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1.
J Trauma Acute Care Surg ; 89(2): 265-271, 2020 08.
Article in English | MEDLINE | ID: covidwho-683261

ABSTRACT

BACKGROUND: The COVID-19 virus is highly contagious, and thus there is a potential of infecting operating staff when operating on these patients. This case series describes a method of performing open tracheostomy for COVID-19 patients while minimizing potential aerosolization of the virus using typically available equipment and supplies. METHODS: This is a case series of 18 patients who were COVID-19-positive and underwent open tracheostomy in the operating room under a negative pressure plastic hood created using readily available equipment and supplies. Patients had to be intubated for at least 14 days, be convalescing from their cytokine storm, and deemed to survive for at least 14 more days. Other indications for tracheostomy were altered mental status, severe deconditioning, respiratory failure and failed extubation attempts. RESULTS: There were 14 men and 4 women with severe SARS-CoV2 infection requiring long-term intubation since March 23 or later. The mean age was 61.7 years, body mass index was 32.6, and the pretracheostomy ventilator day was 20.4 days. The indications for tracheostomy were altered mental status, severe deconditioning and continued respiratory with hypoxia. Failed extubation attempt rate was 16.7% and hemodialysis rate was 38.9%. All patients were hemodynamically stable, without any evidence of accelerating cytokine storm. To date there was one minor bleeding due to postoperative therapeutic anticoagulation. CONCLUSION: This report describes a method of performing open tracheostomy with minimal aerosolization using readily available equipment and supplies in most hospitals. LEVEL OF EVIDENCE: Therapeutic/care management, Level V.


Subject(s)
Betacoronavirus , Coronavirus Infections , Infection Control/methods , Pandemics , Pneumonia, Viral , Respiration, Artificial , Respiratory Insufficiency/therapy , Tracheostomy , Betacoronavirus/isolation & purification , Betacoronavirus/pathogenicity , Coronavirus Infections/complications , Coronavirus Infections/therapy , Coronavirus Infections/virology , Cytokine Release Syndrome/etiology , Cytokine Release Syndrome/therapy , Equipment Design , Female , Humans , Male , Middle Aged , Occupational Exposure/prevention & control , Operating Rooms/methods , Operating Rooms/trends , Outcome and Process Assessment, Health Care , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Respiration, Artificial/adverse effects , Respiration, Artificial/instrumentation , Respiration, Artificial/methods , Respiratory Insufficiency/etiology , Tracheostomy/adverse effects , Tracheostomy/methods
2.
J Korean Med Sci ; 35(28): e263, 2020 Jul 20.
Article in English | MEDLINE | ID: covidwho-655416

ABSTRACT

Coronavirus disease was first reported in December 2019, and the World Health Organization declared it as a pandemic on March 11, 2020. The virus is known to attack various vital organs, including the respiratory system. Patients sometimes require positive pressure ventilation and tracheostomy. Because tracheostomy is a droplet-spreading procedure, medical staff should protect themselves against the risk of transmission of this contagious viral disease. In our case, we performed tracheostomy for a 70-year-old man with coronavirus disease 2019 (COVID-19) who had required more oxygen with gradual weakness of respiratory muscle to maintain his arterial oxygen saturation. We focused on the risks of the medical staffs and patients, and minimized them at the same time using temporary balloon over-inflation, pre-operative adjustment of endotracheal tube position, and attachment of a transparent film dressing to the surgical field without stopping the ventilator while following routine safety measures. Fourteen days after the tracheostomy, all participating medical staff members were healthy and asymptomatic. The patient was discharged 105 days after the COVID-19 diagnosis.


Subject(s)
Coronavirus Infections/pathology , Disease Transmission, Infectious/prevention & control , Pneumonia, Viral/pathology , Tracheostomy/methods , Aged , Betacoronavirus , Humans , Male , Pandemics , Respiration, Artificial/methods
3.
Nurs Stand ; 35(8): 76-82, 2020 08 05.
Article in English | MEDLINE | ID: covidwho-644318

ABSTRACT

A tracheostomy is a surgical procedure that involves creating an opening and inserting a tube in the trachea to enable air transit from the external atmosphere to the lungs. The insertion of a tracheostomy is a common procedure used to wean patients from mechanical ventilation and to manage patients with upper respiratory tract complications. Furthermore, the coronavirus disease 2019 (COVID-19) pandemic has resulted in many patients requiring a tracheostomy as part of respiratory management. The two most commonly used tracheostomy insertion procedures are the open surgical tracheostomy and the percutaneous dilatation tracheostomy, both of which are associated with a range of complications. This article outlines the indications, benefits and complications of tracheostomy insertion, as well as the various types of tracheostomy tube that may be used. It also explains the role of the nurse in caring for patients before, during and after tracheostomy insertion, including the management of tracheostomy-related complications and emergencies.


Subject(s)
Nurse's Role , Respiration, Artificial , Tracheostomy , Betacoronavirus , Coronavirus Infections , Humans , Intensive Care Units , Pandemics , Pneumonia, Viral , Respiration, Artificial/methods , Tracheostomy/methods , United Kingdom
4.
Eur Arch Otorhinolaryngol ; 277(7): 2133-2135, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-628611

ABSTRACT

PURPOSE: The role of tracheostomy in COVID-19-related ARDS is unknown. Nowadays, there is no clear indication regarding the timing of tracheostomy in these patients. METHODS: We describe our synergic experience between ENT and ICU Departments at University Hospital of Modena underlining some controversial aspects that would be worth discussing tracheostomies in these patients. During the last 2 weeks, we performed 28 tracheostomies on patients with ARDS due to COVID-19 infection who were treated with IMV. RESULTS: No differences between percutaneous and surgical tracheostomy in terms of timing and no case of team virus infection. CONCLUSION: In our experience, tracheostomy should be performed only in selected patients within 7- and 14-day orotracheal intubation.


Subject(s)
Coronavirus Infections/diagnosis , Intubation, Intratracheal , Minimally Invasive Surgical Procedures/methods , Pneumonia, Viral/diagnosis , Respiratory Distress Syndrome, Adult/therapy , Tracheostomy/methods , Adult , Betacoronavirus , Coronavirus Infections/epidemiology , Humans , Intensive Care Units , Male , Middle Aged , Pandemics/prevention & control , Patient Care Team , Pneumonia, Viral/epidemiology , Respiratory Distress Syndrome, Adult/etiology , Treatment Outcome
5.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137(4): 263-268, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-626819

ABSTRACT

OBJECTIVES: The main objective was to demonstrate the feasibility of percutaneous tracheostomy performed under difficult conditions by military ENT physicians during their deployment in the military intensive care field hospital of the French Military Medical Service in Mulhouse to confront the exceptional COVID-19 pandemic. The secondary objective was to assess reliability and safety for patient and caregivers, with a risk of iatrogenic viral contamination. MATERIAL AND METHODS: A single-center retrospective study was conducted between March 25 and April 25, 2020, in 47 COVID-19 patients requiring prolonged mechanical ventilation. The inclusion criterion was having undergone percutaneous tracheostomy. RESULTS: Eighteen consecutively included patients had successfully undergone percutaneous tracheostomy despite unfavorable anatomical conditions (short neck: 83.3%, overweight or obese: 88.9%). Median time to completion was 11 days after intubation, with an average duration of 7minutes. The procedure was technically compliant in 83.3% of cases, and considered easy (on self-assessment) in 72.2%, with 2 minor per-procedural complications. No crossover to surgery was required. There was only 1 major post-procedural complication (late hemorrhage). CONCLUSION: This study showed the feasibility of percutaneous tracheostomy by an ENT physician under COVID-19 biohazard conditions. The technique was fast, easy and safe and met safety requirements for patient and staff.


Subject(s)
Coronavirus Infections/therapy , Military Medicine , Otolaryngology , Pneumonia, Viral/therapy , Respiration, Artificial , Tracheostomy/methods , Adult , Aged , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Feasibility Studies , Female , France , Humans , Male , Middle Aged , Military Personnel , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Retrospective Studies
7.
Eur Ann Otorhinolaryngol Head Neck Dis ; 137(4): 333-338, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-592157

ABSTRACT

Tracheostomy in COVID-19-related severe acute respiratory syndrome is at high risk of viral dissemination. The percutaneous dilatation technique could reduce this risk, being performed at the bedside and minimising airway opening. In the COVID-19 context, however, with precarious respiratory status, it requires specific preparation. We designed a 3-hour training module, and here provide a step-by-step schedule, including video analysis, a demonstration of the kit, the recommended precautions related to COVID-19, and several simulation scenarios of increasing difficulty, using a high-tech mannequin. A low-tech procedural simulator was also developed for practicing the steps of the procedure. Our experience (3 sessions with 14 participants) highlighted the difficult points of the procedure in the COVID-19 context, and defined a checklist for clinical practice and an assessment grid. This type of simulation helps to prepare teams for a potentially delicate technical act.


Subject(s)
Coronavirus Infections/surgery , Otolaryngology/education , Pneumonia, Viral/surgery , Simulation Training , Tracheostomy/education , Tracheostomy/methods , Humans , Pandemics
8.
Oral Oncol ; 108: 104844, 2020 09.
Article in English | MEDLINE | ID: covidwho-548231

ABSTRACT

At this moment, the world lives under the SARS-CoV-2 outbreak pandemic. As Otolaryngologists - Head & Neck Surgeons, we need to perform and participate in examinations and procedures within the head and neck region and airway that carry a particularly high risk of exposure and infection because of aerosol and droplet contamination. One of those surgical procedures in demand at this moment is tracheostomy due the increasing ICU admissions. This review of international guidelines for tracheostomy in COVID-19 infected patients, aims to summarize in a systematic way the available recommendations: indications, timing, technique and safety measures for tracheostomy, from all over the world.


Subject(s)
Betacoronavirus/genetics , Betacoronavirus/immunology , Coronavirus Infections/epidemiology , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Tracheostomy/methods , Tracheotomy/methods , Clinical Decision-Making , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , Humans , Otolaryngologists/psychology , Pandemics , Personal Protective Equipment , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Polymerase Chain Reaction , Serologic Tests , Surgeons/psychology
9.
Head Neck ; 42(7): 1382-1385, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-529129

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has resulted in an unprecedented need for critical care intervention. Prolonged intubation and mechanical ventilation has resulted in the need for tracheostomy in some patients. The purpose of this international survey was to assess optimal timing, technique and outcome for this intervention. METHODS: An online survey was generated. Otorhinolaryngologists from both the United Kingdom and Abroad were polled with regards to their experience of tracheostomy in COVID-19 positive ventilated patients. RESULTS: The survey was completed by 50 respondents from 16 nations. The number of ventilated patients totalled 3403, on average 9.7% required a tracheostomy. This was on average performed on day 14 following intubation. The majority of patients were successfully weaned (mean 7.4 days following tracheostomy). CONCLUSION: The results of this brief survey suggest that tracheostomy is of benefit in selected patients. There was insufficient data to suggest improved outcomes with either percutaneous vs an open surgical technique.


Subject(s)
Coronavirus Infections/epidemiology , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Surveys and Questionnaires , Tracheostomy/methods , Airway Management/methods , Critical Care/methods , Female , Hospitals, University , Humans , Intensive Care Units , Internationality , Internet , Intubation, Intratracheal/methods , Male , Otolaryngology/methods , Respiration, Artificial/methods , Risk Assessment , Time Factors , Tracheotomy/methods , Treatment Outcome , United Kingdom
10.
J Cardiopulm Rehabil Prev ; 40(4): 205-208, 2020 07.
Article in English | MEDLINE | ID: covidwho-620427

ABSTRACT

DETAILS OF THE CLINICAL CASE: A 51-yr-old man underwent a respiratory rehabilitation program (RRP), after being tracheostomized and ventilated due to acute respiratory distress syndrome (ARDS) from coronavirus disease-2019 (COVID-19) infection. Respiratory care, early mobilization, and neuromuscular electrical stimulation were started in the ad hoc isolation ward of our rehabilitation center. At baseline, muscle function was consistent with intensive care unit-acquired weakness and the patient still needed mechanical ventilation (MV) and oxygen support. During the first week of RRP in isolation, the patient was successfully weaned from MV, the tracheal cannula was removed, and the walking capacity was recovered. At the end of the RRP, continued in a standard department, respiratory muscles strength increased by 7% and muscle function improved as indicated by the quadriceps size enlargement of 13% and the change of the Medical Research Council sum score from 48/60 to 58/60. DISCUSSION: Providing RRP in patients with severe COVID-19 ARDS involves risks for operators and organizational difficulties, especially in rehabilitation centers; nevertheless, its continuity is important to prevent the development of permanent disabilities in previously healthy subjects. Limited to the experience of only one patient, we were able to carry out a safe RRP during the COVID-19 pandemic, promoting the complete functional recovery of a COVID-19 young patient. SUMMARY: Most patients who develop serious consequences of COVID-19 infection risk a reduction in their quality of life. However, by organizing and directing specialized resources, subacute rehabilitation facilities could ensure the continuity of the RRPs even during the COVID-19 pandemic.


Subject(s)
Coronavirus Infections/therapy , Pneumonia, Viral/therapy , Respiratory Distress Syndrome, Adult/rehabilitation , Respiratory Therapy/methods , Ventilator Weaning/methods , Coronavirus Infections/diagnosis , Feasibility Studies , Humans , Male , Middle Aged , Pandemics , Patient Isolation , Pneumonia, Viral/diagnosis , Recovery of Function , Rehabilitation Centers , Respiration, Artificial/methods , Respiratory Distress Syndrome, Adult/virology , Respiratory Function Tests , Risk Assessment , Severity of Illness Index , Tracheostomy/methods , Treatment Outcome
11.
Eur Arch Otorhinolaryngol ; 277(8): 2403-2404, 2020 08.
Article in English | MEDLINE | ID: covidwho-378190

ABSTRACT

BACKGROUND: The indications and timing for tracheostomy in patients with SARS CoV2-related are controversial. PURPOSE: In a recent issue published in the European Archives of Otorhinolaryngology, Mattioli et al. published a short communication about tracheostomy timing in patients with COVID-19 (Coronavirus Disease 2019); they reported that the tracheostomy could allow early Intensive Care Units discharge and, in the context of prolonged Invasive Mechanical Ventilation, should be suggested within 7 and 14 days to avoid potential tracheal damages. In this Letter to the Editor we would like to present our experience with tracheostomy in a Hub Covid Hospital. METHODS: 8 patients underwent open tracheostomy in case of intubation prolonged over 14 days, bronchopulmonary overlap infections, and patients undergoing weaning. They were followed up and the number and timing of death were recorded. RESULTS: Two patients died after tracheostomy; the median time between tracheostomy and death was 3 days. A negative prognostic trend was observed for a shorter duration of intubation. CONCLUSION: In our experience, tracheostomy does not seem to influence the clinical course and prognosis of the disease, in the face of possible risks of contagion for healthcare workers. The indication for tracheostomy in COVID-19 patients should be carefully evaluated and reserved for selected patients. Although it is not possible to define an optimal timing, it is our opinion that tracheostomy in a stable or clinically improved COVID-19 patient should not be proposed before the 20th day after orotracheal intubation.


Subject(s)
Coronavirus Infections/diagnosis , Critical Care/methods , Intubation, Intratracheal/adverse effects , Minimally Invasive Surgical Procedures/methods , Pneumonia, Viral/diagnosis , Respiration, Artificial/adverse effects , Tracheostomy/adverse effects , Tracheostomy/methods , Betacoronavirus , Coronavirus Infections/epidemiology , Female , Humans , Intensive Care Units , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Respiratory Insufficiency , Severe Acute Respiratory Syndrome , Time Factors , Treatment Outcome
12.
Otolaryngol Head Neck Surg ; 163(3): 462-464, 2020 09.
Article in English | MEDLINE | ID: covidwho-378047

ABSTRACT

During the SARS-CoV-2 pandemic, patients in intensive care units who are undergoing long-term intubation may require tracheostomy. There is controversy about indication and health care professionals' safety regarding the conventional or percutaneous technique. We performed a prospective analysis of a series of 27 consecutive patients with COVID-19 comparing both tracheostomy techniques, safety, and prognosis clinical markers. The results show that the techniques are equally safe, without cases of infection in surgeons. The Sequential Organ Failure Assessment score before surgery and the progression in ventilation support during the first 72 hours after tracheostomy are optimal prognostic markers for these patients.


Subject(s)
Coronavirus Infections/therapy , Patient Safety , Pneumonia, Viral/therapy , Tracheostomy/methods , Aged , Betacoronavirus , Female , Humans , Intensive Care Units , Male , Organ Dysfunction Scores , Pandemics , Prognosis , Prospective Studies
13.
Head Neck ; 42(7): 1363-1366, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-326903

ABSTRACT

BACKGROUND: Percutaneous tracheostomy (PT) in patients with coronavirus disease (COVID-19) included several critical steps associated with increased risk of aerosol generation. We reported a modified PT technique aiming to minimize the risk of aerosol generation and to increase the staff safety in COVID-19 patients. METHODS: PT was performed with a modified technique including the use of a smaller endotracheal tube (ETT) cuffed at the carina during the procedure. RESULTS: The modified technique we proposed was successfully performed in three critically ill patients with COVID-19. CONCLUSIONS: In COVID-19 critically ill patients, a modified PT technique, including the use of a smaller ETT cuffed at the carina and fiber-optic bronchoscope inserted between the tube and the inner surface of the trachea, may ensure a better airway management, respiratory function, patient comfort, and great safety for the staff.


Subject(s)
Bronchoscopy/instrumentation , Coronavirus Infections/surgery , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intubation, Intratracheal/methods , Pneumonia, Viral/surgery , Tracheostomy/methods , Airway Management , Cohort Studies , Coronavirus Infections/diagnosis , Critical Illness , Female , Fiber Optic Technology , Humans , Intensive Care Units , Intubation, Intratracheal/instrumentation , Male , Minimally Invasive Surgical Procedures/methods , Occupational Health , Pandemics , Pneumonia, Viral/diagnosis , Retrospective Studies , Treatment Outcome
15.
Head Neck ; 42(7): 1374-1381, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-305887

ABSTRACT

BACKGROUND: An increasing number of COVID-19 patients worldwide will probably need tracheostomy in an emergency or at the recovering stage of COVID-19. We explored the safe and effective management of tracheostomy in COVID-19 patients, to benefit patients and protect health care workers at the same time. METHODS: We retrospectively analyzed 11 hospitalized COVID-19 patients undergoing tracheostomy. Clinical features of patients, ventilator withdrawal after tracheostomy, surgical complications, and nosocomial infection of the health care workers associated with the tracheostomy were analyzed. RESULTS: The tracheostomy of all the 11 cases (100%) was performed successfully, including percutaneous tracheostomy of 6 cases (54.5%) and conventional open tracheostomy of 5 cases (45.5%). No severe postoperative complications occurred, and no health care workers associated with the tracheostomy are confirmed to be infected by SARS-CoV-2. CONCLUSION: Comprehensive evaluation before tracheostomy, optimized procedures during tracheostomy, and special care after tracheostomy can make the tracheostomy safe and beneficial in COVID-19 patients.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Occupational Health , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Tracheostomy/methods , Adult , Aged , Aged, 80 and over , China , Cohort Studies , Female , Humans , Intubation, Intratracheal , Male , Middle Aged , Minimally Invasive Surgical Procedures , Pandemics/statistics & numerical data , Retrospective Studies , Risk Assessment , Tertiary Care Centers
16.
Lancet Respir Med ; 8(7): 717-725, 2020 07.
Article in English | MEDLINE | ID: covidwho-276408

ABSTRACT

Global health care is experiencing an unprecedented surge in the number of critically ill patients who require mechanical ventilation due to the COVID-19 pandemic. The requirement for relatively long periods of ventilation in those who survive means that many are considered for tracheostomy to free patients from ventilatory support and maximise scarce resources. COVID-19 provides unique challenges for tracheostomy care: health-care workers need to safely undertake tracheostomy procedures and manage patients afterwards, minimising risks of nosocomial transmission and compromises in the quality of care. Conflicting recommendations exist about case selection, the timing and performance of tracheostomy, and the subsequent management of patients. In response, we convened an international working group of individuals with relevant expertise in tracheostomy. We did a literature and internet search for reports of research pertaining to tracheostomy during the COVID-19 pandemic, supplemented by sources comprising statements and guidance on tracheostomy care. By synthesising early experiences from countries that have managed a surge in patient numbers, emerging virological data, and international, multidisciplinary expert opinion, we aim to provide consensus guidelines and recommendations on the conduct and management of tracheostomy during the COVID-19 pandemic.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Internationality , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Tracheostomy/methods , Coronavirus Infections/prevention & control , Critical Care/methods , Humans , Pandemics/prevention & control , Pneumonia, Viral/prevention & control
17.
Orv Hetil ; 161(19): 767-770, 2020 05.
Article in Hungarian | MEDLINE | ID: covidwho-274996

ABSTRACT

Recently, 6 percent of COVID-19 patients required prolonged mechanical ventilation due to severe respiratory failure. Early tracheostomy prevents the risk of postintubation upper airway stenosis. In the pandemic, all surgical interventions that generate aerosol increase the risk of contamination of the medical staff, for which reason the "traditional" indications of tracheostomy have to be revised. Authors present their recommendations based on international experiences. Orv Hetil. 2020; 161(19): 767-770.


Subject(s)
Betacoronavirus , Coronavirus Infections , Infection Control/methods , Pandemics , Pneumonia, Viral , Respiration, Artificial , Tracheostomy , Aerosols , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Tracheostomy/methods
18.
Otolaryngol Head Neck Surg ; 163(1): 135-137, 2020 07.
Article in English | MEDLINE | ID: covidwho-244956

ABSTRACT

The COVID-19 outbreak poses continued struggles due to the unprecedented number of patients admitted to intensive care units and the overwhelming need for mechanical ventilation. We report a preliminary case series of 32 patients with COVID-19 who underwent elective tracheostomies after a mean intubation period of 15 days (range, 9-21 days). The procedure was performed with percutaneous (10 cases) and open (22 cases) surgical techniques. Neither procedure-related complications nor viral transmission to health care workers was observed. Our preliminary experience supports the safety of tracheostomy, provided that appropriate protocols are strictly followed. The postoperative care is still debated, and, prudentially, our protocol includes tracheal tube change not before 2 weeks after tracheostomy, with cuff deflation and decannulation deferred until confirmation of negative SARS-CoV-2 test results. This is the first case series to report on such a rapidly evolving issue and might represent a source of information for clinicians worldwide who will soon be facing the same challenges.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Disease Transmission, Infectious/prevention & control , Intensive Care Units , Pneumonia, Viral/complications , Respiration, Artificial/methods , Respiratory Insufficiency/therapy , Tracheostomy/methods , Adult , Aged , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Elective Surgical Procedures , Female , Follow-Up Studies , Humans , Incidence , Italy/epidemiology , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Respiratory Insufficiency/epidemiology , Respiratory Insufficiency/etiology , Treatment Outcome
20.
Head Neck ; 42(7): 1397-1402, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-209758

ABSTRACT

Tracheostomy procedures have a high risk of aerosol generation. Airway providers have reflected on ways to mitigate the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission risks when approaching a surgical airway. To standardize institutional safety measures with tracheostomy, we advocate using a dedicated tracheostomy time-out applicable to all patients including those suspected of having COVID-19. The aim of the tracheostomy time-out is to reduce preventable errors that may increase the risk of transmission of SARS-CoV-2.


Subject(s)
Clinical Decision-Making , Coronavirus Infections/prevention & control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Severe Acute Respiratory Syndrome/therapy , Time Out, Healthcare/statistics & numerical data , Tracheostomy/methods , Coronavirus Infections/epidemiology , Critical Care/methods , Female , Humans , Male , Occupational Health , Pandemics/statistics & numerical data , Patient Selection , Personal Protective Equipment/statistics & numerical data , Pneumonia, Viral/epidemiology , Risk Assessment , Severe Acute Respiratory Syndrome/epidemiology , Surveys and Questionnaires , United States
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