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He P, Bao X, Jiang F, Liu X, Xu W, Yu D, Chen L, Chen F. Evaluating high-flow oxygen therapy after mechanical thrombectomy under general anesthesia in acute ischemic stroke: A retrospective single-center study. Clin Neurol Neurosurg 2024; 243:108359. [PMID: 38838421 DOI: 10.1016/j.clineuro.2024.108359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/29/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The use of mechanical thrombectomy for acute intracranial vascular occlusion under general anesthesia with endotracheal intubation is well-established as a safe and effective method. However, the process of extubation post-surgery presents challenges for certain patients. This retrospective study assesses the safety and efficacy of combining mechanical ventilation with high-flow oxygen inhalation as an interim strategy, while also examining its impact on long-term clinical outcomes. METHODS This research enrolled 119 patients with acute intracranial large vessel occlusion who underwent mechanical thrombectomy under general anesthesia with tracheal intubation between January 2020 and November 2023. Participants were categorized into two groups: Group 1 (n=55), which received high-flow oxygen (HFO) post-extubation, and Group 2 (n=64), which was treated with routine oxygen supplementation (RO). The study compared reintubation and tracheotomy rates between these groups to determine safety and effectiveness. Additionally, it analyzed long-term clinical outcomes by comparing NIHSS and mRS scores before treatment and at 90-day follow-up. RESULTS The reintubation rate post-extubation was significantly lower in the HFO group (12.7 %, n=7) compared to the RO group (31.2 %, n=20, p=0.016). The incidence of tracheotomy within 7 days was also reduced in the HFO group compared to the RO group (7.3 %, n=4 vs 20.3 %, n=13, p=0.043). Moreover, a greater proportion of patients in the HFO group achieved mRS scores of 0-2 at 90 days post-stroke than those in the RO group (60 %, n=33 vs 40.6 %, n=26, p=0.035). The median NIHSS score at 90 days was more favorable in the HFO group than in the RO group (6, IQR [1-18] vs 8, IQR [1-20], p=0.005). CONCLUSION The study suggests that high-flow oxygen therapy after mechanical thrombectomy under general anesthesia with tracheal intubation may lessen the need for reintubation and tracheotomy, potentially leading to improved long-term prognosis.
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Affiliation(s)
- Pingyou He
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Xiang Bao
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - FengFeng Jiang
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Xiaobo Liu
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Wei Xu
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Danfeng Yu
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Lin Chen
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
| | - Feng Chen
- Department of Neurosurgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
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Fiorelli A, Pecoraro A, Failla G, Blasio FD, Rendina EA, Venuta F, Andreetti C. Endoscopic Management of Benign Airway Stenosis in Coronavirus Disease 2019 Patients. Thorac Cardiovasc Surg 2024; 72:320-325. [PMID: 37072114 DOI: 10.1055/a-2075-8109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND The aims of this study were to evaluate the results of endoscopic dilation for simple benign airway stenosis in coronavirus disease 2019 (COVID-19) patients and whether COVID-19 infection was associated with higher rate of recurrence compared with a control group. METHODS It was an observational multicenter study including consecutive patients with simple benign airway stenosis undergoing endoscopic dilatation with at least 6 months of follow-up. The outcome of patients with COVID-19 infection was compared with that of a control group in relation to patient and stenosis characteristics, and procedure type. Then, univariable and multivariable analyses identified the risk factors for recurrence. RESULTS Seventy-nine patients were included in the study; 56 (71%) of these developed airway stenosis after COVID-19 infection. COVID-19 patients presented a higher rate of stenosis due to prolonged intubation (82 vs. 43%; p = 0.0014); no other differences were found regarding demographic data, characteristics of stenosis, and procedure type. Twenty-four (30%) patients had recurrence after first dilatation (32% for No-COVID-19 vs. 26% for COVID-19 group; p = 0.70), and in 11 (35%) of these, the stenosis recurred after repeated endoscopic treatment (65% for No-COVID-19 vs. 45% for COVID-19 group; p = 0.40). Subglottic stenosis (p = 0.013) and the use of laser (p = 0.016) were significant predictive factors for stenosis recurrence. CONCLUSION COVID-19 infection did not affect the outcome of endoscopic treatment of simple airway stenosis, and the treatment of these subsets of patients should not differ from that of general population.
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Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Giuseppe Failla
- Bronchoscopy Unit, Ospedale Cardarelli, Napoli, Campania, Italy
| | - Francesco De Blasio
- Respiratory Medicine and Pulmonary Rehabilitation Unit, Clinic Center, Naples, Italy
| | - Erino Angelo Rendina
- Thoracic Surgery Unit, Università degli Studi di Roma La Sapienza, Rome, Lazio, Italy
| | - Federico Venuta
- Thoracic Surgery Unit, Università degli Studi di Roma La Sapienza, Rome, Lazio, Italy
| | - Claudio Andreetti
- Thoracic Surgery Unit, Università degli Studi di Roma La Sapienza, Rome, Lazio, Italy
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Tekin P, Bulut A. Tracheostomy Timing in Unselected Critically Ill Patients with Prolonged Intubation: A Prospective Cohort Study. J Clin Med 2024; 13:2729. [PMID: 38792271 PMCID: PMC11121849 DOI: 10.3390/jcm13102729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 04/24/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Tracheostomy procedures are performed in the intensive care unit (ICU) for prolonged intubation, unsuccessful weaning and infection prevention through either percutaneous or surgical techniques. This study aimed to outline the impact of tracheostomy timing in the ICU on mortality, need for mechanical ventilation, and complications. Methods: Patients were included in the study on the day of tracheostomy. Demographic information, tracheostomy timing, technique, complications, sedation requirement and need for mechanical ventilation at discharge were recorded by an anesthesiologist, including the pre-tracheostomy period. Results: Tracheostomy was performed on 33 patients during the first 14 days of intubation and on 54 patients on the 15th day and beyond. There was no significant difference between the tracheostomy timing and mortality, sedation requirement, or weaning from the ventilator. We observed that patients who underwent tracheostomy with the surgical technique experienced more complications, but there was no significant difference. Tracheostomy performed after the 14th day was shown to be associated with prolonged hospital stay. Conclusions: Early tracheostomy does not have any influence on the need for mechanical ventilation, sedation and mortality. The optimal timing for tracheostomy is still controversial. We are of the opinion that randomized controlled trials involving patient groups with similar survival expectations are needed.
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Affiliation(s)
| | - Azime Bulut
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Giresun University, 28100 Giresun, Türkiye;
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Zhang R, Xu X, Chen H, Beck J, Sinderby C, Qiu H, Yang Y, Liu L. Predicting extubation in patients with traumatic cervical spinal cord injury using the diaphragm electrical activity during a single maximal maneuver. Ann Intensive Care 2023; 13:122. [PMID: 38055103 DOI: 10.1186/s13613-023-01217-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The unsuccessful extubation in patients with traumatic cervical spinal cord injuries (CSCI) may result from impairment diaphragm function and monitoring of diaphragm electrical activity (EAdi) can be informative in guiding extubation. We aimed to evaluate whether the change of EAdi during a single maximal maneuver can predict extubation outcomes in CSCI patients. METHODS This is a retrospective study of CSCI patients requiring mechanical ventilation in the ICU of a tertiary hospital. A single maximal maneuver was performed by asking each patient to inhale with maximum strength during the first spontaneous breathing trial (SBT). The baseline (during SBT before maximal maneuver), maximum (during the single maximal maneuver), and the increase of EAdi (ΔEAdi, equal to the difference between baseline and maximal) were measured. The primary outcome was extubation success, defined as no reintubation after the first extubation and no tracheostomy before any extubation during the ICU stay. RESULTS Among 107 patients enrolled, 50 (46.7%) were extubated successfully at the first SBT. Baseline EAdi, maximum EAdi, and ΔEAdi were significantly higher, and the rapid shallow breathing index was lower in patients who were extubated successfully than in those who failed. By multivariable logistic analysis, ΔEAdi was independently associated with successful extubation (OR 2.03, 95% CI 1.52-3.17). ΔEAdi demonstrated high diagnostic accuracy in predicting extubation success with an AUROC 0.978 (95% CI 0.941-0.995), and the cut-off value was 7.0 μV. CONCLUSIONS The increase of EAdi from baseline SBT during a single maximal maneuver is associated with successful extubation and can help guide extubation in CSCI patients.
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Affiliation(s)
- Rui Zhang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine,, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Xiaoting Xu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine,, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Hui Chen
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine,, Southeast University, Nanjing, 210009, Jiangsu, China
- Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215000, People's Republic of China
| | - Jennifer Beck
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Department of Critical Care, St. Michael's Hospital, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
- Member, Institute for Biomedical Engineering and Science Technology (iBEST) at Ryerson University and St-Michael's Hospital, Toronto, Canada
| | - Christer Sinderby
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Department of Critical Care, St. Michael's Hospital, Toronto, Canada
- Member, Institute for Biomedical Engineering and Science Technology (iBEST) at Ryerson University and St-Michael's Hospital, Toronto, Canada
- Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine,, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Yi Yang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine,, Southeast University, Nanjing, 210009, Jiangsu, China
| | - Ling Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine,, Southeast University, Nanjing, 210009, Jiangsu, China.
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Lee H, Lee H, Lim H. Sleep Quality of Family Caregivers of Children With Tracheostomies or Home Ventilators: A Scoping Review. JOURNAL OF FAMILY NURSING 2023; 29:368-381. [PMID: 37039276 DOI: 10.1177/10748407231157406] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Family caregivers of children with tracheostomies or home ventilators are more likely to experience poor sleep quality when undertaking the full responsibility of caring for fragile children. This scoping review aimed to identify the sleep quality, related factors, and their impact on the health of family caregivers of children with tracheostomies or home ventilators. The included studies (N = 16) were retrieved through PubMed, CINAHL, Cochrane Library, Embase, PsycINFO, and Web of Science. Family caregivers' sleep were low in quality, frequently disturbed, and insufficient. Their sleep quality was related to fatigue, anxiety, depression, family functioning, and health-related quality of life. The sleep disturbing factors were classified as child, caregiver, or environment-related, which were mutually interrelated. This review emphasizes the need to develop nursing interventions to both improve the sleep quality of family caregivers and the health of children with tracheostomies or home ventilators based on an in-depth understanding of the family's context.
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Shin D, Ma A, Chan Y. A Retrospective Review of 589 Percutaneous Tracheostomies in a Canadian Community Teaching Hospital. EAR, NOSE & THROAT JOURNAL 2023; 102:NP474-NP480. [PMID: 34134536 DOI: 10.1177/01455613211025744] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The primary objective of this study was to review the complication rate of percutaneous tracheostomies performed by a single surgeon in a community teaching hospital. METHODS This retrospective study reviewed the patients who underwent percutaneous tracheostomy with bronchoscopic guidance in a community hospital setting between 2009 and 2017. Patients older than the age of 18 requiring percutaneous tracheostomy were chosen for this retrospective study. Patients who were medically unstable, had no palpable neck landmarks, and inadequate neck extension were excluded. Indications for percutaneous tracheostomy included patients who had failed to wean from mechanical ventilation, required pulmonary toileting, or in whom airway protection was required. RESULTS Of the 600 patients who received percutaneous tracheostomy, 589 patients were included in the study. Intraoperative complication (2.6%) and postoperative complication rates (11.4%) compared similarly to literature reported rates. The most common intraoperative complications were bleeding, technical difficulties, and accidental extubation. Bleeding, tube obstruction, and infection were the most common postoperative complications. Overall burden of comorbidity, defined by Charlson Comorbidity Index, and coagulopathy were also found to be associated with higher complication rates. The decannulation rate at discharge was 46.3%. CONCLUSION Percutaneous tracheostomy is a safe alternative to open tracheostomies in the community setting for appropriately selected patients.
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Affiliation(s)
- Dongho Shin
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Mississauga, Ontario, Canada
| | - Andrew Ma
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Mississauga, Ontario, Canada
- Division of Otolaryngology-Head and Neck Surgery, University of Toronto, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Yvonne Chan
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Mississauga, Ontario, Canada
- Division of Otolaryngology-Head and Neck Surgery, University of Toronto, Trillium Health Partners, Mississauga, Ontario, Canada
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Keizman E, Frogel JK, Ram E, Volvovitch D, Jamal T, Levin S, Raanani E, Sternik L, Kogan A. Early tracheostomy after cardiac surgery improves intermediate- and long-term survival. Med Intensiva 2023; 47:516-525. [PMID: 36868962 DOI: 10.1016/j.medine.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/05/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE Complicated post-cardiac surgery course, can lead to both prolonged ICU stay and ventilation, and may require a tracheostomy. This study represents the single-center experience with post-cardiac surgery tracheostomy. The aim of this study was to assess the timing of tracheostomy as a risk factor for early, intermediate, and late mortality. The study's second aim was to assess the incidence of both superficial and deep sternal wound infections. DESIGN Retrospective study of prospectively collected data. SETTING Tertiary hospital. PATIENTS Patients were divided into 3 groups, according to the timing of tracheostomy; early (4-10 days); intermediate (11-20 days) and late (≥21 days). INTERVENTIONS None. MAIN VARIABLES OF INTEREST The primary outcomes were early, intermediate, and long-term mortality. The secondary outcome was the incidence of sternal wound infection. RESULTS During the 17-year study period, 12,782 patients underwent cardiac surgery, of whom 407 (3.18%) required postoperative tracheostomy. 147 (36.1%) had early, 195 (47.9%) intermediate, and 65 (16%) had a late tracheostomy. Early, 30-day, and in-hospital mortality was similar for all groups. However, patients, who underwent early- and intermediate tracheostomy, demonstrated statistically significant lower mortality after 1- and 5-year (42.8%; 57.4%; 64.6%; and 55.8%; 68.7%; 75.4%, respectively; P < .001). Cox model demonstrated age [1.025 (1.014-1.036)] and timing of tracheostomy [0.315 (0.159-0.757)] had significant impacts on mortality. CONCLUSIONS This study demonstrates a relationship between the timing of tracheostomy after cardiac surgery and mortality: early tracheostomy (within 4-10 days of mechanical ventilation) is associated with better intermediate- and long-term survival.
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Affiliation(s)
- Eitan Keizman
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Centre, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Jonathan K Frogel
- Department of Anaesthesiology, Sheba Medical Centre, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Eilon Ram
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Centre, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - David Volvovitch
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Centre, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Tamer Jamal
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Centre, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Shany Levin
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Centre, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Ehud Raanani
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Centre, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Leonid Sternik
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Centre, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel
| | - Alexander Kogan
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Centre, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel; Cardiac Surgery ICU, Sheba Medical Centre, affiliated to the Sackler School of Medicine, Tel Aviv University, Israel.
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Kazemian E, Solinski M, Wozniak A, Charous S. Dysphagia After Prolonged Intubation in SARS-CoV-19 Patients: A Single Institution Retrospective Review. Cureus 2023; 15:e41544. [PMID: 37554611 PMCID: PMC10404913 DOI: 10.7759/cureus.41544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 08/10/2023] Open
Abstract
To determine the impact of various factors on swallowing in SARS-CoV-19 patients after prolonged intubation. Methods: A retrospective chart review of SARS-CoV-19 patients intubated between February 2020 and March 2021 was performed. Independent variables, including duration and factors of intubation, and patient demographic characteristics were analyzed. Formal swallow studies were performed for patients who failed a screening swallow evaluation. Results: Seventy-three individuals of 308 patients reviewed had a dysphagia score of ≤5. A total of 49% of patients' dysphagia resolved prior to discharge, with a median of eight days between extubation and the last evaluation. The median duration of intubation was 11 days. Increasing age, congestive heart failure, cerebrovascular disease, and hypertension were associated with dysphagia at the first and/or last evaluation. Hispanic ethnicity was associated with a decreased risk of dysphagia (all p<0.05). Conclusions: Although various patient factors including age and congestive heart failure were associated with the development of dysphagia after prolonged intubation, the length of intubation was not.
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Affiliation(s)
- Elycia Kazemian
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
| | - Mark Solinski
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
| | - Amy Wozniak
- Statistics, Loyola University Chicago Health Sciences Division Center for Translational Research and Education, Maywood, USA
| | - Steven Charous
- Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, Maywood, USA
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Qiu Y, Yin Z, Wang Z, Xie M, Chen Z, Wu J, Wang Z. Early versus late tracheostomy in stroke-related patients: A systematic review and meta-analysis. J Clin Neurosci 2023; 114:48-54. [PMID: 37302372 DOI: 10.1016/j.jocn.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Tracheostomy is an operative intervention for patients who require ventilator assistance while in the intensive care unit (ICU). This study aimed to compare efficacy and safety between early tracheostomy (ET) and late tracheostomy (LT) in stroke patients. METHODS Embase, PubMed, and the Cochrane Library were searched for available studies. Stroke-related patients were categorized into ET and LT groups using seven days as the cutoff timepoint. The primary efficacy outcome was mortality; secondary efficacy outcomes were modified Rankin Scores (mRS) obtained at follow up, as well as durations of hospital stay, ICU stay, and ventilator use. Safety outcomes were total complication and ventilator associated pneumonia (VAP) incidence. RESULTS Nine studies with 3,789 patients were included in the current analysis. No statistical difference in mortality was observed. ET was associated with shorter hospital stay (MD -5.72, 95% CI -9.76 to -1.67), shorter ICU stay (MD -4.77, 95% CI -6.82 to -2.72), and shorter ventilator duration (MD -4.65, 95% CI -8.39 to -0.90); however, no statistically significant difference was found in follow-up mRS scores. Examination of safety measures found the ET group exhibited a lower rate of VAP compared with LT (OR 0.80, 95 % CI 0.68 to 0.93), while no statistical difference was found in total complications. CONCLUSION Our meta-analysis concluded that ET was associated with shorter hospital stay, less time on a ventilator, and lower incidence of VAP. Future studies are warranted to investigate the functional outcomes and the occurrence of complications of ET in stroke patients.
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Affiliation(s)
- Youjia Qiu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, China
| | - Ziqian Yin
- Suzhou Medical College of Soochow University, Suzhou, Jiangsu Province 215002, China
| | - Zilan Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, China.
| | - Minjia Xie
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, China
| | - Zhouqing Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, China
| | - Jiang Wu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, China
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, China.
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Hernández-García E, Hernández-Sandemetrio R, Quintana-Sanjuás A, Zapater-Latorre E, González-Herranz R, Sanz L, Reboll R, Pallarés-Martí B, Ollé-Moliner M, Martínez-Pascual P, Gotxi I, Chacón-Uribe A, Plaza G. Laryngotracheal Complications after Intubation for COVID-19: A Multicenter Study. Life (Basel) 2023; 13:life13051207. [PMID: 37240852 DOI: 10.3390/life13051207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Many of the patients with COVID-19 have suffered respiratory distress requiring prolonged endotracheal intubation (ETI) resulting in laryngotracheal complication with an impact on breathing, phonation, and swallowing. Our aim is to describe laryngeal injuries diagnosed after ETI in patients with COVID-19 in a multicentre study. METHODS A prospective descriptive observational study was conducted from January 2021 to December 2021, including COVID-19 patients with laryngeal complications due to ETI diagnosed in several Spanish hospitals. We analyzed the epidemiological data, previous comorbidities, mean time to ICU admission and ETI, need for tracheostomy, mean time on invasive mechanical ventilation until tracheostomy or weaning, mean time in ICU, type of residual lesions, and their treatment. RESULTS We obtained the collaboration of nine hospitals during the months of January 2021 to December 2021. A total of 49 patients were referred. Tracheostomy was performed in 44.9%, being late in most cases (more than 7-10 days). The mean number of days of ETI until extubation was 17.63 days, and the main post-intubation symptoms were dysphonia, dyspnea, and dysphagia, in 87.8%, 34.7%, and 42.9%, respectively. The most frequent injury was altered laryngeal mobility, present in 79.6%. Statistically, there is a greater amount of stenosis after late ETI and after delayed tracheostomy, not observing the data with the immobility alterations. CONCLUSION The mean number of days of ETI was long, according to the latest guidelines, with the need for several cycles of pronation. This long ETI may have had an impact on the increase of subsequent laryngeal sequelae, such as altered laryngeal mobility or stenosis.
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Affiliation(s)
- Estefanía Hernández-García
- Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain
| | | | - Ana Quintana-Sanjuás
- Department of Otorhinolaryngology, Hospital Universitario Lucus Augusti, 27003 Lugo, Spain
| | | | - Ramón González-Herranz
- Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain
| | - Lorena Sanz
- Department of Otorhinolaryngology, Hospital Universitario Torrejón, 28850 Madrid, Spain
| | - Rosa Reboll
- Department of Otorhinolaryngology, Hospital Universitario Sagunto, 46115 Valencia, Spain
| | - Beatriz Pallarés-Martí
- Department of Otorhinolaryngology, Consorci Corporació Sanitaria Parc Taulí Sabadell, 08208 Sabadell, Spain
| | | | - Paula Martínez-Pascual
- Department of Otorhinolaryngology, Hospital Universitario Severo Ochoa, 28914 Madrid, Spain
| | - Itziar Gotxi
- Department of Otorhinolaryngology, Hospital de Galdakao-Usansolo, 48960 Bizkaia, Spain
| | - Araly Chacón-Uribe
- Department of Otorhinolaryngology, Hospital Universitario Fundación Jiménez Diaz, 28042 Madrid, Spain
| | - Guillermo Plaza
- Department of Otorhinolaryngology, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28042 Madrid, Spain
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Ki S, Cho SB, Park S, Lee J. Management of unanticipated difficult airway in a patient with well-visualized vocal cords using video laryngoscopy - A case report. Anesth Pain Med (Seoul) 2023; 18:204-209. [PMID: 37183289 PMCID: PMC10183615 DOI: 10.17085/apm.23002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/10/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Difficult airway occurs due to anatomical abnormalities of the airway that can be predicted through airway assessments; however, abnormalities beyond the vocal cord can be clinically asymptomatic and undetected until intubation failure to advance the endotracheal tube. CASE We present a case of an unanticipated difficult airway in a stuporous 80-year-old female with a recent history of intracerebral hemorrhage and prolonged intubation. She required emergency ventriculo-peritoneal shunt surgery due to the progression of her hydrocephalus. Under anesthesia, facemask ventilation was easy and video laryngoscopy provided a full view of the glottis; however, endotracheal tube (ETT) entry failed. We suspected stenosis beyond the vocal cord, and a smaller diameter ETT was inserted and maintained for airway management during emergency surgery. Postoperative neck computed tomography findings revealed laryngotracheal stenosis (LTS). CONCLUSIONS Anesthesiologists should be aware that LTS may be asymptomatic and consider difficult airway guidelines in patients with history of prolonged endotracheal intubation.
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Affiliation(s)
- Seunghee Ki
- Department of Anesthesiology and Pain Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seung Bae Cho
- Department of Anesthesiology and Pain Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seongmin Park
- Department of Anesthesiology and Pain Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jeonghan Lee
- Department of Anesthesiology and Pain Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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12
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Bhasarkar A, Dolma K. Utility of Early Tracheostomy in Critically Ill Covid-19 Patients: A Systematic Review. Indian J Otolaryngol Head Neck Surg 2023; 75:1-11. [PMID: 37362113 PMCID: PMC10016177 DOI: 10.1007/s12070-022-03280-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/11/2022] [Indexed: 03/17/2023] Open
Abstract
COVID 19 has proven itself to be an agent of cataclysm and caused an uproar worldwide due to consistent strain on the finite resources available to tackle the situation. With the rapidly mutating viral nature, resultant disease is becoming more severe over time, causing significant numbers of critical cases needing invasive ventilatory support. Available literature dictates that tracheostomy might reduce the stress over healthcare infrastructure. Our systematic review is aimed towards understanding the influence of tracheostomy timing, over the course of the illness, by analyzing the relevant literature, thus aiding in decision making while managing critical COVID 19 patients. With predefined inclusion and exclusion criteria, PubMed data was explored using search terms like 'timing', 'tracheotomy'/'tracheostomy' and 'COVID'/'COVID-19'/'SARS CoV2' and 26 articles were finalised for formal review. 26 studies (3527 patients) were systematically reviewed. 60.3% and 39.5% patients underwent percutaneous dilational tracheostomy and open surgical tracheostomy respectively. We report 7.62%, 21.3%, 56% and 46.53% as approximate estimates, of complication rate, mortality rate, rate of mechanical ventilation weaning and rate of decannulation following tracheostomy in COVID 19 patients, respectively taking into account underestimation of the data. Provided that appropriate preventive measures and safety guidelines are strictly followed, moderately early tracheostomy (between 10 and 14 days of intubation) can prove quite efficacious in management of critical COVID 19 patients. Also, early tracheostomy was associated with early weaning and decannulation, thus reducing the enormous competition for intensive care unit beds.
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Affiliation(s)
- Ashwin Bhasarkar
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Kunzes Dolma
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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13
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Golestani S, Trust MD, Olson KA, Hill C, Bokenkamp M, Coopwood B, Teixeira P, Aydelotte J, Cardenas T, Brown L, Ramos E, Ngoue M, Ali S, Ng C, Brown CV. If at First You Do Not Succeed: Consideration of Attempts in Patients With Trauma. J Surg Res 2023; 283:778-782. [PMID: 36470203 DOI: 10.1016/j.jss.2022.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/08/2022] [Accepted: 08/22/2022] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Failed extubation in critically ill patients is associated with poor outcomes. In critically ill trauma patients who have failed extubation, providers must decide whether to proceed with tracheostomy or attempt extubation again. The aim of this study was to describe the natural history of failed extubation in trauma patients and determine whether tracheostomy or a second attempt at extubation is more appropriate. METHODS Trauma patients admitted to our level I trauma center from 2013 to 2019 were identified. Patients who failed extubation, defined as an unplanned reintubation within 48 h of extubation, were included. Patients who immediately underwent tracheostomy were compared with those who had subsequent attempts at extubation. The primary outcome was mortality, and the secondary outcomes were intensive care unit (ICU) length of stay (LOS), ventilator days, and hospital LOS. RESULTS The population included 93 patients who failed extubation and met inclusion criteria. A total of 53 patients were ultimately successfully extubated, whereas 40 patients underwent a tracheostomy. There was no statistically significant difference in demographics or injury patterns. Patients who underwent tracheostomy had a longer ICU LOS and more ventilator days. There was no difference in mortality or hospital LOS between the two groups. CONCLUSIONS In trauma patients, those who underwent subsequent attempts at extubation did not experience higher rates of mortality than those who received a tracheostomy. Tracheostomy was associated with longer ICU LOS and ventilator days. In certain situations, it is appropriate to consider subsequent attempts at extubation in trauma patients who fail extubation rather than proceeding directly to tracheostomy.
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Affiliation(s)
- Simin Golestani
- Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, Texas.
| | - Marc D Trust
- Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Kristophor A Olson
- Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Charles Hill
- Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Mary Bokenkamp
- Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Ben Coopwood
- Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Pedro Teixeira
- Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Jayson Aydelotte
- Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Tatiana Cardenas
- Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Lawrence Brown
- Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Emilio Ramos
- Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Marielle Ngoue
- Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Sadia Ali
- Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Chloe Ng
- Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Carlos Vr Brown
- Department of Surgery, Dell Medical School, University of Texas at Austin, Austin, Texas
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14
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Lin CW, Chiang TY, Chen WC, Chiu LW, Su YC, Lin HC, Chang CT. Is Postextubation Dysphagia Underestimated in the Era of COVID-19? A Systematic Review and Meta-Analysis. Otolaryngol Head Neck Surg 2023; 168:935-943. [PMID: 36842159 DOI: 10.1002/ohn.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 02/27/2023]
Abstract
OBJECTIVE To investigate the incidence rate of postextubation dysphagia (PED) in patients with COVID-19, as well as relative factors potentially influencing the clinical course of dysphagia. DATA SOURCES Six databases including PubMed, MEDLINE, Embase, ScienceDirect, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science were searched with no restriction on the language. REVIEW METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Data were extracted and cross-examined among 3 of the authors. The random-effects model was adopted for the statistical synthesis. The percentage and 95% confidence interval (CI) were adopted as the effect measurements of the PED incidence rate. Subgroup analyses, sensitivity analyses, and metaregression were also performed to identify the heterogeneity among the studies. RESULTS A total of 594 patients were enrolled and analyzed from the 10 eligible studies. The weighted incidence of PED in patients with COVID-19 was 66.5% (95% CI: 49.7%-79.9%). Age was the potential factor influencing the incidence rate after heterogeneity was adjusted by the metaregression analysis. CONCLUSION Compared to the current evidence reporting only 41% of the non-COVID patients experienced PED, our study further disclosed that a higher 66.5% of COVID-19 patients suffered from PED, which deserves global physicians' attention. With the association between COVID-19 and dysphagia having been more clearly understood, future clinicians are suggested to identify intubated patients' risk factors earlier to strengthen PED care programs in the era of COVID-19.
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Affiliation(s)
- Chung-Wei Lin
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ting-Yi Chiang
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wen-Ching Chen
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Wen Chiu
- Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yung-Chung Su
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Ching Lin
- Department of Otolaryngology, Division of Laryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Business Management and Institute of Biomedical Science, Institute of Healthcare Management, National Sun Yat-sen University, Kaohsiung, Taiwan.,Sleep Center, Robotic Surgery Center and Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chun-Tuan Chang
- Department of Business Management and Institute of Biomedical Science, Institute of Healthcare Management, National Sun Yat-sen University, Kaohsiung, Taiwan
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15
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Marini CP, McMurdo E, McNelis J, Lewis E, Policastro A, Lombardo G, Karev D, Petrone P. A prospective comparative study of the functional results associated with the use of Björk flap tracheostomy versus standard tracheostomy. Eur J Trauma Emerg Surg 2023; 49:1329-1335. [PMID: 36648502 DOI: 10.1007/s00068-023-02223-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/07/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND Placement of a tracheostomy for patients requiring prolonged mechanical ventilation (PMV) improves patients' comfort, decreases dead space ventilation, allows superior airway hygiene, and reduces the incidence of ventilator-associated pneumonia. Controversy still exists regarding the role of standard tracheostomy (ST) as opposed to the less frequently done Björk flap tracheostomy (BFT). This study compares the functional outcomes of these two techniques. STUDY DESIGN Seventy-nine patients receiving tracheostomy in a 12-month period: 38 BFT vs. 41 ST. Data included demographics, indications for PMV, ventilator days before tracheostomy, time to and a number of patients who passed the fiberoptic endoscopic evaluation of swallowing (FEES), time to and a number of patients decannulated. RESULTS Indications in both groups were PMV from trauma (18/38 vs 15/41), pneumonia (13/38 vs 13/41), and ARDS (7/38 vs 11/4), respectively (p > 0.05). Patients in both groups did not differ with regard to age, sex, GCS, duration of PMV before tracheostomy, the time to and a number of patients who passed the 1st FEES. However, the number of days and the number of FEES required before the next successful FEES in the 20 BFT and 21 ST patients who failed the 1st was 9 (4) vs. 16 (5), and 2 (1) vs. 4 (1), respectively (p < 0.05). Additionally, the number of intraoperative complications in aggregate were 0/38 in the BFT as opposed to 6/41 in the ST group (p < 0.05). CONCLUSION We conclude that BFT may be associated with an overall shorter time to restoration of normal swallowing when compared to ST.
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Affiliation(s)
| | | | | | | | | | | | | | - Patrizio Petrone
- Department of Surgery, NYU Long Island School of Medicine, NYU Langone Hospital-Long Island, 222 Station Plaza N., Suite 300, Mineola, NY, 11501, USA.
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16
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Shreckengost CSH, Wan L, Reitz AW, Lin A, Dhamsania RK, Spychalski J, Douglas JM, Lane A, Amin D, Roser S, Berkowitz D, Foianini JE, Moore R, Sreedharan JK, Niroula A, Smith R, Khullar OV. Tracheostomies of Patients With COVID-19: A Survey of Infection Reported by Health Care Professionals. Am J Crit Care 2023; 32:9-20. [PMID: 36065019 DOI: 10.4037/ajcc2022337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Health care professionals (HCPs) performing tracheostomies in patients with COVID-19 may be at increased risk of infection. OBJECTIVE To evaluate factors underlying HCPs' COVID-19 infection and determine whether tracheostomy providers report increased rates of infection. METHODS An anonymous international survey examining factors associated with COVID-19 infection was made available November 2020 through July 2021 to HCPs at a convenience sample of hospitals, universities, and professional organizations. Infections reported were compared between HCPs involved in tracheostomy on patients with COVID-19 and HCPs who were not involved. RESULTS Of the 361 respondents (from 33 countries), 50% (n = 179) had performed tracheostomies on patients with COVID-19. Performing tracheostomies on patients with COVID-19 was not associated with increased infection in either univariable (P = .06) or multivariable analysis (odds ratio, 1.48; 95% CI, 0.90-2.46; P = .13). Working in a low- or middle-income country (LMIC) was associated with increased infection in both univariable (P < .001) and multivariable analysis (odds ratio, 2.88; CI, 1.50-5.53; P = .001). CONCLUSIONS Performing tracheostomy was not associated with COVID-19 infection, suggesting that tracheostomies can be safely performed in infected patients with appropriate precautions. However, HCPs in LMICs may face increased infection risk.
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Affiliation(s)
| | - Limeng Wan
- Limeng Wan is a student, Rollins School of Public Health, Emory University
| | - Alexandra W Reitz
- Alexandra W. Reitz is a resident physician, Department of Surgery, Emory University
| | - Alice Lin
- Alice Lin is a student, Rollins School of Public Health, Emory University
| | - Rohan K Dhamsania
- Rohan K. Dhamsania is a student, Philadelphia College of Osteopathic Medicine, Suwanee, Georgia
| | - Julia Spychalski
- Julia Spychalski is a student, Rollins School of Public Health, Emory University
| | - J Miller Douglas
- J. Miller Douglas is a student, Department of Surgery and Rollins School of Public Health, Emory University
| | - Andrea Lane
- Andrea Lane is a student, Rollins School of Public Health, Emory University
| | - Dina Amin
- Dina Amin is an assistant professor, Department of Surgery, Emory University and a surgeon, Oral and Maxillofacial Surgery, Grady Memorial Hospital, Atlanta, Georgia
| | - Steven Roser
- Steven Roser is a professor, Department of Surgery, Emory University and a surgeon, Oral and Maxillofacial Surgery, Grady Memorial Hospital, Atlanta, Georgia
| | - David Berkowitz
- David Berkowitz is a physician and professor, Department of Medicine, School of Medicine, Emory University
| | | | - Renée Moore
- Renée Moore is a professor, Rollins School of Public Health, Emory University
| | - Jithin K Sreedharan
- Jithin K. Sreedharan is general secretary, Indian Association of Respiratory Care, Kochi, India
| | - Abesh Niroula
- Abesh Niroula is a physician, Department of Medicine, School of Medicine, Emory University
| | - Randi Smith
- Randi Smith is a surgeon, Department of Surgery, Emory University, a professor, Rollins School of Public Health, Emory University, and a surgeon, Trauma and Surgical Critical Care, Grady Memorial Hospital
| | - Onkar V Khullar
- Onkar V. Khullar is a surgeon, Department of Surgery, Emory University
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17
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Sakihama N, Okada R, Takahashi N, Fushimi N, Ooka T, Kawabe H, Ariizumi Y, Ohno K, Ueki Y, Tayama N, Tsutsumi T, Asakage T. Post-intubation laryngeal injury after COVID-19 treatment causing dyspnea: A report of six cases. Auris Nasus Larynx 2022:S0385-8146(22)00235-8. [PMID: 36581538 PMCID: PMC9767890 DOI: 10.1016/j.anl.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 11/15/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Severe cases of COVID-19 often require orotracheal intubation (OTI) and mechanical ventilation, and post-intubation laryngeal injury (PI-LI) is one of the important complications of OTI. Some studies have claimed that the frequency of PI-LI may be higher in COVID-19 patients as compared with that in non-COVID-19 patients, because of the larger size of endotracheal tube used, the longer OTI time, use of prone positioning of the patients, etc. Herein, we describe six cases of PI-LI who presented with dyspnea after recovering from COVID-19. Five of the patients were male and the median OTI period was 9 days. All the patients showed abnormal endoscopic findings, including posterior glottic synechiae/stenosis or subglottic/posterior glottic granulomas. Four patients required surgical intervention, including tracheostomy, laryngomicrosurgery, or laterofixation of the vocal cord. Many post-COVID-19 patients experience persistent symptoms (post-COVID-19 syndrome), including dyspnea. Two of our patients with dyspnea had been treated by internists as cases of post-COVID-19 syndrome. Therefore, we wish to underscore the need for every healthcare professional to be aware of the possibility of PI-LI after OTI, especially during the ongoing COVID-19 pandemic. Otolaryngologists should undertake endoscopic assessment of the larynx in patients presenting with dyspnea after recovering from COVID-19.
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Affiliation(s)
- Naoyuki Sakihama
- Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryuhei Okada
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan,Corresponding author at: Department of Head and Neck Surgery, Tokyo Medical and Dental University, M&D Tower, N-907, 1-5-45, Bunkyo, Tokyo 113-8519, Japan
| | - Naoto Takahashi
- Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoki Fushimi
- Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan,Department of Otolaryngology, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Tomoki Ooka
- Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroaki Kawabe
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yosuke Ariizumi
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuchika Ohno
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yutaka Ueki
- Department of Trauma and Acute Critical Care Medical Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Niro Tayama
- Department of Otolaryngology, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Takeshi Tsutsumi
- Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiro Asakage
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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18
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Surgical Excision of Unusual Sacked Neck and Mediastinum Abscess of Odontogenic Origin. Antibiotics (Basel) 2022; 11:antibiotics11121757. [PMID: 36551414 PMCID: PMC9774090 DOI: 10.3390/antibiotics11121757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022] Open
Abstract
The most common cause of neck infections is odontogenic abscesses that can often be life-threatening and require a surgical drain associated with antibiotic therapy. We present a case of the surgical management of an odontogenic sack-shaped and walled abscess arising from elements 3.6, 3.7 and 3.8 that reached the laterocervical spaces and anterior mediastinum in a 28-year-old healthy woman. Typical signs and symptoms of cervical complications of dental origin are fever, a neck mass, lymphadenopathy, trismus and odynophagia. The gold standard treatment in these situations is a multidisciplinary approach involving an oral surgeon, ENT specialist and thoracic surgeon to drain the infected material. To the best of our knowledge, this is the first described case report of a dental abscess enclosed in a sack in the deep space of the neck and in the anterior space of the mediastinum.
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19
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Bickenbach J, Fritsch S. [Weaning from invasive ventilation : Challenges in the clinical routine]. DIE ANAESTHESIOLOGIE 2022; 71:910-920. [PMID: 36418440 DOI: 10.1007/s00101-022-01219-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
Modern intensive care medicine is caught between the conflicting demands of an efficient but also increasingly more technical intensive care treatment with numerous therapeutic options and, at the same time, an ageing society with increasing morbidity. This is reflected, among other things, in an increasing number of ventilated patients in intensive care units and an increasing proportion of patients for whom ventilation cannot easily be discontinued. Weaning from a ventilator, which can account for more than 50% of the total ventilation time, therefore plays a central role in this process. This main topic article presents the need for strategically wise and holistic actions to minimize the consequences of invasive mechanical ventilation for patients. An attempt is made to shed more light on individual aspects of the ventilation weaning process with high relevance for clinical practice. Especially for prolonged weaning from ventilation, many more concepts are needed than simply ending ventilation.
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Affiliation(s)
- Johannes Bickenbach
- Klinik für Operative Intensivmedizin und Intermediate Care, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - Sebastian Fritsch
- Klinik für Operative Intensivmedizin und Intermediate Care, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
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20
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Singh Y, Soni KD, Singh A, Choudhary N, Perveen F, Aggarwal R, Patel N, Kumar S, Trikha A. Clinical characteristics of COVID-19 patients who underwent tracheostomy and its effect on outcome: A retrospective observational study. World J Virol 2022; 11:477-484. [PMID: 36483098 PMCID: PMC9724205 DOI: 10.5501/wjv.v11.i6.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/12/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The exponential rise in Coronavirus disease 2019 (COVID-19) cases has resulted in an increased number of patients requiring prolonged ventilatory support and subsequent tracheostomy. With the limited availability of literature regarding the outcomes of COVID-19 patients with tracheostomy, we attempted to study the clinical characteristics and multiple parameters affecting the outcomes in these patients.
AIM To determine all-cause mortality following tracheostomy and its association with various risk factors in COVID-19 patients.
METHODS This retrospective study included 73 adult COVID-19 patients admitted to the ICU between 1 April, 2020 and 30 September, 2021 who underwent tracheostomy as a result of acute respiratory failure due to COVID-19. The data collected included demographics (age, sex), comorbidities, type of oxygen support at admission, severity of COVID-19, complications, and other parameters such as admission to tracheostomy, intubation to tracheostomy, ICU stay, hospital stay, and outcome.
RESULTS This study included 73 adult patients with an average age of 52 ± 16.67 years, of which 52% were men. The average time for admission to tracheostomy was 18.12 ± 12.98 days while intubation to tracheostomy was 11.97 ± 9 days. The mortality rate was 71.2% and 28.8% of patients were discharged alive. The mean duration of ICU and hospital stay was 25 ± 11 days and 28.21 ± 11.60 days, respectively. Greater age, severe COVID-19, mechanical ventilation, shock and acute kidney injury were associated with poor prognosis; however, early tracheostomy in intubated patients resulted in better outcomes.
CONCLUSION Patients with severe COVID-19 requiring mechanical ventilation have a poor prognosis but patients with early tracheostomy may benefit with no added risk. We recommend that the timing of tracheostomy be decided on a case-by-case basis and a well-designed randomised controlled trial should be performed to elucidate the potential benefit of early tracheostomy in such patients.
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Affiliation(s)
- Yudhyavir Singh
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Kapil Dev Soni
- Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Abhishek Singh
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Nikita Choudhary
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Fahina Perveen
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Richa Aggarwal
- Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Nishant Patel
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Shailendra Kumar
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anjan Trikha
- Department of Anesthesia, All India Institute of Medical Sciences, New Delhi 110029, India
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21
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Quinn L, Veenith T, Bion J, Hemming K, Whitehouse T, Lilford R. Bayesian analysis of a systematic review of early versus late tracheostomy in ICU patients. Br J Anaesth 2022; 129:693-702. [PMID: 36163077 PMCID: PMC9642836 DOI: 10.1016/j.bja.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/02/2022] [Accepted: 08/15/2022] [Indexed: 12/01/2022] Open
Abstract
Background A recent systematic review and meta-analysis of RCTs of early vs late tracheostomy in mechanically ventilated patients suggest that early tracheostomy reduces the duration of ICU stay and mechanical ventilation, but does not reduce short-term mortality or ventilator-associated pneumonia (VAP). Meta-analysis of randomised trials is typically performed using a frequentist approach, and although reporting confidence intervals, interpretation is usually based on statistical significance. To provide a robust basis for clinical decision-making, we completed the search used from the previous review and analysed the data using Bayesian methods to estimate posterior probabilities of the effect of early tracheostomy on clinical outcomes. Methods The search was completed for RCTS comparing early vs late tracheostomy in the databases PubMed, EMBASE, and Cochrane library in June 2022. Effect estimates and 95% confidence intervals were calculated for the outcomes short-term mortality, VAP, duration of ICU stay, and mechanical ventilation. A Bayesian meta-analysis was performed with uninformative priors. Risk ratios (RRs) and standardised mean differences (SMDs) with 95% credible intervals were reported alongside posterior probabilities for any benefit (RR<1; SMD<0), a small benefit (number needed to treat, 200; SMD<–0.5), or modest benefit (number needed to treat, 100; SMD<–1). Results Nineteen RCTs with 3508 patients were included. Comparing patients with early vs late tracheostomy, the posterior probabilities for any benefit, small benefit, and modest benefit, respectively, were: 99%, 99%, and 99% for short-term mortality; 94%, 78%, and 51% for VAP; 97%, 43%, and 1% for duration of mechanical ventilation; and 97%, 75%, and 27% and for length of ICU stay. Conclusions Bayesian meta-analysis suggests a high probability that early tracheostomy compared with delayed tracheostomy has at least some benefit across all clinical outcomes considered.
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Affiliation(s)
- Laura Quinn
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK.
| | - Tonny Veenith
- Department of Critical Care and Anaesthesia, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Julian Bion
- Intensive Care Medicine, University of Birmingham, Birmingham, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tony Whitehouse
- Department of Critical Care and Anaesthesia, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Richard Lilford
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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22
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Association of mortality and early tracheostomy in patients with COVID-19: a retrospective analysis. Sci Rep 2022; 12:15406. [PMID: 36104383 PMCID: PMC9474557 DOI: 10.1038/s41598-022-19567-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 08/31/2022] [Indexed: 12/15/2022] Open
Abstract
COVID-19 adds to the complexity of optimal timing for tracheostomy. Over the course of this pandemic, and expanded knowledge of the disease, many centers have changed their operating procedures and performed an early tracheostomy. We studied the data on early and delayed tracheostomy regarding patient outcome such as mortality. We performed a retrospective analysis of all tracheostomies at our institution in patients diagnosed with COVID-19 from March 2020 to June 2021. Time from intubation to tracheostomy and mortality of early (≤ 10 days) vs. late (> 10 days) tracheostomy were the primary objectives of this study. We used mixed cox-regression models to calculate the effect of distinct variables on events. We studied 117 tracheostomies. Intubation to tracheostomy shortened significantly (Spearman’s correlation coefficient; rho = − 0.44, p ≤ 0.001) during the course of this pandemic. Early tracheostomy was associated with a significant increase in mortality in uni- and multivariate analysis (Hazard ratio 1.83, 95% CI 1.07–3.17, p = 0.029). The timing of tracheostomy in COVID-19 patients has a potentially critical impact on mortality. The timing of tracheostomy has changed during this pandemic tending to be performed earlier. Future prospective research is necessary to substantiate these results.
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23
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Battaglini D, Premraj L, White N, Sutt AL, Robba C, Cho SM, Di Giacinto I, Bressan F, Sorbello M, Cuthbertson B, Bassi GL, Suen J, Fraser J, Pelosi P. Tracheostomy outcomes in critically ill COVID-19 patients: a systematic review, meta-analysis, and meta-regression. Br J Anaesth 2022; 129:679-692. [PMID: 36182551 PMCID: PMC9345907 DOI: 10.1016/j.bja.2022.07.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/12/2022] [Accepted: 07/12/2022] [Indexed: 11/22/2022] Open
Abstract
Background We performed a systematic review of mechanically ventilated patients with COVID-19, which analysed the effect of tracheostomy timing and technique (surgical vs percutaneous) on mortality. Secondary outcomes included intensive care unit (ICU) and hospital length of stay (LOS), decannulation from tracheostomy, duration of mechanical ventilation, and complications. Methods Four databases were screened between January 1, 2020 and January 10, 2022 (PubMed, Embase, Scopus, and Cochrane). Papers were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Population or Problem, Intervention or exposure, Comparison, and Outcome (PICO) guidelines. Meta-analysis and meta-regression for main outcomes were performed. Results The search yielded 9024 potentially relevant studies, of which 47 (n=5268 patients) were included. High levels of between-study heterogeneity were observed across study outcomes. The pooled mean tracheostomy timing was 16.5 days (95% confidence interval [CI]: 14.7–18.4; I2=99.6%). Pooled mortality was 22.1% (95% CI: 18.7–25.5; I2=89.0%). Meta-regression did not show significant associations between mortality and tracheostomy timing, mechanical ventilation duration, time to decannulation, and tracheostomy technique. Pooled mean estimates for ICU and hospital LOS were 29.6 (95% CI: 24.0–35.2; I2=98.6%) and 38.8 (95% CI: 32.1–45.6; I2=95.7%) days, both associated with mechanical ventilation duration (coefficient 0.8 [95% CI: 0.2–1.4], P=0.02 and 0.9 [95% CI: 0.4–1.4], P=0.01, respectively) but not tracheostomy timing. Data were insufficient to assess tracheostomy technique on LOS. Duration of mechanical ventilation was 23.4 days (95% CI: 19.2–27.7; I2=99.3%), not associated with tracheostomy timing. Data were insufficient to assess the effect of tracheostomy technique on mechanical ventilation duration. Time to decannulation was 23.8 days (95% CI: 19.7–27.8; I2=98.7%), not influenced by tracheostomy timing or technique. The most common complications were stoma infection, ulcers or necrosis, and bleeding. Conclusions In patients with COVID-19 requiring tracheostomy, the timing and technique of tracheostomy did not clearly impact on patient outcomes. Systematic Review Protocol PROSPERO CRD42021272220.
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24
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Sindi A. The impact of tracheostomy delay in intensive care unit patients: a two-year retrospective cohort study. Eur J Med Res 2022; 27:132. [PMID: 35883165 PMCID: PMC9316324 DOI: 10.1186/s40001-022-00753-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/04/2022] [Indexed: 11/14/2022] Open
Abstract
Aims This study was undertaken to evaluate our tracheostomy service and identify reasons for any delays. Methods A retrospective study in an academic tertiary-care hospital in Jeddah, Saudi Arabia. Inclusion criteria were any patients in ICU who required a surgical tracheostomy over a 2-year period (January 2014 to December 2015). The primary outcome was delayed tracheostomy referral and secondary outcomes included the number of days between referral and consultation, days between consultation and tracheostomy placement, and mortality rates. Results Ninety-nine patients had a tracheostomy between January 2014 to December 2015 and could be analysed, mean age of 52.7 years, 44.5% females. The average duration from referral to tracheostomy was 5.12 days (SD 6.52). Eighteen patients (18.2%) had delayed tracheostomy (> 7 days from referral). The main reasons for the delay were the patient’s medical condition (50%, n = 9), followed by low haemoglobin (38.9%, n = 7). Administrative reasons were recorded in 5 cases only (28%); 2 due to operating room lack of time, 2 due to multidisciplinary issues, and 1 due to family refusal. Laboratory-confirmed low haemoglobin, a prescription of anti-platelets, or a prescription of anti-coagulation were not associated with a longer duration between referral and tracheostomy placement. An increase of 1 day in the time between referral and tracheostomy corresponded to an increase in delay in discharge from ICU of 1.24 days (95% CI 0.306 to 2.18). Conclusion Although most delays related to the clinical condition of the patient, administrative and multidisciplinary factors also play a role. Early tracheostomy (less than 14 days) from intubation increases the survival rates of patients and improves their clinical outcomes. Further prospective evaluation is needed to confirm the impact of delay in performing surgical tracheostomy among ICU patients whose bedside percutaneous tracheostomy is contraindicated.
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Affiliation(s)
- Anees Sindi
- Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. .,King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia.
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25
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Eeg-Olofsson M, Pauli N, Hafsten L, Jacobsson J, Lundborg C, Brink M, Larsson H, Lindell E, Löwhagen K, Gisslén M, Bergquist H. TTCOV19: timing of tracheotomy in SARS-CoV-2-infected patients: a multicentre, single-blinded, randomized, controlled trial. Crit Care 2022; 26:142. [PMID: 35585614 PMCID: PMC9115544 DOI: 10.1186/s13054-022-04005-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/01/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Critically ill COVID-19 patients may develop acute respiratory distress syndrome and the need for respiratory support, including mechanical ventilation in the intensive care unit. Previous observational studies have suggested early tracheotomy to be advantageous. The aim of this parallel, multicentre, single-blinded, randomized controlled trial was to evaluate the optimal timing of tracheotomy. METHODS SARS-CoV-2-infected patients within the Region Västra Götaland of Sweden who needed intubation and mechanical respiratory support were included and randomly assigned to early tracheotomy (≤ 7 days after intubation) or late tracheotomy (≥ 10 days after intubation). The primary objective was to compare the total number of mechanical ventilation days between the groups. RESULTS One hundred fifty patients (mean age 65 years, 79% males) were included. Seventy-two patients were assigned to early tracheotomy, and 78 were assigned to late tracheotomy. One hundred two patients (68%) underwent tracheotomy of whom sixty-one underwent tracheotomy according to the protocol. The overall median number of days in mechanical ventilation was 18 (IQR 9; 28), but no significant difference was found between the two treatment regimens in the intention-to-treat analysis (between-group difference: - 1.5 days (95% CI - 5.7 to 2.8); p = 0.5). A significantly reduced number of mechanical ventilation days was found in the early tracheotomy group during the per-protocol analysis (between-group difference: - 8.0 days (95% CI - 13.8 to - 2.27); p = 0.0064). The overall correlation between the timing of tracheotomy and days of mechanical ventilation was significant (Spearman's correlation: 0.39, p < 0.0001). The total death rate during intensive care was 32.7%, but no significant differences were found between the groups regarding survival, complications or adverse events. CONCLUSIONS The potential superiority of early tracheotomy when compared to late tracheotomy in critically ill patients with COVID-19 was not confirmed by the present randomized controlled trial but is a strategy that should be considered in selected cases where the need for MV for more than 14 days cannot be ruled out. Trial registration NCT04412356 , registered 05/24/2020.
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Affiliation(s)
- Måns Eeg-Olofsson
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gröna stråket 5, 413 45, Gothenburg, Sweden.
| | - Nina Pauli
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gröna stråket 5, 413 45, Gothenburg, Sweden
| | - Louise Hafsten
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gröna stråket 5, 413 45, Gothenburg, Sweden
| | - Josephine Jacobsson
- Department of Anesthesia and Intensive Care Medicine, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Anesthesia and Intensive Care Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christopher Lundborg
- Department of Anesthesia and Intensive Care Medicine, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Anesthesia and Intensive Care Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Brink
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helen Larsson
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Otorhinolaryngology, Region Västra Götaland, NU-Hospital Group, Head and Neck Surgery, Trollhättan, Sweden
| | - Ellen Lindell
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Otorhinolaryngology, Region Västra Götaland, Södra Älvsborg Hospital, Boras, Sweden
| | - Karin Löwhagen
- Department of Anesthesia and Intensive Care Medicine, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Anesthesia and Intensive Care Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Gisslén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Bergquist
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gröna stråket 5, 413 45, Gothenburg, Sweden
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26
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Hansson A, Sunnergren O, Hammarskjöld A, Alkemark C, Taxbro K. Characteristics, complications, and a comparison between early and late tracheostomy: A retrospective observational study on tracheostomy in patients with COVID‐19‐related acute respiratory distress syndrome. Health Sci Rep 2022; 5:e595. [PMID: 35509382 PMCID: PMC9059198 DOI: 10.1002/hsr2.595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/08/2023] Open
Abstract
Background and Aims As the coronavirus disease 2019 (COVID-19) pandemic spread worldwide in 2020, the number of patients requiring intensive care and invasive mechanical ventilation (IMV) has increased rapidly. During the pandemic, early recommendations suggested that tracheostomy should be postponed, as the potential benefits were not certain to exceed the risk of viral transmission to healthcare workers. The aim of this study was to assess the utility of tracheostomy in patients with COVID-19-related acute respiratory distress syndrome, in terms of patient and clinical characteristics, outcomes, and complications, by comparing between early and late tracheostomy. Methods A multicenter, retrospective observational study was conducted in Jönköping County, Sweden. Between 14 March 2020 and 13 March 2021, 117 patients were included. All patients ≥18 years of age with confirmed COVID-19, who underwent tracheostomy were divided into two groups based on the timing of the procedure (≤/>7 days). Outcomes including the time on IMV, intensive care unit (ICU) length of stay, and mortality 30 days after ICU admission, as well as complications due to tracheostomy were compared between the groups. Results Early tracheostomy (<7 days, n = 56) was associated with a shorter median duration of mechanical ventilation (7 [12], p = 0.001) as well as a shorter median ICU stay (8 [14], p = 0.001). The most frequent complication of tracheostomy was minor bleeding. With the exception of a higher rate of obesity in the group receiving late tracheostomy, the patient characteristics were similar between the groups. Conclusion This study showed that early tracheostomy was safe and associated with a shorter time on IMV as well as a shorter ICU length of stay, implicating possible clinical benefits in critically ill COVID-19 patients. However, it is necessary to verify these findings in a randomized controlled trial.
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Affiliation(s)
- Anna Hansson
- Department of Anaesthesiology and Intensive Care Medicine Ryhov County Hospital Jönköping Sweden
- Faculty of Medicine and Health Sciences, School of Medicine Linköping University Linköping Sweden
| | - Ola Sunnergren
- Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
- Department of Otorhinolaryngology Region Jönköping County Jönköping Sweden
| | - Anneli Hammarskjöld
- Department of Anaesthesiology and Intensive Care Medicine Ryhov County Hospital Jönköping Sweden
| | - Catarina Alkemark
- Department of Anaesthesiology and Intensive Care Medicine Ryhov County Hospital Jönköping Sweden
| | - Knut Taxbro
- Department of Anaesthesiology and Intensive Care Medicine Ryhov County Hospital Jönköping Sweden
- Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
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27
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Pawlik J, Tomaszek L, Mazurek H, Mędrzycka-Dąbrowska W. Risk Factors and Protective Factors against Ventilator-Associated Pneumonia-A Single-Center Mixed Prospective and Retrospective Cohort Study. J Pers Med 2022; 12:jpm12040597. [PMID: 35455713 PMCID: PMC9025776 DOI: 10.3390/jpm12040597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/02/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Understanding the factors associated with the development of ventilator-associated pneumonia (VAP) in critically ill patients in the intensive care unit (ICU) will allow for better prevention and control of VAP. The aim of the study was to evaluate the incidence of VAP, as well as to determine risk factors and protective factors against VAP. Design: Mixed prospective and retrospective cohort study. Methods: The cohort involved 371 critically ill patients who received standard interventions to prevent VAP. Additionally, patients in the prospective cohort were provided with continuous automatic pressure control in tapered cuffs of endotracheal or tracheostomy tubes and continuous automatic subglottic secretion suction. Logistic regression was used to assess factors affecting VAP. Results: 52 (14%) patients developed VAP, and the incidence density of VAP per 1000 ventilator days was 9.7. The median days to onset of VAP was 7 [4; 13]. Early and late onset VAP was 6.2% and 7.8%, respectively. According to multivariable logistic regression analysis, tracheotomy (OR = 1.6; CI 95%: 1.1 to 2.31), multidrug-resistant bacteria isolated in the culture of lower respiratory secretions (OR = 2.73; Cl 95%: 1.83 to 4.07) and ICU length of stay >5 days (OR = 3.32; Cl 95%: 1.53 to 7.19) were positively correlated with VAP, while continuous control of cuff pressure and subglottic secretion suction used together were negatively correlated with VAP (OR = 0.61; Cl 95%: 0.43 to 0.87). Conclusions: Tracheotomy, multidrug-resistant bacteria, and ICU length of stay >5 days were independent risk factors of VAP, whereas continuous control of cuff pressure and subglottic secretion suction used together were protective factors against VAP.
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Affiliation(s)
- Jarosław Pawlik
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland; (J.P.); or (L.T.)
| | - Lucyna Tomaszek
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland; (J.P.); or (L.T.)
- National Institute of Tuberculosis and Lung Diseases, 34-700 Rabka-Zdroj, Poland
| | - Henryk Mazurek
- Department of Pneumonology and Cystic Fibrosis, National Institute of Tuberculosis and Lung Diseases, 34-700 Rabka-Zdroj, Poland;
- Institute of Health, State University of Applied Sciences in Nowy Sącz, 33-300 Nowy Sącz, Poland
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University of Gdansk, 80-211 Gdansk, Poland
- Correspondence:
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28
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Ralli M, Colizza A, D’Aguanno V, Scarpa A, Russo G, Petrone P, Grassia R, Guarino P, Capasso P. Risk of SARS-CoV-2 contagion in otolaryngology specialists. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:S58-S67. [PMID: 35763275 PMCID: PMC9137374 DOI: 10.14639/0392-100x-suppl.1-42-2022-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/31/2022] [Indexed: 06/15/2023]
Abstract
COVID-19 has rapidly spread in the past two years with a profound impact on otolaryngological activities, which has undergone radical transformation to guarantee diagnostic and therapeutic procedures mainly in oncology and urgent patients, while ensuring protection for healthcare personnel and patients. During the initial phases of the pandemic, scheduled visits and elective surgeries were postponed leading to a delay in the diagnosis and treatment of several diseases, including head and neck cancer, with a shift toward more advanced cancer stages and more aggressive treatments. Aerosol and droplets are the main routes of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), thus leading to a high risk of contagion during otolaryngology visits and surgery. Therefore, the correct use of personal protective equipment (PPE) and attention to procedure-specific risks and measures to avoid contagion are of utmost importance for healthcare professionals, and especially for those dealing with otolaryngology diseases. This narrative review highlights that otolaryngological activity implies a high risk of contagion during outpatient visit, surgery, or urgent conditions. The correct use of PPE, evaluation of procedure-specific risks and reduction of non-urgent procedures are considered the main strategies to limit contagion.
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Affiliation(s)
- Massimo Ralli
- Department of Sense Organs. Sapienza University of Rome, Rome, Italy
| | - Andrea Colizza
- Department of Sense Organs. Sapienza University of Rome, Rome, Italy
| | | | - Alfonso Scarpa
- Department of Medicine, Surgery and Dentistry. University of Salerno, Salerno, Italy
| | - Gennaro Russo
- Otolaryngology Unit, AORN dei Colli, V. Monaldi Hospital, Napoli, Italy
| | | | - Rosa Grassia
- Otolaryngology Unit, AORN dei Colli, V. Monaldi Hospital, Napoli, Italy
| | - Pierre Guarino
- Otolaryngology Unit, Santo Spirito Hospital, Pescara, Italy
| | - Pasquale Capasso
- Otolaryngology Unit, AORN dei Colli, V. Monaldi Hospital, Napoli, Italy
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29
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Hallan DR, Simion C, Rizk E. Early Versus Late Tracheostomy in Spontaneous Intracerebral Hemorrhage. Cureus 2022; 14:e24059. [PMID: 35573583 PMCID: PMC9097938 DOI: 10.7759/cureus.24059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/12/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Recent literature supports early tracheostomy (<=7 days) over delayed tracheostomy (>7 days-3 months) to improve overall clinical outcomes for patients admitted with an acute head injury. There is conflicting evidence for the same in hemorrhagic stroke. Using a multi-institutional database, we explored this question in nontraumatic spontaneous intracerebral hemorrhage (sICH) patients. METHODS We used a de-identified database network (TriNetX's Research Network) to gather information on early tracheostomy (<=7 days) and late tracheostomy (>7d-3 months) in sICH patients. After accounting for the most common comorbidities, we explored the impact of this intervention on multiple patient outcomes including intensive care unit (ICU) length of stay, pneumonia, and mortality at 30, 90, and 365 days. RESULTS After propensity score matching, a total of 1210 patients were identified for both early tracheostomy (cohort 1) and late tracheostomy (cohort 2) cohorts. The 30-day survival rate was 0.9287 in cohort 1 vs 0.9536 in cohort 2, with a risk difference of 2.39% (95% confidence interval (CI) 0.557%-4.23%; relative risk (RR) 1.54, 95% CI (1.10-2.15); OR 1.577, 95% CI (1.11-2.24); p = 0.006). The 90-day and 365-day end-point survival rates were not statistically different between cohorts. ICU level of care codes were billed an average of 9.76 (SD 8.964) times in cohort 1 vs 14.618 (SD 11.851) in cohort 2 (p<0.0001). At 365 days, there were no differences between the two groups for pulmonary embolism, myocardial infarction, deep venous thrombosis, palliative care consultation, and percutaneous endoscopic gastrostomy tube placement. Cohort 1 had decreased incidence of pneumonia with 665 (54.95%) patients compared to cohort 2 with 725 (59.91%) (RR 0.917, 95% CI (0.856-0.983), OR 0.816, 95% CI (0.695-0.95), p = 0.013). CONCLUSION Early tracheostomy in sICH patients was associated with decreased pneumonia risk, decreased length of ICU care, and no difference in mortality at 90 and 365 days.
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Affiliation(s)
- David R Hallan
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Christopher Simion
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Elias Rizk
- Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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30
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Tolotti A, Cadorin L, Bonetti L, Valcarenghi D, Pagnucci N. Communication experiences of tracheostomy patients with nurses in the ICU: A scoping review. J Clin Nurs 2022; 32:2361-2370. [PMID: 35343019 DOI: 10.1111/jocn.16296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/31/2022] [Accepted: 02/24/2022] [Indexed: 01/23/2023]
Abstract
INTRODUCTION The quality of care for tracheostomy and mechanically ventilated patients in intensive care units (ICUs) has improved considerably. However, the communication barrier attributable to these procedures generates many problems for patients, as they are unable to communicate effectively with family members and ICU healthcare professionals, especially nurses. AIMS To describe (1) tracheostomy patients' needs, emotions and difficulties when communicating with ICU nurses and (2) which strategies nurses and patients have adopted to improve their communication. METHODS A scoping review was completed using the Joanna Briggs Institute method and following the PRISMA-ScR Checklist. The research question was developed using the Population, Concept and Context framework. Five databases were searched. After screening, two researchers independently analysed the 75 papers, and finally, 19 studies were included in this review. RESULTS All studies used a qualitative design. Seven adopted a phenomenological and two a hermeneutic approach, involving a total of 265 patients. Two main themes and four subthemes were identified: (1) the tracheostomy patients' needs, emotions and difficulties communicating with ICU nurses (patients' emotions, communication needs, and their content and difficulties) and (2) strategies that nurses and patients adopted to improve communication (communication strategies). CONCLUSIONS It is essential to develop effective communication with tracheostomy patients to ensure they feel relieved, safe and considered. Communication content should focus on information relating to the person's personal condition and active involvement in care. RELEVANCE TO CLINICAL PRACTICE It is important to prioritise the communication process in tracheostomised patients and create the organisational conditions that foster effective communication processes. Developing training programmes for new or practising nurses is essential to instil greater awareness about this crucial fundamental need.
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Affiliation(s)
- Angela Tolotti
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Lucia Cadorin
- Continuing Education Office, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Loris Bonetti
- Nursing Research Competence Centre, Nursing Direction Department, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland.,Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Dario Valcarenghi
- Nursing Development and Research Unit, Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Nicola Pagnucci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Clunie GM, Bolton L, Lovell L, Bradley E, Bond C, Bennington S, Roe J. Considerations for speech and language therapy management of dysphagia in patients who are critically ill with COVID-19: a single centre case series. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Patients treated with intubation and tracheostomy for COVID-19 infection are at risk of increased incidence of laryngeal injury, dysphagia and dysphonia. Because of the novelty of the SARS-CoV-2 virus, little is known about the type of dysphagia patients experience as a result of infection and critical illness. The aim of this case series report was to progress understanding of COVID-19 and dysphagia following admission to an intensive care unit and to guide speech and language therapy clinical practice in the ongoing pandemic. Methods A retrospective case review was conducted of all patients at Imperial College Healthcare NHS Trust, London who underwent a tracheostomy because of COVID-19 and received an instrumental assessment of swallowing in the early stages of the pandemic. Results A total of 11 patients were identified, and descriptive statistics were used to present demographic data, with a narrative account of their dysphagia profile used to describe presentation. Causes and presentation of dysphagia were heterogenous, with each patient requiring individualised clinical management to maximise outcome. A positive trend was seen in terms of recovery trajectory and progressing to oral intake. Conclusions This study reports on early experience of the presentation of dysphagia in patients with COVID-19 and demonstrates the value of instrumental assessment. It indicates the need for further research to consolidate knowledge and guide clinical practice.
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Affiliation(s)
- Gemma M Clunie
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lee Bolton
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Lindsay Lovell
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Elizabeth Bradley
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Cara Bond
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Sarah Bennington
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Justin Roe
- Speech and Language Therapy Department, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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Karna ST, Trivedi S, Singh P, Khurana A, Gouroumourty R, Dodda B, Saigal S, Sharma JP, Karna A, Shrivastava P, Hussain A, Gupta V, Behera G, Waindeskar V. Weaning Outcomes and 28-day Mortality after Tracheostomy in COVID-19 Patients in Central India: A Retrospective Observational Cohort Study. Indian J Crit Care Med 2022; 26:85-93. [PMID: 35110850 PMCID: PMC8783235 DOI: 10.5005/jp-journals-10071-24080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Tracheostomy is integral in long-term intensive care of coronavirus disease-2019 (COVID-19) patients. There is a paucity of studies on weaning outcomes and mortality after tracheostomy in COVID-19 in Indian scenario. Materials and methods We conducted a retrospective, single-center, observational study of severe COVID-19 patients who underwent elective tracheostomy (n = 65) during critical care in a tertiary care institute in Central India from May 1, 2020, to April 30, 2021. Data were collected from Medical records, ICU charts, and follow-up visits by patient. A primary objective was to study the clinical characteristics, tracheostomy complications, weaning outcomes, and mortality at 28 and 60 days of ICU admission. We categorized the cohort into two groups (deceased and survivor) and studied association of clinical parameters with 28-day mortality. Cox Proportional regression analysis was applied to calculate the hazard ratio among the predictors of mortality with p value <0.05 as significant. Results Elective tracheostomy was done in 69 of 436 (15.8%) patients on invasive mechanical ventilation, of which 65 were included. Tracheostomy was percutaneous in 45/65 (69%) and surgical in 20/65 (31%) with timing from intubation as early in 41/65 and late in 24/65 with most common indication as weaning failure followed by anticipated prolonged ventilation. Tracheostomy complications were present in 29/65 (45%) patients with no difference in complication rates between timing and type of tracheostomy. Downsizing, decannulation, and weaning were successful in 22%, 32 (49%), and 35/65 (54%) patients after tracheostomy. The 28-day mortality was 30/65 (46%). The fractional inspired oxygen concentration (FiO2) requirement in survivors was lower (0.4–0.6, p = 0.015) with a higher PaO2/FiO2 ratio (118–200, p = 0.033). Early tracheostomy within 7 days of intubation was not associated with weaning or survival benefit. Conclusions We suggest that tracheostomy should be delayed to after 7 days of intubation, especially till FiO2 reduces to 0.5 with improvement in PaO2/FiO2 for better outcomes and avoiding a wasted procedure (CTRI/2021/07/034768). Study Highlights Tracheostomy is integral in care of COVID-19 patients needing prolonged ventilation. There is no difference in complications in early/late or percutaneous dilatational/surgical technique. We observed successful weaning post-tracheostomy in 54% patients. Mortality at 28 days was 46%. Early tracheostomy within 7 days of intubation did not improve weaning or survival. How to cite this article Karna ST, Trivedi S, Singh P, Khurana A, Gouroumourty R, Dodda B, et al. Weaning Outcomes and 28-day Mortality after Tracheostomy in COVID-19 Patients in Central India: A Retrospective Observational Cohort Study. Indian J Crit Care Med 2022;26(1):85–93.
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Affiliation(s)
- Sunaina Tejpal Karna
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Saurabh Trivedi
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Pooja Singh
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
- Pooja Singh, Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India, Phone: +91 9340969292, e-mail:
| | - Alkesh Khurana
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Revadi Gouroumourty
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Brahmam Dodda
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Saurabh Saigal
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Jai Prakash Sharma
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Amit Karna
- Department of Anesthesiology and Critical Care, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India
| | - Pranav Shrivastava
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Aqeel Hussain
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Vikas Gupta
- Department of Otorhinolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Gankalyan Behera
- Department of Otorhinolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Vaishali Waindeskar
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Rozenblat T, Reifen E, Benov A, Shaul C, Neuman U, Karol D, Schvartz R, Bachar G. The value of tracheostomy of critically ill COVID-19 patients - A multicentral study. Am J Otolaryngol 2022; 43:103230. [PMID: 34537504 PMCID: PMC8440006 DOI: 10.1016/j.amjoto.2021.103230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/09/2021] [Indexed: 12/23/2022]
Abstract
Purpose Tracheostomy is an aerosol-generating procedure, thus performing it during the COVID-19 pandemic arises considerations such as the most appropriate timing and the patients to whom it is suitable. Medical teams lack sufficient data to assist determining whether or not to conduct tracheostomy, its short- and long-term implications are not fully understood. This study aims to shed light on the critically ill COVID-19 patients that require tracheostomy, and to investigate its value. Methods A retrospective multicentral case-control study of 157 hospitalized critically ill COVID-19 patients, among whom 30 patients went through tracheostomy and consisted of our study group. Results The mean age was similar between study and control groups (68.9 ± 12.7 years vs 70.5 ± 15.8 years, p = 0.57), as well as comorbidity prevalence (56.7% vs 67.7%, p = 0.25). Patients in the study group were hospitalized for longer duration until defined critically ill (5 ± 4.3 vs 3 ± 3.9 days; p = 0.01), until admitted to the intensive care unit (6 ± 6.6 vs 2.5 ± 3.7 days respectively; p = 0.005), and until discharged (24 ± 9.7 vs 10.7 ± 9.1 days, p < 0.001). Mortality rate was lower in the study group (30% vs 59.8%, p = 0.003). Kaplan Meier survival analysis revealed a statistically significant difference in survival time between groups (Log rank chi-sq = 20.91, p < 0.001) with mean survival time of 41 ± 3.1 days vs 21 ± 2.2 days. Survival was significantly longer in the study group (OR = 0.37, p = 0.004). Conclusion Tracheostomy allows for more prolonged survival for gradually deteriorating critically ill COVID-19 patients. This should be integrated into the medical teams' considerations when debating whether or not to conduct tracheostomy.
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Affiliation(s)
- Tal Rozenblat
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ella Reifen
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.
| | - Avi Benov
- Israel Defense Forces, Medical Corps, Tel Hasomer, Ramat Gan, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - Chanan Shaul
- Department of Otolaryngology-Head and Neck Surgery, Shaare Zedek Medical Center Affiliated with the Hebrew University Medical School, Jerusalem, Israel.
| | - Uri Neuman
- Department of Otolaryngology, Meir Medical Center, Kfar Saba, Israel.
| | - Dana Karol
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
| | - Reut Schvartz
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
| | - Gideon Bachar
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Almutairi D, Alqahtani R, Alghamdi A, Binammar D, Alzaidi S, Ghafori A, Alsharif H. Tracheotomy Outcomes in 71 COVID-19 Patients: A Multi-Centric Study in Saudi Arabia. Clin Pract 2021; 11:947-953. [PMID: 34940008 PMCID: PMC8700003 DOI: 10.3390/clinpract11040109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 12/03/2022] Open
Abstract
Since its outbreak in late 2019, the COVID-19 pandemic has seen a sharp rise in the demand for oxygen and ventilation facilities due to the associated extensive damage that it causes to the lungs. This study is considered the first and largest study in Saudi Arabia to evaluate the outcomes of tracheostomy in intubated COVID-19 patients. This is a retrospective, observational cohort study that was conducted at King Abdulaziz Medical City (KAMC) in Jeddah, Western Region, Saudi Arabia and King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. The findings of the study revealed that seventy-one patients with COVID-19 underwent tracheotomy between 1 March 2020 and 31 October 2020. The average period between intubation and tracheostomy was 9.97 days. Hypertension, diabetes, lung disease and obesity (BMI > 30) were significant risk factors of mortality. The overall 30-day mortality rate was 38.4%.
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Affiliation(s)
- Dakheelallah Almutairi
- Department of Otorhinolaryngology-Head and Neck Surgery, King Abdulaziz Medical City, Jeddah 21423, Saudi Arabia;
- College of Medicine, King Saud Bin-Abdul-Aziz University for Health Sciences, Ministry of National Guard, Jeddah 14611, Saudi Arabia; (A.A.); (D.B.)
| | - Raneem Alqahtani
- College of Medicine, King Saud Bin-Abdul-Aziz University for Health Sciences, Ministry of National Guard, Jeddah 14611, Saudi Arabia; (A.A.); (D.B.)
- Correspondence: ; Tel.: +966-55-352-1010
| | - Arwa Alghamdi
- College of Medicine, King Saud Bin-Abdul-Aziz University for Health Sciences, Ministry of National Guard, Jeddah 14611, Saudi Arabia; (A.A.); (D.B.)
| | - Dina Binammar
- College of Medicine, King Saud Bin-Abdul-Aziz University for Health Sciences, Ministry of National Guard, Jeddah 14611, Saudi Arabia; (A.A.); (D.B.)
| | - Suzan Alzaidi
- Department of Otorhinolaryngology-Head and Neck Surgery, King Fahad Armed Forces Hospital, Jeddah 23311, Saudi Arabia; (S.A.); (A.G.)
| | - Abdullah Ghafori
- Department of Otorhinolaryngology-Head and Neck Surgery, King Fahad Armed Forces Hospital, Jeddah 23311, Saudi Arabia; (S.A.); (A.G.)
| | - Hassan Alsharif
- Intensive Care Department (ICD), King Fahad Armed Forces Hospital, Jeddah 23311, Saudi Arabia;
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Cote CL, Melong J, Tremblay P, Fagan A, Cooper M, Mullins G, Vician M, Brown T, Herman CR. Long-term laryngotracheal complications following cardiac surgery. J Card Surg 2021; 36:4597-4603. [PMID: 34647349 DOI: 10.1111/jocs.16066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/23/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Long-term laryngotracheal complications have not been described in adult patients undergoing cardiac surgery. The purpose of this study was to determine the incidence of and risk factors for laryngotracheal complications following cardiac surgery. METHODS A retrospective chart review of patients at high risk for laryngotracheal complications following cardiac surgery between 2006 and 2016 was performed. High-risk patients were reviewed to determine the presence of laryngotracheal complications including laryngotracheal stenosis, keyhole deformity, or vocal cord immobility. Logistic regression was used to identify predictors of long-term laryngotracheal complications. RESULTS Of 11,417 patients who underwent cardiac surgery, 1099 were identified as at high risk. Of these, 24 (2.2%) developed laryngotracheal complications following their surgery and intensive care unit (ICU) stay. Laryngotracheal stenosis and keyhole deformity were present in 13 (1.2%) and 6 (0.5%) patients, respectively. Logistic regression demonstrated older age (age ≥ 70 odds ratio [OR] 0.31, 95% confidence interval [CI] 0.12-0.83) was protective, while readmission to ICU for ventilation (OR 3.11, 95% CI 1.17-8.25) and receiving a tracheostomy (OR 7.83, 95% CI 2.22-27.6) were associated with laryngotracheal complications. CONCLUSIONS The incidence of long-term laryngotracheal complications following cardiac surgery was 2.2%. Readmission to ICU for ventilation and having a tracheostomy performed were associated with laryngotracheal complications.
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Affiliation(s)
- Claudia L Cote
- Division of Cardiac Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jonathan Melong
- Division of Otolaryngology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Philippe Tremblay
- Division of Cardiac Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew Fagan
- Department of Critical Care, Western University, London, Ontario, Canada
| | - Matthew Cooper
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Graeme Mullins
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Vician
- Division of Cardiac Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tim Brown
- Division of Otolaryngology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christine R Herman
- Division of Cardiac Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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Okada M, Watanuki H, Masato T, Sugiyama K, Futamura Y, Matsuyama K. Impact of Tracheostomy Timing on Outcomes After Cardiovascular Surgery. J Cardiothorac Vasc Anesth 2021; 36:2335-2338. [PMID: 34756803 DOI: 10.1053/j.jvca.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/11/2021] [Accepted: 10/01/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study aimed to investigate whether tracheostomy timing in patients undergoing cardiac surgery had an impact on outcomes. DESIGN Retrospective, observational study. SETTING Single-center university hospital. PARTICIPANTS Patients requiring tracheostomy among a total of 961 patients who underwent cardiovascular surgery via a median sternotomy from January 2014 to March 2021. INTERVENTIONS Early versus late tracheostomy. MEASUREMENTS AND MAIN RESULTS During the study period, tracheostomy was performed in 28 patients (2.9%). According to tracheostomy timing, postoperative day seven was chosen as the cutoff to define early (≤seven days) and late (>seven days) tracheostomy. Patients in the early-tracheostomy group had a significantly shorter ventilation time after tracheostomy compared with the late-tracheostomy group (p = 0.039), and early tracheostomy resulted in a reduction in total ventilation time (p = 0.001). The incidence of pressure ulcers was significantly lower in the early-tracheostomy group compared with the late- tracheostomy group. There was a higher tracheal tube removal rate in the early-tracheostomy group compared with the late-tracheostomy group (p = 0.0007). The one-year survival rate in the early- and late-tracheostomy groups was 65% and 31%, respectively. The long-term mortality rate was significantly lower in the early-tracheostomy group compared with the late- tracheostomy group (p = 0.04). CONCLUSIONS Early tracheostomy (<seven days) may provide better clinical outcomes, with lower mortality and morbidity rates, when patients are judged to require at least seven days of ventilation after cardiovascular surgery.
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Affiliation(s)
- Masaho Okada
- Department of Cardiac Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Hirotaka Watanuki
- Department of Cardiac Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Tochii Masato
- Department of Cardiac Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Kayo Sugiyama
- Department of Cardiac Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Yasuhiro Futamura
- Department of Cardiac Surgery, Aichi Medical University Hospital, Aichi, Japan
| | - Katsuhiko Matsuyama
- Department of Cardiac Surgery, Aichi Medical University Hospital, Aichi, Japan.
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Félix L, Tavares TL, Almeida VPB, Tiago RSL. Incidence of Laryngotracheal Lesions After Orotracheal Intubation in Coronavirus Disease Patients. Laryngoscope 2021; 132:1075-1081. [PMID: 34516003 DOI: 10.1002/lary.29862] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/22/2021] [Accepted: 08/28/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the incidence of lesions and severe sequelae and the risk factors for the development of laryngotracheal lesions after orotracheal intubation (OTI) in coronavirus disease (COVID-19) patients. STUDY DESIGN Prospective cohort study. METHODS In this prospective cohort study, we evaluated patients diagnosed with COVID-19 who were consecutively admitted to a tertiary hospital and required OTI from March 1, 2020 to October 31, 2020. Patients discharged were called for outpatient follow-up and endoscopic examination. RESULTS A total of 1,357 patients diagnosed with COVID-19, as confirmed by nasal swab reverse transcription polymerase chain reaction, were admitted. OTI for mechanical ventilation was required in 421 patients (31%). Of the intubated patients, 172 (40.9%) were discharged and 249 (59.1%) died. Outpatient evaluation by videoendoscopy was performed in 95 patients (55.2%) approximately 100 days after extubation. Laryngotracheal lesions were observed in 38 patients (40%), with 17.9% diagnosed with laryngotracheal stenosis or unilateral immobility while 6.3% had severe stenosis (grades 3 and 4). The factors presenting statistical significance for the development of laryngotracheal lesions were the endotracheal tube (ETT) size; prone position over the OTI period; and the increased leukocyte count, d-dimer, prothrombin time (PT), and international normalized ratio (INR) on the day OTI was performed. CONCLUSIONS The incidence of laryngotracheal lesion in COVID-19 patients is 40%, with 6.3% of them presenting with severe stenosis. There was a greater risk for the development of laryngotracheal lesions in patients using a larger ETT, kept in a prone position, presenting a greater inflammatory reaction (increased leukocyte count), or developing coagulation disorders (increased d-dimer, PT, and INR). LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Letícia Félix
- Otorhinolaryngology Service, Department of Laryngology and Cervicofacial Surgery, São Paulo State Civil Servants Hospital - FMO/IAMSPE, São Paulo, Brazil
| | - Tracy L Tavares
- Otorhinolaryngology Service, Department of Laryngology and Cervicofacial Surgery, São Paulo State Civil Servants Hospital - FMO/IAMSPE, São Paulo, Brazil
| | - Vinicius P B Almeida
- Otorhinolaryngology Service, Department of Laryngology and Cervicofacial Surgery, São Paulo State Civil Servants Hospital - FMO/IAMSPE, São Paulo, Brazil
| | - Romualdo S L Tiago
- Otorhinolaryngology Service, Department of Laryngology and Cervicofacial Surgery, São Paulo State Civil Servants Hospital - FMO/IAMSPE, São Paulo, Brazil
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Benito DA, Bestourous DE, Tong JY, Pasick LJ, Sataloff RT. Tracheotomy in COVID-19 Patients: A Systematic Review and Meta-analysis of Weaning, Decannulation, and Survival. Otolaryngol Head Neck Surg 2021; 165:398-405. [PMID: 33399526 DOI: 10.1177/0194599820984780] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/09/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES A systematic review and meta-analysis was conducted to determine the cumulative incidences of decannulation and mechanical ventilation weaning in patients with coronavirus disease 2019 (COVID-19) who have undergone a tracheotomy. Weighted average mean times to tracheotomy, to decannulation, and to death were calculated from reported or approximated means. DATA SOURCES PubMed, SCOPUS, CINAHL, and the Cochrane library. REVIEW METHODS Studies were screened by 3 investigators independently. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Studies including patients with COVID-19 who underwent a tracheotomy were identified. Studies without reported mechanical ventilation weaning or decannulation were excluded. Data were pooled using a random-effects model. RESULTS After identifying 232 unique studies, 18 articles encompassing outcomes for 3234 patients were ultimately included for meta-analysis, with a weighted mean follow-up time of 28.6 ± 6.2 days after tracheotomy. Meta-analysis revealed that 55.0% of tracheotomized patients were weaned successfully from mechanical ventilation (95% CI, 47.4%-62.2%). Approximately 34.9% of patients were decannulated successfully, with a mean decannulation time of 18.6 ± 5.7 days after tracheotomy. The pooled mortality in tracheotomized patients with COVID-19 was 13.1%, with a mean time of death of 13.0 ± 4.0 days following tracheotomy. CONCLUSION At the current state of the coronavirus pandemic, over half of patients who have required tracheotomies are being weaned off of mechanical ventilation. While 13.1% patients have died prior to decannulation, over a third of all tracheotomized patients with COVID-19 reported in the literature have undergone successful decannulation.
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Affiliation(s)
- Daniel A Benito
- Division of Otolaryngology-Head & Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Daniel E Bestourous
- Division of Otolaryngology-Head & Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Jane Y Tong
- Department of Otolaryngology-Head & Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Luke J Pasick
- Department of Otolaryngology-Head & Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert T Sataloff
- Department of Otolaryngology-Head & Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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Abstract
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2021. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2021 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901 .
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Affiliation(s)
- Thomas Williams
- Academic Foundation Trainee, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | - Brendan A McGrath
- Acute Intensive Care Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
- Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
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40
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Cambria F, Fusconi M, Candelori F, Galli M, Stanganelli FRF, Venuta F, Valentini V, de Vincentiis M. Surgical multidisciplinary approach in the management of odontogenic or non-odontogenic neck infections. ACTA ACUST UNITED AC 2021; 41:S138-S144. [PMID: 34060529 PMCID: PMC8172099 DOI: 10.14639/0392-100x-suppl.1-41-2021-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/25/2021] [Indexed: 11/23/2022]
Abstract
In recent years, in our university hospital, the number of odontogenic and non-odontogenic abscesses has been rapidly increasing. We included 70 patients from January 4th 2018 to February 19th 2020 affected by the odontogenic ones. Deep neck infection can spread to the chest and is associated with high morbidity and mortality. The purpose of this mini-review is to demonstrate that, in case of complications, a multidisciplinary approach is needed to treat these infections, so that all practitioners should work together to achieve the patient’s rapid recovery.
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Affiliation(s)
| | - Massimo Fusconi
- Department of Sense Organs, University Sapienza of Rome, Italy
| | | | - Massimo Galli
- Department of Oral and Maxillo-Facial Surgery, University Sapienza of Rome, Italy
| | | | - Federico Venuta
- Department of Thoracic Surgery, University Sapienza of Rome, Rome, Italy
| | | | - Marco de Vincentiis
- Department of Oral and Maxillo-Facial Surgery, University Sapienza of Rome, Italy
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Mehta Y, Kochar G. Tracheostomy in COVID Times. JOURNAL OF CARDIAC CRITICAL CARE TSS 2021. [DOI: 10.1055/s-0041-1732837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Yatin Mehta
- Department of Anesthesiology and Critical Care, Medanta – The Medicity, Gurugram, India
| | - Gaurav Kochar
- Department of Anesthesiology and Critical Care, Medanta – The Medicity, Gurugram, India
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Tetaj N, Maritti M, Stazi G, Marini MC, Centanni D, Garotto G, Caravella I, Dantimi C, Fusetti M, Santagata C, Macchione M, De Angelis G, Giansante F, Busso D, Di Lorenzo R, Scarcia S, Carucci A, Cabas R, Gaviano I, Petrosillo N, Antinori A, Palmieri F, D’Offizi G, Ianniello S, Campioni P, Pugliese F, Vaia F, Nicastri E, Ippolito G, Marchioni L. Outcomes and Timing of Bedside Percutaneous Tracheostomy of COVID-19 Patients over a Year in the Intensive Care Unit. J Clin Med 2021; 10:jcm10153335. [PMID: 34362118 PMCID: PMC8347124 DOI: 10.3390/jcm10153335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 12/29/2022] Open
Abstract
Background: The benefits and timing of percutaneous dilatational tracheostomy (PDT) in Intensive Care Unit (ICU) COVID-19 patients are still controversial. PDT is considered a high-risk procedure for the transmission of SARS-CoV-2 to healthcare workers (HCWs). The present study analyzed the optimal timing of PDT, the clinical outcomes of patients undergoing PDT, and the safety of HCWs performing PDT. Methods: Of the 133 COVID-19 patients who underwent PDT in our ICU from 1 April 2020 to 31 March 2021, 13 patients were excluded, and 120 patients were enrolled. A trained medical team was dedicated to the PDT procedure. Demographic, clinical history, and outcome data were collected. Patients who underwent PDT were stratified into two groups: an early group (PDT ≤ 12 days after orotracheal intubation (OTI) and a late group (>12 days after OTI). An HCW surveillance program was also performed. Results: The early group included 61 patients and the late group included 59 patients. The early group patients had a shorter ICU length of stay and fewer days of mechanical ventilation than the late group (p < 0.001). On day 7 after tracheostomy, early group patients required fewer intravenous anesthetic drugs and experienced an improvement of the ventilation parameters PaO2/FiO2 ratio, PEEP, and FiO2 (p < 0.001). No difference in the case fatality ratio between the two groups was observed. No SARS-CoV-2 infections were reported in the HCWs performing the PDTs. Conclusions: PDT was safe and effective for COVID-19 patients since it improved respiratory support parameters, reduced ICU length of stay and duration of mechanical ventilation, and optimized the weaning process. The procedure was safe for all HCWs involved in the dedicated medical team. The development of standardized early PDT protocols should be implemented, and PDT could be considered a first-line approach in ICU COVID-19 patients requiring prolonged mechanical ventilation.
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Affiliation(s)
- Nardi Tetaj
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
- Correspondence: ; Tel.: +39-065-517-0424
| | - Micaela Maritti
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Giulia Stazi
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Maria Cristina Marini
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Daniele Centanni
- Clinical and Research Department of Infectious Diseases, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy; (D.C.); (N.P.); (A.A.); (F.P.); (G.D.); (E.N.)
| | - Gabriele Garotto
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Ilaria Caravella
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Cristina Dantimi
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Matteo Fusetti
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Carmen Santagata
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Manuela Macchione
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Giada De Angelis
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Filippo Giansante
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Donatella Busso
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Rachele Di Lorenzo
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Silvana Scarcia
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Alessandro Carucci
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Ricardo Cabas
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Ilaria Gaviano
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
| | - Nicola Petrosillo
- Clinical and Research Department of Infectious Diseases, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy; (D.C.); (N.P.); (A.A.); (F.P.); (G.D.); (E.N.)
| | - Andrea Antinori
- Clinical and Research Department of Infectious Diseases, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy; (D.C.); (N.P.); (A.A.); (F.P.); (G.D.); (E.N.)
| | - Fabrizio Palmieri
- Clinical and Research Department of Infectious Diseases, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy; (D.C.); (N.P.); (A.A.); (F.P.); (G.D.); (E.N.)
| | - Gianpiero D’Offizi
- Clinical and Research Department of Infectious Diseases, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy; (D.C.); (N.P.); (A.A.); (F.P.); (G.D.); (E.N.)
| | - Stefania Ianniello
- Department of Radiology and Diagnostic Imaging, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy; (S.I.); (P.C.)
| | - Paolo Campioni
- Department of Radiology and Diagnostic Imaging, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy; (S.I.); (P.C.)
| | - Francesco Pugliese
- Department of Anesthesia and Critical Care Medicine, Sapienza University of Rome, 00161 Rome, Italy;
| | - Francesco Vaia
- Health Direction, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy;
| | - Emanuele Nicastri
- Clinical and Research Department of Infectious Diseases, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy; (D.C.); (N.P.); (A.A.); (F.P.); (G.D.); (E.N.)
| | - Giuseppe Ippolito
- Scientific Direction, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy;
| | - Luisa Marchioni
- UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy; (M.M.); (G.S.); (M.C.M.); (G.G.); (I.C.); (C.D.); (M.F.); (C.S.); (M.M.); (G.D.A.); (F.G.); (D.B.); (R.D.L.); (S.S.); (A.C.); (R.C.); (I.G.); (L.M.)
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Li J, Perez A, Schehl J, Albers A, Husain IA. The Association Between Upper Airway Patency and Speaking Valve Trial Tolerance for Patients With Tracheostomy: A Clinical Retrospective Study and an In Vitro Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1728-1736. [PMID: 34057847 DOI: 10.1044/2021_ajslp-20-00331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Purpose Upper airway patency is crucial in a patient's ability to tolerate a one-way speaking valve (SV). Traditional assessment of airway patency is mainly subjective. We developed four noninvasive methods to assess patency (leak volume, transtracheal pressure [TTP], end-tidal CO2, and Mallampati score) in our institution. This study was aimed to evaluate the effectiveness of the four methods and explore the relationship between the patient's upper airway patency and SV trial tolerance. Method A retrospective cohort study was conducted to enroll adult patients with tracheostomies eligible for an SV trial from April 2019 through January 2020. An in vitro study was also implemented to explore the relationship between upper airway patency and noninvasive measurements. Results Forty patients (22 men and 18 women) were included; 16 used SV in-line with mechanical ventilation. Twenty-four patients tolerated an SV trial of > 10 min; they had lower TTP (3.0 [2.0-9.0] vs. 15.0 [9.3-21.3] cm H2O, p < .001), higher leak volume (268.5 ± 177.2 vs. 88.6 ± 99.6 ml, p = .038), and lower percentage of patients with Mallampati Classification IV (16.7 vs. 50.0%, p = .035), compared to the 16 patients who did not tolerate an SV trial. Twenty-two patients with a TTP of ≤ 9 cm H2O had higher percentage tolerating an SV trial than those with a TTP of > 9 cm H2O (86.4 vs. 35.3%, p = .002). The in vitro study demonstrated a strong correlation between upper airway patency and TTP, peak inspiratory flow, and tidal volume inhaled from the upper airway. Conclusions TTP, Mallampati classification, and leak volume can be used to assess upper airway patency for adult patients with tracheostomies undergoing an SV trial. A TTP of ≤ 9 cm H2O might indicate adequate upper airway patency to tolerate the SV trial.
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Affiliation(s)
- Jie Li
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL
| | - Andrew Perez
- Department of Cardiopulmonary Sciences, Division of Respiratory Care, Rush University, Chicago, IL
| | - Joan Schehl
- Department of Speech-Language Pathology, Rush University Medical Center, Chicago, IL
| | - Allison Albers
- Department of Speech-Language Pathology, Rush University Medical Center, Chicago, IL
| | - Inna A Husain
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, IL
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Chandran A, Kumar R, Kanodia A, Shaphaba K, Sagar P, Thakar A. Outcomes of Ttracheostomy in COVID-19 Patients: A Single Centre Experience. Indian J Otolaryngol Head Neck Surg 2021; 74:3043-3049. [PMID: 34277386 PMCID: PMC8276681 DOI: 10.1007/s12070-021-02758-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/04/2021] [Indexed: 02/08/2023] Open
Abstract
The rapid emergence of COVID-19 has led to increase in the number of patients requiring prolonged ventilation and tracheostomy. Though global guidelines are evolving, there is a paucity of literature about optimal timing and outcome after tracheostomy in COVID-19 patients. We set out to assess the clinical characteristics and outcome of COVID-19 patients who underwent tracheostomy.This single-center, prospective observational cohort study analyzed all the consecutive tracheostomy performed on COVID-19 patients from April 1 2020 to January 31, 2021. The primary outcome measure was the 30-day mortality rate following tracheostomy and association with various prognostic risk factors. The secondary outcome measures included various tracheostomy-related events, perioperative complications, and decannulation rate.The study included 51 patients with a median age of 52 years and the majority were male (62.74%). 62.74% (32 of 51) tracheostomies were done early (within 10 days of intubation) and the mean duration from endotracheal intubation to tracheostomy was 10.27 days. The 30-day mortality rate was 66.66% (34 of 51) with no tracheostomy-related mortality and the mean duration between tracheostomy and death was 8.29 days. The presence of sepsis was associated with a higher rate of mortality (p = 0.002) while the timing of tracheostomy was not related to increased mortality (p = 0.365). The most common perioperative complication was tracheostoma bleeding (16.64%). At a median follow-up of 7.5 months, only four patients were decannulated.Though associated with a higher rate of 30-day mortality rate, tracheostomy among COVID-19 patients is a safe and an effective weaning tool.
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Affiliation(s)
- Aswin Chandran
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Rajeev Kumar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Anupam Kanodia
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Konthoujam Shaphaba
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Prem Sagar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
| | - Alok Thakar
- Department of Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, 110029 India
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Staibano P, Levin M, McHugh T, Gupta M, Sommer DD. Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2021; 147:646-655. [PMID: 34042963 PMCID: PMC8160928 DOI: 10.1001/jamaoto.2021.0930] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/08/2021] [Indexed: 12/16/2022]
Abstract
Importance Approximately 5% to 15% of patients with COVID-19 require invasive mechanical ventilation (IMV) and, at times, tracheostomy. Details regarding the safety and use of tracheostomy in treating COVID-19 continue to evolve. Objective To evaluate the association of tracheostomy with COVID-19 patient outcomes and the risk of SARS-CoV-2 transmission among health care professionals (HCPs). Data Sources EMBASE (Ovid), Medline (Ovid), and Web of Science from January 1, 2020, to March 4, 2021. Study Selection English-language studies investigating patients with COVID-19 who were receiving IMV and undergoing tracheostomy. Observational and randomized clinical trials were eligible (no randomized clinical trials were found in the search). All screening was performed by 2 reviewers (P.S. and M.L.). Overall, 156 studies underwent full-text review. Data Extraction and Synthesis We performed data extraction in accordance with Meta-analysis of Observational Studies in Epidemiology guidelines. We used a random-effects model, and ROBINS-I was used for the risk-of-bias analysis. Main Outcomes and Measures SARS-CoV-2 transmission between HCPs and levels of personal protective equipment, in addition to complications, time to decannulation, ventilation weaning, and intensive care unit (ICU) discharge in patients with COVID-19 who underwent tracheostomy. Results Of the 156 studies that underwent full-text review, only 69 were included in the qualitative synthesis, and 14 of these 69 studies (20.3%) were included in the meta-analysis. A total of 4669 patients were included in the 69 studies, and the mean (range) patient age across studies was 60.7 (49.1-68.8) years (43 studies [62.3%] with 1856 patients). We found that in all studies, 1854 patients (73.8%) were men and 658 (26.2%) were women. We found that 28 studies (40.6%) investigated either surgical tracheostomy or percutaneous dilatational tracheostomy. Overall, 3 of 58 studies (5.17%) identified a small subset of HCPs who developed COVID-19 that was associated with tracheostomy. Studies did not consistently report the number of HCPs involved in tracheostomy. Among the patients, early tracheostomy was associated with faster ICU discharge (mean difference, 6.17 days; 95% CI, -11.30 to -1.30), but no change in IMV weaning (mean difference, -2.99 days; 95% CI, -8.32 to 2.33) or decannulation (mean difference, -3.12 days; 95% CI, -7.35 to 1.12). There was no association between mortality or perioperative complications and type of tracheostomy. A risk-of-bias evaluation that used ROBINS-I demonstrated notable bias in the confounder and patient selection domains because of a lack of randomization and cohort matching. There was notable heterogeneity in study reporting. Conclusions and Relevance The findings of this systematic review and meta-analysis indicate that enhanced personal protective equipment is associated with low rates of SARS-CoV-2 transmission during tracheostomy. Early tracheostomy in patients with COVID-19 may reduce ICU stay, but this finding is limited by the observational nature of the included studies.
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Affiliation(s)
- Phillip Staibano
- Department of Surgery, Otolaryngology–Head and Neck Division, McMaster University, Hamilton, Ontario, Canada
| | - Marc Levin
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tobial McHugh
- Department of Surgery, Otolaryngology–Head and Neck Division, McMaster University, Hamilton, Ontario, Canada
| | - Michael Gupta
- Department of Surgery, Otolaryngology–Head and Neck Division, McMaster University, Hamilton, Ontario, Canada
| | - Doron D. Sommer
- Department of Surgery, Otolaryngology–Head and Neck Division, McMaster University, Hamilton, Ontario, Canada
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Prin M, Kaizer A, Cardenas J, Mtalimanja O, Kadyaudzu C, Charles A, Ginde A. Tracheostomy Practices for Mechanically Ventilated Patients in Malawi. World J Surg 2021; 45:2638-2642. [PMID: 34080049 PMCID: PMC8171994 DOI: 10.1007/s00268-021-06176-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/28/2022]
Abstract
Background Tracheostomy is used for patients who require prolonged mechanical ventilation. Extensive research has described the provision and optimal timing of tracheostomy, but very little describes tracheostomy utilization in low- and middle-income countries, particularly in sub-Saharan Africa. Methods This prospective cohort study describes patients admitted to the intensive care unit (ICU) of a tertiary hospital in Malawi who received tracheostomy versus those who did not, with a primary outcome of hospital mortality. We performed subgroup analysis of patients with severe head injuries. Results The analysis included 451 patients admitted to the study ICU between September 2016 and July 2018. Overall hospital mortality was 40% for patients who received tracheostomy and 63% for patients who did not. Logistic regression modeling revealed an odds ratio (OR) of 0.34 (95% CI 0.18–0.64) for hospital mortality among patients who received tracheostomy versus those who did not (p < 0.001). Standardized mortality ratio weighting revealed an odds ratio of 0.81 (95% CI 0.65–0.99, p < 0.001) for hospital death among patients who received tracheostomy versus those who did not. In the subgroup excluding severe head injury, both ICU (50%) and hospital mortality (75%) were higher overall, but hospital mortality was not more common for patients with tracheostomy versus without (OR 1.28, 95% CI 0.94–1.74, p = 0.104). Conclusions Tracheostomy is not associated with hospital mortality in a Malawi ICU cohort, but these results are affected by the presence of head injury. Research may focus on home tracheostomy care given the lack of hospital discharge options for patients in austere settings. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-021-06176-3.
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Affiliation(s)
- Meghan Prin
- Department of Anesthesiology, University of Colorado Anschutz Medical Center, 12401 E. 17th Avenue, 7th Floor, Aurora, CO, 80045, USA.
| | - Alex Kaizer
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Jesus Cardenas
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Onias Mtalimanja
- Department of Anesthesiology, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Clement Kadyaudzu
- Department of Anesthesiology, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Anthony Charles
- Department of Surgery, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Adit Ginde
- Department of Emergency Medicine, University of Colorado Anschutz Medical Center, Aurora, CO, USA
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Pauli N, Eeg‐Olofsson M, Bergquist H. Tracheotomy in COVID-19 patients: A retrospective study on complications and timing. Laryngoscope Investig Otolaryngol 2021; 6:446-452. [PMID: 34195366 PMCID: PMC8223451 DOI: 10.1002/lio2.560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/05/2021] [Accepted: 03/29/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The aim of this study was to analyze the timing of tracheotomy and the duration of mechanical ventilation and stay in the intensive care unit (ICU) in patients with COVID-19 infection. Furthermore, we aimed to investigate tracheotomy complications and mortality. METHODS Consecutive patients with COVID-19 infection admitted to the Department of Infectious Diseases in Gothenburg, Sweden were identified. Medical records were retrieved and retrospectively assessed. RESULTS One hundred eighty-eight patients with COVID-19 infection requiring hospital care were identified. Of these, 116 patients were critically ill and intubated, and 55 patients underwent tracheotomy. The mean time from endotracheal intubation to tracheotomy was 12 days (range 5-28 days). There was a correlation between the timing of tracheotomy and the duration of mechanical ventilation, where a shorter time between intubation and tracheotomy was correlated with a shorter duration of mechanical ventilation (r .58, P < .001), and a correlation was identified between the timing of tracheotomy and the duration of ICU stay (r .52, P < .001). Perioperative hypoxemia was registered in 9% of tracheotomies performed, whereas postoperative bleeding was observed in 27% of cases, the majority of which were minor. CONCLUSIONS This retrospective cohort study indicates that early tracheotomy is related to a reduced need for mechanical ventilation and a shorter duration of stay in the ICU in severe cases of COVID-19 disease. Complications during and after tracheotomy in this specific cohort included risk perioperative hypoxia and postoperative bleeding. Prospective randomized controlled trials would be of value to confirm these findings. LEVEL OF EVIDENCE 4, Case series.
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Affiliation(s)
- Nina Pauli
- Department of OtorhinolaryngologyInstitute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University HospitalGothenburgSweden
| | - Måns Eeg‐Olofsson
- Department of OtorhinolaryngologyInstitute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University HospitalGothenburgSweden
| | - Henrik Bergquist
- Department of OtorhinolaryngologyInstitute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University HospitalGothenburgSweden
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Surgical airway procedures in emergency surgical patients: Results of what has become a back-up procedure. World J Surg 2021; 45:2683-2693. [PMID: 34023921 PMCID: PMC8322015 DOI: 10.1007/s00268-021-06110-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/11/2022]
Abstract
Background Cricothyroidotomy and surgical tracheostomy are methods to secure airway patency. In emergency surgery, these methods are nowadays mostly reserved for patients unsuited for percutaneous procedures. Detailed description of complications and functional outcomes following both procedures is underreported in current literature. The aim of this study was to evaluate outcomes following cricothyroidotomy and tracheostomy in this presumed complex population. Methods In this retrospective cohort study, adult emergency surgical patients treated with cricothyroidotomy and/or surgical tracheostomy were included. Postoperative complications and functional outcomes in trauma and non-trauma patients were evaluated. Results Forty-one trauma patients and 11 non-trauma emergency surgical patients (mainly after elective onco-abdominal or vascular surgery) were included. Of 52 patients, seven underwent cricothyroidotomy pre-tracheostomy. Mortality was higher in non-trauma patients (p = 0.04) following both procedures. Over half of patients (56%, n = 29) regained unsupported airway patency with a tendency toward increased tracheostomy removal in trauma patients. Among complications, only pneumonia occurred frequently (60%, n = 31), with no relation to patient type. Other complications included local infection (5.8%, n = 4) and wound dehiscence (1.9%, n = 1). Adverse functional outcomes were frequently observed and were mild and self-limiting. Cervical spinal cord injury reduced overall unsupported airway patency (p = 0.01); with high cervical spinal cord injury related to adverse functional outcomes and increased home ventilation need. Conclusions No major procedure-related complications or functional adverse events were encountered following cricothyroidotomy and surgical tracheostomy, even though only complex patients were included. Only mild, self-limiting functional problems occurred, especially in trauma patients with cervical injury who underwent early tracheostomy by longitudinal incision. This information can aid clinicians in making tailor-made decisions for individual patients.
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Association of Tracheostomy with Changes in Sedation during COVID-19: A Quality Improvement Evaluation at the University of Michigan. Ann Am Thorac Soc 2021; 18:907-909. [PMID: 33233918 PMCID: PMC8086533 DOI: 10.1513/annalsats.202009-1096rl] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Volo T, Stritoni P, Battel I, Zennaro B, Lazzari F, Bellin M, Michieletto L, Spinato G, Busatto C, Politi D, Spinato R. Elective tracheostomy during COVID-19 outbreak: to whom, when, how? Early experience from Venice, Italy. Eur Arch Otorhinolaryngol 2021; 278:781-789. [PMID: 32656673 PMCID: PMC7354359 DOI: 10.1007/s00405-020-06190-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/03/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE The need for prolonged invasive mechanical ventilation in COVID-19 patients is placing the otorhinolaryngologist in front of an increasing request for tracheostomy. Nowadays, there is uncertainty regarding the timing of tracheostomy, the prognosis of these patients and the safety of healthcare workers. The aim of this study is to evaluate the efficacy and safety of tracheostomy placement in patients with COVID-19. METHODS A retrospective cohort study on 23 COVID 19 patients, to analyse the timing of tracheostomy, the risk factors associated with in-hospital death and the infection of the involved health care workers. Early tracheostomy was defined as ≤ 10 days and late ones > 10 days. RESULTS The mortality rate of COVID-19 patients admitted to ICU that underwent tracheostomy was 18%. The overall mortality of patients admitted to ICU was 53%. The univariate analysis revealed that early tracheostomy, SOFA score > 6, and D-dimer level > 4 were significantly associated with a greater risk of death. At the multivariate analysis SOFA score > 6 and D-dimer level > 4 resulted as significant factors for a higher risk of death. No health care workers associated with tracheostomy are confirmed to be infected by SARS-CoV2. CONCLUSION We suggest to wait at least 14 days to perform tracheostomy. In patients with SOFA score > 6 and D dimer > 4, tracheostomy should not be performed or should be postponed. Optimized procedures and enhanced personal protective equipment can make the tracheostomy safe and beneficial in COVID-19 patients.
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Affiliation(s)
- T Volo
- Department of Otorhinolaryngology-Head and Neck Surgery, Mestre Hospital, via Paccagnella 11, 30174, Venice, Italy.
| | - P Stritoni
- Department of Otorhinolaryngology-Head and Neck Surgery, Mestre Hospital, via Paccagnella 11, 30174, Venice, Italy
| | - I Battel
- Department of Physical Medicine & Rehabilitation, Venice Hospital, 30122, Venice, Italy
| | - B Zennaro
- Department of Otorhinolaryngology-Head and Neck Surgery, Mestre Hospital, via Paccagnella 11, 30174, Venice, Italy
| | - F Lazzari
- Department of Critical Care, Mestre Hospital, 30174, Venice, Italy
| | - M Bellin
- Department of Critical Care, Mestre Hospital, 30174, Venice, Italy
| | - L Michieletto
- Department of Pneumology, Mestre Hospital, 30174, Venice, Italy
| | - G Spinato
- Department of Otorhinolaryngology, University of Padova, 31100, Treviso, Italy
| | - C Busatto
- DISIA, Statistics, Computer Science, Applications "G. Parenti", University of Florence, 50134, Florence, Italy
| | - D Politi
- Department of Otorhinolaryngology-Head and Neck Surgery, Mestre Hospital, via Paccagnella 11, 30174, Venice, Italy
| | - R Spinato
- Department of Otorhinolaryngology-Head and Neck Surgery, Mestre Hospital, via Paccagnella 11, 30174, Venice, Italy
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