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Outcomes After Tracheostomy in COVID-19 Patients.
Chao, Tiffany N; Harbison, Sean P; Braslow, Benjamin M; Hutchinson, Christoph T; Rajasekaran, Karthik; Go, Beatrice C; Paul, Ellen A; Lambe, Leah D; Kearney, James J; Chalian, Ara A; Cereda, Maurizio F; Martin, Niels D; Haas, Andrew R; Atkins, Joshua H; Rassekh, Christopher H.
  • Chao TN; Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Harbison SP; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Braslow BM; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Hutchinson CT; Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Rajasekaran K; Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Go BC; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Paul EA; Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Lambe LD; Department of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Kearney JJ; Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Chalian AA; Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Cereda MF; Department of Anesthesia and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Martin ND; Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Haas AR; Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Atkins JH; Department of Anesthesia and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Rassekh CH; Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Ann Surg ; 272(3): e181-e186, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-1066507
Semantic information from SemMedBD (by NLM)
1. Tracheostomy procedure TREATS COVID-19
Subject
Tracheostomy procedure
Predicate
TREATS
Object
COVID-19
2. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
3. Tracheostomy procedure TREATS Patients
Subject
Tracheostomy procedure
Predicate
TREATS
Object
Patients
4. Critical Illness PROCESS_OF Patients
Subject
Critical Illness
Predicate
PROCESS_OF
Object
Patients
5. Intubatio TREATS C0010340
Subject
Intubatio
Predicate
TREATS
Object
C0010340
6. Intubatio TREATS C0030705
Subject
Intubatio
Predicate
TREATS
Object
C0030705
7. Intubated PROCESS_OF Patients
Subject
Intubated
Predicate
PROCESS_OF
Object
Patients
8. COVID-19 AFFECTS Prognosis bad
Subject
COVID-19
Predicate
AFFECTS
Object
Prognosis bad
9. COVID-19 CAUSES Acute respiratory failure
Subject
COVID-19
Predicate
CAUSES
Object
Acute respiratory failure
10. Tracheostomy procedure TREATS Intubated
Subject
Tracheostomy procedure
Predicate
TREATS
Object
Intubated
11. Interventional procedure ADMINISTERED_TO Health Personnel
Subject
Interventional procedure
Predicate
ADMINISTERED_TO
Object
Health Personnel
12. Interventional procedure ADMINISTERED_TO Patients
Subject
Interventional procedure
Predicate
ADMINISTERED_TO
Object
Patients
13. Tracheostomy procedure TREATS COVID-19
Subject
Tracheostomy procedure
Predicate
TREATS
Object
COVID-19
14. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
15. Tracheostomy procedure TREATS Patients
Subject
Tracheostomy procedure
Predicate
TREATS
Object
Patients
16. Critical Illness PROCESS_OF Patients
Subject
Critical Illness
Predicate
PROCESS_OF
Object
Patients
17. Intubation, Intratracheal TREATS Critical Illness
Subject
Intubation, Intratracheal
Predicate
TREATS
Object
Critical Illness
18. Intubation, Intratracheal TREATS Patients
Subject
Intubation, Intratracheal
Predicate
TREATS
Object
Patients
19. Intubated PROCESS_OF Patients
Subject
Intubated
Predicate
PROCESS_OF
Object
Patients
20. COVID-19 AFFECTS Prognosis bad
Subject
COVID-19
Predicate
AFFECTS
Object
Prognosis bad
21. COVID-19 CAUSES Acute respiratory failure
Subject
COVID-19
Predicate
CAUSES
Object
Acute respiratory failure
22. Tracheostomy procedure TREATS Intubated
Subject
Tracheostomy procedure
Predicate
TREATS
Object
Intubated
23. Interventional procedure ADMINISTERED_TO Health Personnel
Subject
Interventional procedure
Predicate
ADMINISTERED_TO
Object
Health Personnel
24. Interventional procedure ADMINISTERED_TO Patients
Subject
Interventional procedure
Predicate
ADMINISTERED_TO
Object
Patients
ABSTRACT

OBJECTIVE:

To determine the outcomes of patients undergoing tracheostomy for COVID-19 and of healthcare workers performing these procedures.

BACKGROUND:

Tracheostomy is often performed for prolonged endotracheal intubation in critically ill patients. However, in the context of COVID-19, tracheostomy placement pathways have been altered due to the poor prognosis of intubated patients and the risk of transmission to providers through this highly aerosolizing procedure.

METHODS:

A prospective single-system multi-center observational cohort study was performed on patients who underwent tracheostomy after acute respiratory failure secondary to COVID-19.

RESULTS:

Of the 53 patients who underwent tracheostomy, the average time from endotracheal intubation to tracheostomy was 19.7 days ±â€Š6.9 days. The most common indication for tracheostomy was acute respiratory distress syndrome, followed by failure to wean ventilation and post-extracorporeal membrane oxygenation decannulation. Thirty patients (56.6%) were liberated from the ventilator, 16 (30.2%) have been discharged alive, 7 (13.2%) have been decannulated, and 6 (11.3%) died. The average time from tracheostomy to ventilator liberation was 11.8 days ±â€Š6.9 days (range 2-32 days). Both open surgical and percutaneous dilational tracheostomy techniques were performed utilizing methods to mitigate aerosols. No healthcare worker transmissions resulted from performing the procedure.

CONCLUSIONS:

Alterations to tracheostomy practices and processes were successfully instituted. Following these steps, tracheostomy in COVID-19 intubated patients seems safe for both patients and healthcare workers performing the procedure.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / Tracheostomy / Critical Care / COVID-19 / Intubation, Intratracheal Type of study: Controlled clinical trial / Observational study / Risk factors Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged / Young adult Language: English Journal: Ann Surg Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / Tracheostomy / Critical Care / COVID-19 / Intubation, Intratracheal Type of study: Controlled clinical trial / Observational study / Risk factors Topics: Long Covid Limits: Adult / Aged / Female / Humans / Male / Middle aged / Young adult Language: English Journal: Ann Surg Year: 2020 Document Type: Article