was performed comparing 25 consecutive patients who underwent PUG placement between April 2020 and August 2020 with 25 consecutive patients who underwent PRG placement between February 2020 and March 2020. Procedure time, sedation, analgesia requirements, and complications were compared between the two groups in non-inferiority analysis. RESULTS: Technical success rates were 96% in both groups (24/25) of procedures. Ninety-two percent of patients in the PUG cohort were admitted to the ICU at the time of G-tube request. Aside from significantly more COVID-19 patients in the PUG group (P < .001), there was no other statistically significant difference in patient demographics. Intra-procedure pain medication requirements were the same for both groups, 50 micrograms of IV fentanyl (P = 1.0). Intra-procedure sedation with IV midazolam was insignificantly higher in the PUG group 1.12 mg vs 0.8 mg (P = .355). Procedure time trended toward statistical significance (P = .076), with PRG being shorter than PUG (30.5 ± 14.1 minutes vs 39.7 ± 17.9 minutes). There were 2 non-device related major complications in the PUG group and 1 major and 1 minor complication in the PRG group. CONCLUSION: PUG is similar in terms of complications to PRG gastrostomy tube placement and a safe method for gastrostomy tube placement in the critically ill with the added benefits of bedside placement, elimination of radiation exposure, and expanded and improved access to care.


Subject(s)
COVID-19 , Gastrostomy , Gastrostomy/methods , Humans , Prospective Studies , Retrospective Studies , Ultrasonography, Interventional
2.
A A Pract ; 14(14): e01371, 2020 Dec 21.
Article in English | MEDLINE | ID: covidwho-992617

ABSTRACT

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.


Subject(s)
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
4.
Ulus Travma Acil Cerrahi Derg ; 28(3): 395-398, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-926047

ABSTRACT

We present here a gastrostomy procedure performed on a patient diagnosed with COVID-19 with no oral intake due to esophageal cancer in order to permit the initiation of COVID-19 treatment, and the COVID-19 protocols followed as per the pandemic guidelines. A 55-year-old female patient diagnosed recently with esophageal squamous-cell carcinoma was consulted for a surgical gastrostomy in the absence of oral intake due to complete esophageal obstruction prior to neoadjuvant chemotherapy. The patient had a new-onset cough and elevated body temperature (38°C) on admission to our clinic, and so was tested for COVID-19, with the final diagnosis established with PCR. In order to initiate COVID-19 treatment, a surgical gastrostomy was performed under semi-emergency conditions, following COVID-19 infection prevention guidelines. COVID-19 treatment, nutrition, and supportive therapy were initiated through the gastrostomy catheter. The patient is clinically stable on day 7 of treatment. A COVID-19 patient may require emergency surgical intervention during the fight against pandemic. When a surgical procedure is performed, all guidelines defined to protect healthcare workers from COVID-19 infection should be followed.


Subject(s)
COVID-19 , Esophageal Neoplasms , COVID-19/drug therapy , Esophageal Neoplasms/drug therapy , Esophageal Neoplasms/surgery , Female , Gastrostomy/methods , Humans , Middle Aged , Operating Rooms , Pandemics
5.
Respir Care ; 65(11): 1773-1783, 2020 11.
Article in English | MEDLINE | ID: covidwho-695569

ABSTRACT

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.


Subject(s)
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
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