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Tracheobronchial Slough, a Potential Pathology in Endotracheal Tube Obstruction in Patients With Coronavirus Disease 2019 (COVID-19) in the Intensive Care Setting.
Rubano, Jerry A; Jasinski, Patrick T; Rutigliano, Daniel N; Tassiopoulos, Apostolos K; Davis, James E; Beg, Tazeen; Poovathoor, Shaji; Bergese, Sergio D; Ahmad, Sahar; Jawa, Randeep S; Vosswinkel, James A; Talamini, Mark A.
  • Rubano JA; Division of Trauma Emergency Surgery and Critical Care, Department of Surgery, Stony Brook Medicine, Stony Brook, New York.
  • Jasinski PT; Department of Surgery, Stony Brook Medicine, Stony Brook, New York.
  • Rutigliano DN; Division of Trauma Emergency Surgery and Critical Care, Department of Surgery, Stony Brook Medicine, Stony Brook, New York.
  • Tassiopoulos AK; Division of Vascular and Endovascular Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, New York.
  • Davis JE; Department of Pathology, Stony Brook Medicine, Stony Brook, New York.
  • Beg T; Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York.
  • Poovathoor S; Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York.
  • Bergese SD; Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York.
  • Ahmad S; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stony Brook Medicine, Stony Brook, New York.
  • Jawa RS; Division of Trauma Emergency Surgery and Critical Care, Department of Surgery, Stony Brook Medicine, Stony Brook, New York.
  • Vosswinkel JA; Division of Trauma Emergency Surgery and Critical Care, Department of Surgery, Stony Brook Medicine, Stony Brook, New York.
  • Talamini MA; Department of Surgery, Stony Brook Medicine, Stony Brook, New York.
Ann Surg ; 272(2): e63-e65, 2020 08.
Article in English | MEDLINE | ID: covidwho-706917
Semantic information from SemMedBD (by NLM)
1. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
2. Necrotic debris COEXISTS_WITH Obstruction
Subject
Necrotic debris
Predicate
COEXISTS_WITH
Object
Obstruction
3. Obstruction PROCESS_OF Patients
Subject
Obstruction
Predicate
PROCESS_OF
Object
Patients
4. Parenchyma PART_OF Lung
Subject
Parenchyma
Predicate
PART_OF
Object
Lung
5. Acute obstruction PROCESS_OF Patients
Subject
Acute obstruction
Predicate
PROCESS_OF
Object
Patients
6. Intubated PROCESS_OF Patients
Subject
Intubated
Predicate
PROCESS_OF
Object
Patients
7. Respiration PROCESS_OF Patients
Subject
Respiration
Predicate
PROCESS_OF
Object
Patients
8. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
9. Necrotic debris COEXISTS_WITH Obstruction
Subject
Necrotic debris
Predicate
COEXISTS_WITH
Object
Obstruction
10. Obstruction PROCESS_OF Patients
Subject
Obstruction
Predicate
PROCESS_OF
Object
Patients
11. Parenchyma PART_OF Lung
Subject
Parenchyma
Predicate
PART_OF
Object
Lung
12. Acute obstruction PROCESS_OF Patients
Subject
Acute obstruction
Predicate
PROCESS_OF
Object
Patients
13. Intubated PROCESS_OF Patients
Subject
Intubated
Predicate
PROCESS_OF
Object
Patients
14. Respiration PROCESS_OF Patients
Subject
Respiration
Predicate
PROCESS_OF
Object
Patients
ABSTRACT

BACKGROUND:

A novel coronavirus (COVID-19) erupted in the latter part of 2019. The virus, SARS-CoV-2 can cause a range of symptoms ranging from mild through fulminant respiratory failure. Approximately 25% of hospitalized patients require admission to the intensive care unit, with the majority of those requiring mechanical ventilation. High density consolidations in the bronchial tree and in the pulmonary parenchyma have been described in the advanced phase of the disease. We noted a subset of patients who had a sudden, significant increase in peak airway, plateau and peak inspiratory pressures. Partial or complete ETT occlusion was noted to be the culprit in the majority of these patients.

METHODS:

With institutional IRB approval, we examined a subset of our mechanically ventilated COVID-19 patients. All of the patients were admitted to one of our COVID-19 ICUs. Each was staffed by a board certified intensivist. During multidisciplinary rounds, all arterial blood gas (ABG) results, ventilator settings and ventilator measurements are discussed and addressed. ARDSNet Protocols are employed. In patients with confirmed acute occlusion of the endotracheal tube (ETT), acute elevation in peak airway and peak inspiratory pressures are noted in conjunction with desaturation. Data was collected retrospectively and demographics, ventilatory settings and ABG results were recorded.

RESULTS:

Our team has observed impeded ventilation in intubated patients who are several days into the critical course. Pathologic evaluation of the removed endotracheal tube contents from one of our patients demonstrated a specimen consistent with sloughed tracheobronchial tissues and inflammatory cells in a background of dense mucin. Of 110 patients admitted to our adult COVID-19 ICUs, 28 patients required urgent exchange of their ETT.

CONCLUSION:

Caregivers need to be aware of this pathological finding, recognize, and to treat this aspect of the COVID-19 critical illness course, which is becoming more prevalent.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Pneumonia, Viral / Respiration, Artificial / Trachea / Bronchi / Coronavirus Infections / Intubation, Intratracheal Subject: Pneumonia, Viral / Respiration, Artificial / Trachea / Bronchi / Coronavirus Infections / Intubation, Intratracheal Language: English Journal: Ann Surg Clinical aspect: Prognosis Year: 2020

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Full text: Available Collection: International databases Database: MEDLINE Document Type: Article Main subject: Pneumonia, Viral / Respiration, Artificial / Trachea / Bronchi / Coronavirus Infections / Intubation, Intratracheal Subject: Pneumonia, Viral / Respiration, Artificial / Trachea / Bronchi / Coronavirus Infections / Intubation, Intratracheal Language: English Journal: Ann Surg Clinical aspect: Prognosis Year: 2020
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