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Use of Tracheostomy During the COVID-19 Pandemic: American College of Chest Physicians/American Association for Bronchology and Interventional Pulmonology/Association of Interventional Pulmonology Program Directors Expert Panel Report.
Lamb, Carla R; Desai, Neeraj R; Angel, Luis; Chaddha, Udit; Sachdeva, Ashutosh; Sethi, Sonali; Bencheqroun, Hassan; Mehta, Hiren; Akulian, Jason; Argento, A Christine; Diaz-Mendoza, Javier; Musani, Ali; Murgu, Septimiu.
  • Lamb CR; Department of Medicine, Division of Pulmonary and Critical Care, Lahey Hospital and Medical Center, Burlington, MA.
  • Desai NR; Chicago Chest Center, AMITA Health, Lisle, IL; Department of Medicine, Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL.
  • Angel L; Department of Medicine, Division of Pulmonary and Critical Care, New York University Langone Health, NY.
  • Chaddha U; Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
  • Sachdeva A; Department of Medicine, Division of Pulmonary and Critical Care, University of Maryland School of Medicine, Baltimore, MD.
  • Sethi S; Respiratory Institute, Division of Pulmonary and Critical Care, Cleveland Clinic, Cleveland, OH.
  • Bencheqroun H; Department of Medicine, Division of Pulmonary and Critical Care, University of California Riverside, CA.
  • Mehta H; Division of Pulmonary and Critical Care and Sleep Medicine, University of Florida, FL.
  • Akulian J; Division of Pulmonary and Critical Care, UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC.
  • Argento AC; Department of Medicine, Division of Pulmonary and Critical Care, Northwestern University, Feinberg School of Medicine, Chicago, IL.
  • Diaz-Mendoza J; Division of Pulmonary and Critical Care, Henry Ford Hospital and Department of Medicine, Wayne State University, Detroit, MI.
  • Musani A; Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Denver, CO.
  • Murgu S; Division of Pulmonary and Critical Care Medicine, The University of Chicago, Chicago, IL. Electronic address: smurgu@medicine.bsd.uchicago.edu.
Chest ; 158(4): 1499-1514, 2020 10.
Article in English | MEDLINE | ID: covidwho-805272
Semantic information from SemMedBD (by NLM)
1. Tracheostomy procedure TREATS Respiratory Failure
Subject
Tracheostomy procedure
Predicate
TREATS
Object
Respiratory Failure
2. Tracheostomy procedure TREATS Patients
Subject
Tracheostomy procedure
Predicate
TREATS
Object
Patients
3. Respiratory Failure PROCESS_OF Patients
Subject
Respiratory Failure
Predicate
PROCESS_OF
Object
Patients
4. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
5. Pulmonologists DIAGNOSES COVID-19
Subject
Pulmonologists
Predicate
DIAGNOSES
Object
COVID-19
6. Additional comments PROCESS_OF Patients
Subject
Additional comments
Predicate
PROCESS_OF
Object
Patients
7. Interventional procedure ADMINISTERED_TO Health Personnel
Subject
Interventional procedure
Predicate
ADMINISTERED_TO
Object
Health Personnel
8. Tracheostomy procedure TREATS Respiratory Failure
Subject
Tracheostomy procedure
Predicate
TREATS
Object
Respiratory Failure
9. Tracheostomy procedure TREATS Patients
Subject
Tracheostomy procedure
Predicate
TREATS
Object
Patients
10. Respiratory Failure PROCESS_OF Patients
Subject
Respiratory Failure
Predicate
PROCESS_OF
Object
Patients
11. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
12. Pulmonologists DIAGNOSES COVID-19
Subject
Pulmonologists
Predicate
DIAGNOSES
Object
COVID-19
13. Additional comments PROCESS_OF Patients
Subject
Additional comments
Predicate
PROCESS_OF
Object
Patients
14. Interventional procedure ADMINISTERED_TO Health Personnel
Subject
Interventional procedure
Predicate
ADMINISTERED_TO
Object
Health Personnel
ABSTRACT

BACKGROUND:

The role of tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic remains unknown. The goal of this consensus statement is to examine the current evidence for performing tracheostomy in patients with respiratory failure from COVID-19 and offer guidance to physicians on the preparation, timing, and technique while minimizing the risk of infection to health care workers (HCWs).

METHODS:

A panel including intensivists and interventional pulmonologists from three professional societies representing 13 institutions with experience in managing patients with COVID-19 across a spectrum of health-care environments developed key clinical questions addressing specific topics on tracheostomy in COVID-19. A systematic review of the literature and an established modified Delphi consensus methodology were applied to provide a reliable evidence-based consensus statement and expert panel report.

RESULTS:

Eight key questions, corresponding to 14 decision points, were rated by the panel. The results were aggregated, resulting in eight main recommendations and five additional remarks intended to guide health-care providers in the decision-making process pertinent to tracheostomy in patients with COVID-19-related respiratory failure.

CONCLUSION:

This panel suggests performing tracheostomy in patients expected to require prolonged mechanical ventilation. A specific timing of tracheostomy cannot be recommended. There is no evidence for routine repeat reverse transcription polymerase chain reaction testing in patients with confirmed COVID-19 evaluated for tracheostomy. To reduce the risk of infection in HCWs, we recommend performing the procedure using techniques that minimize aerosolization while wearing enhanced personal protective equipment. The recommendations presented in this statement may change as more experience is gained during this pandemic.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Respiratory Insufficiency / Tracheostomy / Infectious Disease Transmission, Patient-to-Professional / Coronavirus Infections / Betacoronavirus Type of study: Clinical Practice Guide / Prognostic study / Reviews / Risk factors Topics: Long Covid Limits: Humans Language: English Journal: Chest Year: 2020 Document Type: Article Affiliation country: J.chest.2020.05.571

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Respiratory Insufficiency / Tracheostomy / Infectious Disease Transmission, Patient-to-Professional / Coronavirus Infections / Betacoronavirus Type of study: Clinical Practice Guide / Prognostic study / Reviews / Risk factors Topics: Long Covid Limits: Humans Language: English Journal: Chest Year: 2020 Document Type: Article Affiliation country: J.chest.2020.05.571