Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 24
Filter
1.
Am J Otolaryngol ; 43(1): 103240, 2022.
Article in English | MEDLINE | ID: covidwho-1437392

ABSTRACT

PURPOSE: At the height of the COVID-19 pandemic, our institution instituted a Safe Tracheostomy Aftercare Taskforce (STAT) team to care for the influx of patients undergoing tracheostomies. This review was undertaken to understand this team's impact on outcomes of tracheostomy care. METHODS: We compared retrospective data collected from patients undergoing tracheostomies at our institution from February to June 2019, prior to creation of the STAT team, to prospectively collected data from tracheostomies performed from February to June 2020, while the STAT team was in place and performed statistical analysis on outcomes of care such as decannulation prior to discharge, timely tube change, and post-discharge follow-up. RESULTS: We found that the STAT team significantly increased rate of decannulation prior to discharge (P < 0.0005), performance of timely trach tube change when indicated (P < 0.05), and rates of follow-up for tracheostomy patients after discharge from the hospital (P < 0.0005). CONCLUSION: The positive impact of the STAT team on outcomes of patient care such as decannulation prior to discharge, timely tube change, and post-discharge follow-up makes a strong case for its continuation even in non-pandemic times.


Subject(s)
Aftercare/standards , COVID-19/therapy , Patient Care Team/standards , Tracheostomy/standards , Adult , Advisory Committees , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pandemics , Patient Discharge , Retrospective Studies , SARS-CoV-2
3.
Acta Otorrinolaringol Esp (Engl Ed) ; 71(6): 386-392, 2020.
Article in Spanish | MEDLINE | ID: covidwho-1002943

ABSTRACT

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.


Subject(s)
Betacoronavirus , Consensus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Societies, Medical , Tracheostomy/standards , Anesthesiology , Bronchoscopy/adverse effects , Bronchoscopy/standards , COVID-19 , Contraindications, Procedure , Coronary Care Units , Elective Surgical Procedures/standards , Emergencies , Humans , Intensive Care Units , Otolaryngology , Otorhinolaryngologic Surgical Procedures , Pandemics , Postoperative Care/methods , Postoperative Care/standards , Respiration, Artificial/standards , Resuscitation , SARS-CoV-2 , Spain , Time Factors , Tracheostomy/adverse effects , Tracheostomy/methods
4.
Med Intensiva (Engl Ed) ; 44(8): 493-499, 2020 Nov.
Article in Spanish | MEDLINE | ID: covidwho-1002891

ABSTRACT

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.


Subject(s)
Betacoronavirus , Consensus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Societies, Medical , Tracheostomy/standards , Anesthesiology , Bronchoscopy/adverse effects , Bronchoscopy/standards , COVID-19 , Contraindications, Procedure , Coronary Care Units , Elective Surgical Procedures/standards , Emergencies , Humans , Intensive Care Units , Otolaryngology , Otorhinolaryngologic Surgical Procedures , Pandemics , Postoperative Care/methods , Postoperative Care/standards , Respiration, Artificial/standards , Resuscitation , SARS-CoV-2 , Spain/epidemiology , Time Factors , Tracheostomy/adverse effects , Tracheostomy/methods
5.
J Surg Res ; 260: 38-45, 2021 04.
Article in English | MEDLINE | ID: covidwho-974321

ABSTRACT

BACKGROUND: Urgent guidance is needed on the safety for providers of percutaneous tracheostomy in patients diagnosed with COVID-19. The objective of the study was to demonstrate that percutaneous dilational tracheostomy (PDT) with a period of apnea in patients requiring prolonged mechanical ventilation due to COVID-19 is safe and can be performed for the usual indications in the intensive care unit. METHODS: This study involves an observational case series at a single-center medical intensive care unit at a level-1 trauma center in patients diagnosed with COVID-19 who were assessed for tracheostomy. Success of a modified technique included direct visualization of tracheal access by bronchoscopy and a blind dilation and tracheostomy insertion during a period of patient apnea to reduce aerosolization. Secondary outcomes include transmission rate of COVID-19 to providers and patient complications. RESULTS: From April 6th, 2020 to July 21st, 2020, 2030 patients were admitted to the hospital with COVID-19, 615 required intensive care unit care (30.3%), and 254 patients required mechanical ventilation (12.5%). The mortality rate for patients requiring mechanical ventilation was 29%. Eighteen patients were assessed for PDT, and 11 (61%) underwent the procedure. The majority had failed extubation at least once (72.7%), and the median duration of intubation before tracheostomy was 15 d (interquartile range 13-24). The median positive end-expiratory pressure at time of tracheostomy was 10.8. The median partial pressure of oxygen (PaO2)/FiO2 ratio on the day of tracheostomy was 142.8 (interquartile range 104.5-224.4). Two patients had bleeding complications. At 1-week follow-up, eight patients still required ventilator support (73%). At the most recent follow-up, eight patients (73%) have been liberated from the ventilator, one patient (9%) died as a result of respiratory/multiorgan failure, and two were discharged on the ventilator (18%). Average follow-up was 20 d. None of the surgeons performing PDT have symptoms of or have tested positive for COVID-19. CONCLUSIONS: and relevance: PDT for patients with COVID-19 is safe for health care workers and patients despite higher positive end-expiratory pressure requirements and should be performed for the same indications as other causes of respiratory failure.


Subject(s)
Bronchoscopy/adverse effects , COVID-19/therapy , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Postoperative Complications/epidemiology , Respiration, Artificial/adverse effects , Tracheostomy/adverse effects , Adult , Aged , Airway Extubation/statistics & numerical data , Bronchoscopy/instrumentation , Bronchoscopy/methods , Bronchoscopy/standards , COVID-19/diagnosis , COVID-19/mortality , COVID-19/transmission , COVID-19 Nucleic Acid Testing/statistics & numerical data , Female , Follow-Up Studies , Hospital Mortality , Humans , Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data , Intensive Care Units/standards , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Postoperative Complications/etiology , Respiration, Artificial/instrumentation , Respiration, Artificial/methods , Respiration, Artificial/statistics & numerical data , Retrospective Studies , SARS-CoV-2/isolation & purification , Severity of Illness Index , Time Factors , Tracheostomy/instrumentation , Tracheostomy/methods , Tracheostomy/standards , Treatment Outcome
7.
Otolaryngol Head Neck Surg ; 162(6): 804-808, 2020 06.
Article in English | MEDLINE | ID: covidwho-913947

ABSTRACT

The novel coronavirus disease 2019 (COVID-19) pandemic has unfolded with remarkable speed, posing unprecedented challenges for health care systems and society. Otolaryngologists have a special role in responding to this crisis by virtue of expertise in airway management. Against the backdrop of nations struggling to contain the virus's spread and to manage hospital strain, otolaryngologists must partner with anesthesiologists and front-line health care teams to provide expert services in high-risk situations while reducing transmission. Airway management and airway endoscopy, whether awake or sedated, expose operators to infectious aerosols, posing risks to staff. This commentary provides background on the outbreak, highlights critical considerations around mitigating infectious aerosol contact, and outlines best practices for airway-related clinical decision making during the COVID-19 pandemic. What otolaryngologists need to know and what actions are required are considered alongside the implications of increasing demand for tracheostomy. Approaches to managing the airway are presented, emphasizing safety of patients and the health care team.


Subject(s)
Airway Management/standards , Coronavirus Infections/prevention & control , Disease Transmission, Infectious/prevention & control , Otolaryngologists/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Tracheostomy/standards , Airway Management/methods , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Female , Head/surgery , Humans , Male , Neck/surgery , Occupational Health , Pandemics/statistics & numerical data , Patient Safety , Personal Protective Equipment/statistics & numerical data , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , SARS-CoV-2 , Safety Management/methods , Safety Management/standards
8.
Respir Care ; 65(11): 1767-1772, 2020 11.
Article in English | MEDLINE | ID: covidwho-740523

ABSTRACT

COVID-19 has impacted how we deliver care to patients, and much remains unknown regarding optimal management of respiratory failure in this patient population. There are significant controversies regarding tracheostomy in patients with COVID-19 related to timing, location of procedure, and technique. In this narrative review, we explore the recent literature, publicly available guidelines, protocols from different institutions, and clinical reports to provide critical insights on how to deliver the most benefit to our patients while safeguarding the health care force. Consensus can be reached that patients with COVID-19 should be managed in a negative-pressure environment with proper personal protective equipment, and that performing tracheostomy is a complex decision that should be made through multidisciplinary discussions considering patient prognosis, institutional resources, staff experience, and risks to essential health care workers. A broad range of practices exist because there is no conclusive guidance regarding the optimal timing or technique for tracheostomy.


Subject(s)
Coronavirus Infections , Infection Control , Pandemics , Pneumonia, Viral , Respiratory Insufficiency , Tracheostomy , Betacoronavirus , COVID-19 , Clinical Protocols , Coronavirus Infections/complications , Coronavirus Infections/therapy , Humans , Infection Control/instrumentation , Infection Control/methods , Infection Control/standards , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Respiratory Insufficiency/etiology , Respiratory Insufficiency/surgery , SARS-CoV-2 , Time-to-Treatment , Tracheostomy/methods , Tracheostomy/standards
9.
Auris Nasus Larynx ; 47(5): 715-726, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-664236

ABSTRACT

On April 14, the Society of Swallowing and Dysphagia of Japan (SSDJ) proposed its position statement on dysphagia treatment considering the ongoing spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The main routes of transmission of SARS-CoV-2 are physical contact with infected persons and exposure to respiratory droplets. In cases of infection, the nasal cavity and nasopharynx have the highest viral load in the body. Swallowing occurs in the oral cavity and pharynx, which correspond to the sites of viral proliferation. In addition, the possibility of infection by aerosol transmission is also concerning. Dysphagia treatment includes a broad range of clinical assessments and examinations, dysphagia rehabilitation, oral care, nursing care, and surgical treatments. Any of these can lead to the production of droplets and aerosols, as well as contact with viral particles. In terms of proper infection control measures, all healthcare professionals involved in dysphagia treatment must be fully briefed and must appropriately implement all measures. In addition, most patients with dysphagia should be considered to be at a higher risk for severe illness from COVID-19 because they are elderly and have complications including heart diseases, diabetes, respiratory diseases, and cerebrovascular diseases. This statement establishes three regional categories according to the status of SARS-CoV-2 infection. Accordingly, the SSDJ proposes specific infection countermeasures that should be implemented considering 1) the current status of SARS-CoV-2 infection in the region, 2) the patient status of SARS-CoV-2 infection, and 3) whether the examinations or procedures conducted correspond to aerosol-generating procedures, depending on the status of dysphagia treatment. This statement is arranged into separate sections providing information and advice in consideration of the COVID-19 outbreak, including "terminology", "clinical swallowing assessment and examination", "swallowing therapy", "oral care", "surgical procedure for dysphagia", "tracheotomy care", and "nursing care". In areas where SARS-CoV-2 infection is widespread, sufficient personal protective equipment should be used when performing aerosol generation procedures. The current set of statements on dysphagia management in the COVID-19 outbreak is not an evidence-based clinical practice guideline, but a guide for all healthcare workers involved in the treatment of dysphagia during the COVID-19 epidemic to prevent SARS-CoV-2 infection.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Deglutition Disorders/therapy , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , COVID-19 , Coronavirus Infections/transmission , Deglutition Disorders/diagnosis , Deglutition Disorders/nursing , Deglutition Disorders/surgery , Humans , Japan , Personal Protective Equipment , Pneumonia, Viral/transmission , SARS-CoV-2 , Tracheostomy/standards
10.
Rev. Col. Bras. Cir ; 47: e20202549, 2020. tab, graf
Article in Portuguese | WHO COVID, LILACS (Americas) | ID: covidwho-635034

ABSTRACT

RESUMO Atualmente médicos e profissionais da saúde encontram-se frente a uma pandemia desafiadora causada por uma nova cepa denominada 2019 Novel Coronavírus (COVID-19). A infecção humana pelo COVID-19 ainda não tem o espectro clínico completamente descrito, bem como não se sabe com precisão o padrão de letalidade, mortalidade, infectividade e transmissibilidade. Não há vacina ou medicamento específico disponível. O tratamento é de suporte e inespecífico. No Brasil, assim como no restante do mundo o número de casos de COVID-19 tem crescido de maneira alarmante levando a um aumento do número de internações assim como da mortalidade pela doença. Atualmente os estados com maior número de casos são, respectivamente, São Paulo, Rio de Janeiro, Distrito Federal e Ceará. O objetivo deste trabalho é oferecer alternativas a fim de orientar cirurgiões quanto ao manejo cirúrgico das vias aéreas em pacientes com suspeita e/ou confirmação para infecção pelo COVID-19.


ABSTRACT Currently doctors and health professionals are facing a challenging pandemic caused by a new strain called 2019 Novel Coronavirus (COVID-19). Human infection with COVID-19 does not yet have the clinical spectrum fully described, and the pattern of lethality, mortality, infectivity and transmissibility is not known with precision. There is no specific vaccine or medication available. Treatment is supportive and nonspecific. In Brazil, as in the rest of the world, the number of COVID-19 cases has grown alarmingly, leading to an increase in the number of hospitalizations as well as in mortality from the disease. Currently, the states with the highest number of cases are, respectively, São Paulo, Rio de Janeiro, Distrito Federal and Ceará. The objective of this work is to offer alternatives in order to guide surgeons regarding the surgical management of the airways in patients with suspicion and / or confirmation for COVID-19 infection.


Subject(s)
Humans , Pneumonia, Viral/surgery , Coronavirus Infections/surgery , Airway Management/methods , Betacoronavirus , Pneumonia, Viral/prevention & control , Postoperative Care/standards , Risk Management/standards , Tracheostomy/standards , Equipment Contamination/prevention & control , Occupational Exposure/prevention & control , Coronavirus Infections/prevention & control , Airway Management/standards , Pandemics/prevention & control , Surgeons/standards , SARS-CoV-2 , COVID-19 , Laryngeal Muscles/surgery
11.
Rev. Col. Bras. Cir ; 47: e20202574, 2020.
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-616996

ABSTRACT

ABSTRACT The COVID-19 Pandemic has resulted in a high number of hospital admissions and some of those patients need ventilatory support in intensive care units. The viral pneumonia secondary to Sars-cov-2 infection may lead to acute respiratory distress syndrome (ARDS) and longer mechanical ventilation needs, resulting in a higher demand for tracheostomies. Due to the high aerosolization potential of such procedure, and the associated risks of staff and envoirenment contamination, it is necesseray to develop a specific standardization of the of the whole process involving tracheostomies. This manuscript aims to demonstrate the main steps of the standardization created by a tracheostomy team in a tertiary hospital dedicated to providing care for patients with COVID-19.


RESUMO A pandemia da COVID-19 tem gerado um número elevado de internações hospitalares e muitos pacientes são admitidos nas unidades de terapia intensiva para suporte ventilatório invasivo. A pneumonia viral provocada pelo Sars-cov-2 pode resultar na síndrome da disfunção respiratória aguda (SDRA) e em um tempo prolongado de ventilação mecânica, gerando uma demanda maior de traqueostomias. Diante do alto potencial de aerossolização desse procedimento, com risco de contaminação da equipe e do ambiente, é necessário criar uma padronização específica de todo o processo que envolve essa cirurgia. Este artigo visa demonstrar as principais etapas dessa padronização desenvolvida por um equipe dedicada à realização de traqueostomias em um hospital terciário dedicado ao atendimento de pacientes com suspeita ou confirmação de COVID-19.


Subject(s)
Humans , Pneumonia, Viral/surgery , Tracheostomy/standards , Elective Surgical Procedures/standards , Coronavirus Infections/surgery , Tertiary Care Centers/standards , Operating Rooms/standards , Pneumonia, Viral/prevention & control , Brazil , Coronavirus Infections/prevention & control , Aerosols/adverse effects , Pandemics/prevention & control , Operative Time , Personal Protective Equipment/standards , Betacoronavirus , SARS-CoV-2 , COVID-19
13.
Am J Speech Lang Pathol ; 29(3): 1320-1334, 2020 08 04.
Article in English | MEDLINE | ID: covidwho-594936

ABSTRACT

Purpose As the COVID-19 pandemic has unfolded, there has been growing recognition of risks to frontline health care workers. When caring for patients with tracheostomy, speech-language pathologists have significant exposure to mucosal surfaces, secretions, and aerosols that may harbor the SARS-CoV-2 virus. This tutorial provides guidance on practices for safely performing patient evaluation and procedures, thereby reducing risk of infection. Method Data were collated through review of literature, guidelines, and consensus statements relating to COVID-19 and similar high-consequent infections, with a focus on mitigating risk of transmission to health care workers. Particular emphasis was placed on speech-language pathologists, nurses, and other allied health professionals. A multinational interdisciplinary team then analyzed findings, arriving at recommendations through consensus via electronic communications and video conference. Results Reports of transmission of infection to health care workers in the current COVID-19 pandemic and previous outbreaks substantiate the need for safe practices. Many procedures routinely performed by speech-language pathologists have a significant risk of infection due to aerosol generation. COVID-19 testing can inform level of protective equipment, and meticulous hygiene can stem spread of nosocomial infection. Modifications to standard clinical practice in tracheostomy are often required. Personal protective equipment, including either powered air-purifying respirator or N95 mask, gloves, goggles, and gown, are needed when performing aerosol-generating procedures in patients with known or suspected COVID-19 infection. Conclusions Speech-language pathologists are often called on to assist in the care of patients with tracheostomy and known or suspected COVID-19 infection. Appropriate care of these patients is predicated on maintaining the health and safety of the health care team. Careful adherence to best practices can significantly reduce risk of infectious transmission.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pneumonia, Viral/therapy , Speech-Language Pathology/standards , Tracheostomy/standards , COVID-19 , Consensus , Coronavirus Infections/transmission , Coronavirus Infections/virology , Humans , Interdisciplinary Communication , International Cooperation , Pandemics , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Practice Guidelines as Topic , SARS-CoV-2
15.
Rev Esp Anestesiol Reanim (Engl Ed) ; 67(9): 504-510, 2020 Nov.
Article in English, Spanish | MEDLINE | ID: covidwho-592287

ABSTRACT

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.


Subject(s)
Betacoronavirus , Consensus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Societies, Medical , Tracheostomy/standards , Anesthesiology , Bronchoscopy/adverse effects , Bronchoscopy/standards , COVID-19 , Contraindications, Procedure , Coronary Care Units , Elective Surgical Procedures/standards , Emergencies , Humans , Intensive Care Units , Otolaryngology , Otorhinolaryngologic Surgical Procedures , Pandemics , Postoperative Care/methods , Postoperative Care/standards , Respiration, Artificial/standards , Resuscitation , SARS-CoV-2 , Spain/epidemiology , Time Factors , Tracheostomy/adverse effects , Tracheostomy/methods
17.
Oral Oncol ; 107: 104784, 2020 08.
Article in English | MEDLINE | ID: covidwho-271026
18.
Otolaryngol Head Neck Surg ; 163(1): 67-69, 2020 07.
Article in English | MEDLINE | ID: covidwho-133313

ABSTRACT

The ongoing coronavirus disease 2019 pandemic has led to unprecedented demands on the modern health care system, and the highly contagious nature of the virus has led to particular concerns of infection among health care workers and transmission within health care facilities. While strong data regarding the transmissibility of the infection are not yet widely available, preliminary information suggests risk of transmission among asymptomatic individuals, including those within health care facilities. We believe that the presence of a tracheostomy or laryngectomy stoma poses a unique risk of droplet and aerosol spread particularly among patients with unsuspected infection. At our institution, guidelines for the care of open airways were developed by a multidisciplinary open airway working group, and here we review those recommendations to provide practical guidance to other institutions.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Disease Transmission, Infectious/prevention & control , Pandemics , Pneumonia, Viral/complications , Respiratory Insufficiency/therapy , Tracheostomy/standards , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Humans , Patient Safety , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Respiratory Insufficiency/etiology , SARS-CoV-2
19.
J Otolaryngol Head Neck Surg ; 49(1): 23, 2020 Apr 27.
Article in English | MEDLINE | ID: covidwho-125494

ABSTRACT

INTRODUCTION: The performance of tracheotomy is a common procedural request by critical care departments to the surgical services of general surgery, thoracic surgery and otolaryngology - head & neck surgery. A Canadian Society of Otolaryngology - Head & Neck Surgery (CSO-HNS) task force was convened with multi-specialty involvement from otolaryngology-head & neck surgery, general surgery, critical care and anesthesiology to develop a set of recommendations for the performance of tracheotomies during the COVID-19 pandemic. MAIN BODY: The tracheotomy procedure is highly aerosol generating and directly exposes the entire surgical team to the viral aerosol plume and secretions, thereby increasing the risk of transmission to healthcare providers. As such, we believe extended endotracheal intubation should be the standard of care for the entire duration of ventilation in the vast majority of patients. Pre-operative COVID-19 testing is highly recommended for any non-emergent procedure. CONCLUSION: The set of recommendations in this document highlight the importance of avoiding tracheotomy procedures in patients who are COVID-19 positive if at all possible. Recommendations for appropriate PPE and environment are made for COVID-19 positive, negative and unknown patients requiring consideration of tracheotomy. The safety of healthcare professionals who care for ill patients and who keep critical infrastructure operating is paramount.


Subject(s)
Coronavirus Infections/diagnosis , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics , Personal Protective Equipment/standards , Pneumonia, Viral/diagnosis , Respiratory Insufficiency/surgery , Tracheostomy/standards , COVID-19 , Canada , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Humans , Intubation, Intratracheal , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Respiration, Artificial , Respiratory Insufficiency/etiology , Time Factors , Tracheostomy/methods , Tracheotomy
SELECTION OF CITATIONS
SEARCH DETAIL