1
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Wahid NW, Deutsch P, Amlani A, Gupta KK, Griffiths H, Ahmad I. Bedside open tracheostomy in COVID-19 patients - a safe and swift approach. Med Oral Patol Oral Cir Bucal 2023; 29:26326. [PMID: 37992143 PMCID: PMC11175577 DOI: 10.4317/medoral.26326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/09/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Tracheostomy can be performed as an open surgical procedure, percutaneous, or hybrid and forms an important step in the management of patients infected with coronavirus disease 2019 (COVID-19) requiring weaning from mechanical ventilation. The purpose of this article is to share our experience to performing bedside surgical tracheostomy in COVID-19 patients in a safe and effective manner, whilst minimising the risk of viral transmission, to optimise patient outcomes and reduce risk to healthcare professionals. MATERIAL AND METHODS As recommended by ENT UK, we prospectively established a COVID Airway Team within the ENT department at Birmingham Heartlands Hospital, consisting of four head and neck consultant surgeons to perform either open-bedside, open-theatre or percutaneous tracheostomy in COVID-19 patients. A specific stepwise method for bedside open surgical tracheostomy was based on ENT UK and British Laryngological Society recommendations. RESULTS Thirty patients underwent tracheostomy during the study period (14 bedside-open, 5 open-theatre, 11 percutaneous). Mean duration of mechanical intubation prior to bedside-open tracheostomy was 14.5 days. The average time for open-bedside tracheostomy was 9 minutes compared to 31 minutes for open-theatre. There were no significant tracheostomy related complications with bedside-open tracheostomy. No healthcare professional involved reported acute COVID-19 infection. CONCLUSIONS We describe our effective, safe and swift approach to bedside open tracheostomy during the COVID-19 pandemic. Our experience demonstrated a short mean procedural time, with no tracheostomy-related complications and no reported viral transmission amongst the healthcare members involved.
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Affiliation(s)
- N-W Wahid
- Birmingham Heartlands Hospital B9 5SS, Bordesley Green East Birmingham, United Kingdom
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2
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Saraf¹ A, Manhas M, Manhas A, Ahmad R, Kalsotra P. Elective Tracheostomy During Covid-19 Pandemic- A Tertiary Care Centre Experience. Indian J Otolaryngol Head Neck Surg 2023:1-5. [PMID: 36684822 PMCID: PMC9838437 DOI: 10.1007/s12070-022-03381-x] [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: 09/06/2021] [Accepted: 12/07/2022] [Indexed: 01/11/2023] Open
Abstract
Aims and Objectives : The aim of our study was to present an experience of elective tracheostomy in COVID-19 patients at our institute. Materials and methods The present prospective study was conducted, after approval by Institutional Ethics Committee, in the Department of ENT, SMGS Hospital, GMC Jammu from May 2020 to March 2021 over 60 patients having need for prolonged mechanical ventilation and having tested positive for COVID-19 with nasopharyngeal swab on rtPCR assay testing. Detailed information regarding following aspects was gathered :Age, Gender, Comorbidities (Diabetes, Cardiovascular disease, Pulmonary disease, Malignancy), time of endotracheal intubation to tracheostomy, time to wean sedation after tracheostomy, time to wean mechanical ventilation after tracheostomy, surgical complications, mortality, any health care worker in operating team getting infected by SARS-CoV-2. All 60 patients underwent Elective Open Tracheostomy Bed-side in the ICU section of our institute. Results The mean age of presentation was 55.9 ± 2.34 years, with male preponderance. The most common indication for tracheostomy was ARDS (Acute Respiratory Distress Syndrome) (56.6%). Out of 60 patients, co-morbidities were present in 44 patients (73.3%). The mean time between endotracheal intubation and tracheostomy was 12.2 ± 4.9 days. The mean time to wean mechanical ventilation after tracheostomy was 10.4 ± 2.31 days. The mean time to wean sedation was 2.2 ± 0.83 days. There were no deaths during the procedure. Out of 60 patients, 5 patients (8.3%) died due to complications of COVID-19. Conclusion Our study provides important clinical data (such as timing of tracheostomy, pre-operative evaluation of patients, recommendations during procedure, outcomes of tracheostomy and postoperative care) on this threatening issue of tracheostomy in COVID-19 patients and might be of immense help to various Otorhinolaryngologists who are dealing with the same situation.
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Affiliation(s)
- Aditiya Saraf¹
- Department of ENT and Head and Neck Surgery, SMGS Hospital, Government Medical College, Jammu, Jammu and Kashmir India
| | - Monica Manhas
- Department of Physiology, Government Medical College, Jammu, Jammu and Kashmir India
| | - Amit Manhas
- Department of Anaesthesia, Government Medical College, Jammu, Jammu and Kashmir India
| | - Raies Ahmad
- Department of ENT and Head and Neck Surgery, SMGS Hospital, Government Medical College, Jammu, Jammu and Kashmir India
| | - Parmod Kalsotra
- Department of ENT and Head and Neck Surgery, SMGS Hospital, Government Medical College, Jammu, Jammu and Kashmir India
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3
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DEZZANI EO. COVID-19 and surgery. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.22.05497-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Botti C, Menichetti M, Marchese C, Pernice C, Giordano D, Perano D, Russo P, Ghidini A. The role of tracheotomy in patients with moderate to severe impairment of the lower airways. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:S73-S78. [PMID: 35763277 PMCID: PMC9137380 DOI: 10.14639/0392-100x-suppl.1-42-2022-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/07/2022] [Indexed: 01/08/2023]
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5
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Kapoor D, Ramavat AS, Mehndiratta M, Agrawal A, Arora V, Goel A. Impact of coronavirus disease 2019 on ENT clinical practice and training: the resident's perspective. J Laryngol Otol 2021; 135:1-5. [PMID: 34612181 PMCID: PMC8523968 DOI: 10.1017/s0022215121002814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The arrival of the coronavirus disease 2019 pandemic disrupted life suddenly and forcefully, and healthcare systems around the world are still struggling to come to terms with it. This paper reviews the impact of the pandemic on ENT practice and training. METHODS The present manuscript was developed as a narrative review to examine the role of otorhinolaryngologists in the management of the pandemic, and assess its impact on practice and training in the specialty. RESULTS Otorhinolaryngologists handle secretions of organs implicated in disease transmission, leaving them particularly vulnerable even while performing simple procedures. Although the pandemic increased skill expectations, it simultaneously reduced learning opportunities for trainees. In addition, attention to emergencies has been delayed. Further, the suspension of elective procedures has affected patients with malignancies. CONCLUSION While planning service resumption, provisions need to be made for protective equipment and training; improving teleconsultation services will help provide sustainable care during further waves.
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Affiliation(s)
- D Kapoor
- Department of ENT and Head and Neck Surgery, University College of Medical Sciences, Guru Teg Bahadur Hospital, Delhi, India
| | - A S Ramavat
- Department of Otorhinolaryngology, and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - A Agrawal
- Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - V Arora
- Department of ENT and Head and Neck Surgery, University College of Medical Sciences, Guru Teg Bahadur Hospital, Delhi, India
| | - A Goel
- Department of Medicine, University College of Medical Sciences, Guru Teg Bahadur Hospital, Delhi, India
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6
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Jones H, Gendre A, Walshe P, Walsh M, Glynn F, Lacy P, Gaffney R, McConn Walsh R, Mamdouh S, O'Rourke J, Morgan R, O'Brien ME, Shine N, Curley GF, O'Neill JP. The Royal College of surgeons multidisciplinary guidelines on elective tracheostomy insertion in COVID-19 ventilated patients. Surgeon 2021; 19:e265-e269. [PMID: 33423925 PMCID: PMC7833599 DOI: 10.1016/j.surge.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/28/2020] [Accepted: 12/11/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The current COVID-19 pandemic has placed enormous strain on healthcare systems worldwide. Understanding of COVID-19 is rapidly evolving. Pneumonia associated with COVID-19 may lead to respiratory failure requiring mechanical ventilation. The rise in patients requiring mechanical ventilation may lead to an increase in tracheostomies being performed in patients with COVID-19. Performing tracheostomy in patients with active SARS-CoV-2 infection poses a number of challenges. METHODS These guidelines were written following multidisciplinary agreement between Otolaryngology, Head and Neck Surgery, Respiratory Medicine and the Department of Anaesthetics and Critical Care Medicine in the Royal College of Surgeons in Ireland. A literature review was performed and a guideline for elective tracheostomy insertion in patients with COVID-19 proposed. CONCLUSION The decision to perform tracheostomy in patients with COVID-19 should be undertaken by senior members of the multidisciplinary team. Steps should be taken to minimise risks to healthcare workers.
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Affiliation(s)
- Holly Jones
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland.
| | - Adrien Gendre
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
| | - Peter Walshe
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
| | - Michael Walsh
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
| | - Fergal Glynn
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
| | - Peter Lacy
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
| | - Robert Gaffney
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
| | - Rory McConn Walsh
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
| | - Sherif Mamdouh
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
| | - James O'Rourke
- Department of Anaesthesia and Critical Care Medicine, The Royal College of Surgeons, Ireland
| | - Ross Morgan
- Department of Respiratory Medicine, The Royal College of Surgeons, Ireland
| | | | - Neville Shine
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
| | - Gerard F Curley
- Department of Anaesthesia and Critical Care Medicine, The Royal College of Surgeons, Ireland
| | - James Paul O'Neill
- Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland
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7
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von Sneidern M, Lehmann AE, Jafari A, Vlasakov IK, Shen SA, Goss D, Bleier BS. Reflecting on the COVID-19 Surgical Literature Surge: A Scoping Review of Pandemic Otolaryngology Publications. Otolaryngol Head Neck Surg 2021; 167:65-72. [PMID: 34491871 DOI: 10.1177/01945998211041933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the high-volume 2020 COVID-19-related surgical literature, with special attention to otolaryngology articles in regard to content, level of evidence, citations, and public attention. STUDY DESIGN A scoping literature review was performed with PubMed and Web of Science, including articles pertaining to COVID-19 and surgical specialties (March 20-May 19, 2020) or otolaryngologic subspecialties (March 20-December 31, 2020). SETTING Scoping literature review. METHODS Otolaryngology-specific COVID-19-related articles were reviewed for publication date, county of origin, subspecialty, content, level of evidence, and Altmetric Attention Score (a weighted approximation of online attention received). Data were analyzed with Pearson correlation coefficients, analysis of variance, independent t tests, and univariable and logistic regressions. RESULTS This review included 773 early COVID-19 surgical articles and 907 otolaryngology-specific COVID-19-related articles from 2020. Otolaryngology was the most represented surgical specialty within the early COVID-19-related surgical literature (30.4%). The otolaryngology-specific COVID-19 surgical literature responsively reflects the unique concerns within each otolaryngologic subspecialty. Although this literature was largely based on expert opinion (64.5%), articles with stronger levels of evidence received significantly more citations (on Web of Science and Google Scholar, P < .001 for both) and public attention (according to Altmetric Attention Scores, P < .001). CONCLUSION Despite concerns of a surge in underrefereed publications during the COVID-19 pandemic, our review of the surgical literature offers some degree of reassurance. Specifically, the COVID-19 otolaryngology literature responsively reflects the unique concerns and needs of the field, and more scholarly citations and greater online attention have been given to articles offering stronger levels of scientific evidence.
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Affiliation(s)
- Manuela von Sneidern
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, New York University, New York, New York, USA
| | - Ashton E Lehmann
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Otolaryngology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Aria Jafari
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | | | - Sarek A Shen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Deborah Goss
- Howe Library, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Benjamin S Bleier
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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8
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Castillo-Allendes A, Contreras-Ruston F, Cantor L, Codino J, Guzman M, Malebran C, Manzano C, Pavez A, Vaiano T, Wilder F, Behlau M. Terapia de voz en el contexto de la pandemia covid-19; recomendaciones para la práctica clínica. J Voice 2021; 35:808.e1-808.e12. [PMID: 32917457 PMCID: PMC7442931 DOI: 10.1016/j.jvoice.2020.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Since the beginning of the new pandemic, COVID-19 health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment. OBJECTIVE To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists. METHODS A group of 11 experts in voice and swallowing disorders from 5 different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context. RESULTS The clinical guide provides 79 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics. CONCLUSION This guideline should be taken only as recommendations; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.
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Affiliation(s)
- Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | - Francisco Contreras-Ruston
- Speech-Language Pathology and Audiology Department, Universidad de Valparaíso, San Felipe, Chile,Address correspondence and reprint requests to Francisco Contreras-Ruston, CEV–Centro de Estudos da Voz, Rua Machado Bittencourt, 361, SP 04044-001, Brazil
| | - Lady Cantor
- Department of Collective Health, Universidad Nacional de Colombia, Bogotá, Colombia,Program of Speech and Language Pathology, Universidad Manuela Beltrán, Bogotá, Colombia
| | - Juliana Codino
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan,Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
| | - Marco Guzman
- Universidad de los Andes, Chile, Santiago, Chile
| | - Celina Malebran
- Escuela de Fonoaudiología, Universidad Católica Silva Henríquez, Santiago, Chile
| | - Carlos Manzano
- Hospital Médica Sur, Ciudad de México, México,Centro Médico ABC, Ciudad de México, México
| | - Axel Pavez
- Physical Medicine and Rehabilitation Service, Hospital de Urgencia Asistencia Pública. Santiago, Chile
| | - Thays Vaiano
- CEV - Centro de Estudos da Voz, São Paulo, Brazil,Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Fabiana Wilder
- Carrera de Fonoaudiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina,Servicio de Fonoudiología, Hospital de Clínicas “José de San Martin”, Buenos Aires, Argentina
| | - Mara Behlau
- CEV - Centro de Estudos da Voz, São Paulo, Brazil,Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
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9
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Castillo-Allendes A, Contreras-Ruston F, Cantor L, Codino J, Guzman M, Malebran C, Manzano C, Pavez A, Vaiano T, Wilder F, Behlau M. Terapia Vocal No Contexto Da Pandemia Do Covid-19; Orientações Para A Prática Clínica. J Voice 2021; 35:808.e13-808.e24. [PMID: 32917460 PMCID: PMC7439998 DOI: 10.1016/j.jvoice.2020.08.019] [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] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Since the beginning of the new pandemic, Corona Virus Disease 2019 (COVID-19) health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment. OBJECTIVE To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists. METHODS A group of 11 experts in voice and swallowing disorders from five different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context. RESULT The clinical guide provides 79 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics. CONCLUSION This guideline should be taken only as recommendation; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.
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Affiliation(s)
- Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | - Francisco Contreras-Ruston
- Speech-Language Pathology and Audiology Department, Universidad de Valparaíso, San Felipe, Chile,Address correspondence and reprint requests to Francisco Contreras-Ruston, CEV–Centro de Estudos da Voz, Rua Machado Bittencourt, 361, SP 04044-001, Brazil
| | - Lady Cantor
- Department of Collective Health, Universidad Nacional de Colombia, Bogotá, Colombia,Program of Speech and Language Pathology, Universidad Manuela Beltrán, Bogotá, Colombia
| | - Juliana Codino
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan,Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
| | - Marco Guzman
- Universidad de los Andes, Chile, Santiago, Chile
| | - Celina Malebran
- Escuela de Fonoaudiología, Universidad Católica Silva Henríquez, Santiago, Chile
| | - Carlos Manzano
- Hospital Médica Sur, Ciudad de México, México,Centro Médico ABC, Ciudad de México, México
| | - Axel Pavez
- Physical Medicine and Rehabilitation Service, Hospital de Urgencia Asistencia Pública. Santiago, Chile
| | - Thays Vaiano
- CEV - Centro de Estudos da Voz, São Paulo, Brazil,Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Fabiana Wilder
- Carrera de Fonoaudiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina,Servicio de Fonoudiología, Hospital de Clínicas “José de San Martin,” Buenos Aires, Argentina
| | - Mara Behlau
- CEV - Centro de Estudos da Voz, São Paulo, Brazil,Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
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10
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Castillo-Allendes A, Contreras-Ruston F, Cantor-Cutiva LC, Codino J, Guzman M, Malebran C, Manzano C, Pavez A, Vaiano T, Wilder F, Behlau M. Voice Therapy in the Context of the COVID-19 Pandemic: Guidelines for Clinical Practice. J Voice 2021; 35:717-727. [PMID: 32878736 PMCID: PMC7413113 DOI: 10.1016/j.jvoice.2020.08.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Since the beginning of the new pandemic, COVID-19 health services have had to face a new scenario. Voice therapy faces a double challenge, interventions using telepractice, and delivering rehabilitation services to a growing population of patients at risk of functional impairment related to the COVID-19 disease. Moreover, as COVID-19 is transmitted through droplets, it is critical to understand how to mitigate these risks during assessment and treatment. OBJECTIVE To promote safety, and effective clinical practice to voice assessment and rehabilitation in the pandemic COVID-19 context for speech-language pathologists. METHODS A group of 11 experts in voice and swallowing disorders from five different countries conducted a consensus recommendation following the American Academy of Otolaryngology-Head and Neck Surgery rules building a clinical guide for speech-language pathologists during this pandemic context. RESULTS The clinical guide provides 65 recommendations for clinicians in the management of voice disorders during the pandemic and includes advice from assessment, direct treatment, telepractice, and teamwork. The consensus was reached 95% for all topics. CONCLUSION This guideline should be taken only as recommendation; each clinician must attempt to mitigate the risk of infection and achieve the best therapeutic results taking into account the patient's particular reality.
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Affiliation(s)
- Adrián Castillo-Allendes
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan
| | | | - Lady Catherine Cantor-Cutiva
- Department of Collective Health, Universidad Nacional de Colombia, Bogotá, Colombia; Program of Speech and Language Pathology, Universidad Manuela Beltrán, Bogotá, Colombia
| | - Juliana Codino
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, Michigan; Lakeshore Professional Voice Center, Lakeshore Ear, Nose, and Throat Center, St. Clair Shores, Michigan
| | - Marco Guzman
- Universidad de los Andes, Chile, Santiago, Chile
| | - Celina Malebran
- Escuela de Fonoaudiología, Universidad Católica Silva Henríquez, Santiago, Chile
| | - Carlos Manzano
- Hospital Médica Sur, Ciudad de México, México; Centro Médico ABC, Ciudad de México, México
| | - Axel Pavez
- Physical Medicine and Rehabilitation Service, Hospital de Urgencia Asistencia Pública. Santiago, Chile
| | - Thays Vaiano
- CEV - Centro de Estudos da Voz, São Paulo, Brazil; Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Fabiana Wilder
- Carrera de Fonoaudiología, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina; Servicio de Fonoudiología, Hospital de Clínicas "José de San Martin", Buenos Aires, Argentina
| | - Mara Behlau
- CEV - Centro de Estudos da Voz, São Paulo, Brazil; Speech-Language Pathology and Audiology Department, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
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11
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Novel Use of Tracheostomy Shield for Emergency Tracheostomy in Covid 19 Era. Indian J Otolaryngol Head Neck Surg 2021; 74:3416-3419. [PMID: 34026594 PMCID: PMC8128088 DOI: 10.1007/s12070-021-02632-7] [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: 05/01/2021] [Accepted: 05/10/2021] [Indexed: 11/20/2022] Open
Abstract
To evaluate the problems in doing emergency tracheostomy and tracheostomy care of patients with unknown COVID-19 status. Study the usefulness of the specially designed Tracheostomy Shield. A prospective hospital-based study was conducted at a tertiary care center in India treating COVID and Non COVID patients. The study was done from April 2020 to December 2020. A total of 80 tracheostomy were done using Tracheostomy shield. Open tracheostomies were 38 while 42 patients were already intubated (closed circuit). The Tracheostomy shield was also used in 380 tracheostomy tubes changes. Two patients were found COVID positive on RT-PCR after tracheostomy. There was no scope for testing all tube changes with RT-PCR. The use of our indigenously designed Tracheostomy shield has been effective in reducing the aerosol spread and there was no COVID transmission reported. The use of patient Tracheostomy shield is of uttermost importance in reducing the respiratory droplets splashing on to the surgeon and assistant while doing awake tracheostomy. It is extremely useful while changing tubes as there are chances of false negatives antigen test which might be miss leading. The use of Tracheostomy shield is very important in the current context of new and fast evolving respiratory infections.
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12
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"A Systematic Review on Guidelines and Recommendations for Tracheostomy During COVID-19 Pandemic". Indian J Otolaryngol Head Neck Surg 2021; 74:2947-2958. [PMID: 33942020 PMCID: PMC8082219 DOI: 10.1007/s12070-021-02517-9] [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: 09/25/2020] [Accepted: 03/15/2021] [Indexed: 12/23/2022] Open
Abstract
World is under threat of COVID-19 pandemic, associated with many numbers of critically ill patients. To manage these intubated patients there are need of more ventilators but world is not prepared for this type of situation and there are lacunae of such arrangements in most of the countries. As we know patients cannot be intubated for long time and they should be given preference to alternative airway in the form of tracheostomy. COVID-19 is aerosol transmitted disease which lead to indeed challenge to health care providers to safely perform tracheostomy and provide post tracheostomy care to these patients with minimising risks of nosocomial transmission to themselves and accompanying nursing staff. There are so many guidelines and recommendations for the timing, desired place of tracheostomy, change in tracheostomy steps related to conventional method and the subsequent management of patients. So, the aim of this systematic review is to give a brief review of available data on COVID-19 related to the timing, personal protections, operative steps modifications, and subsequent post tracheostomy care during this pandemic.
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13
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Turkdogan S, Kay-Rivest E, Giroux M, Piché C, Khwaja K, Mascarella M, Khalife S, Alohali S, Kost K. Percutaneous Tracheostomy With a Demistifier Canopy in the COVID-19 Era: A Safe Technique in the Intensive Care Unit. EAR, NOSE & THROAT JOURNAL 2021; 102:312-318. [PMID: 33734882 DOI: 10.1177/01455613211001595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Endoscopic percutaneous tracheostomy (PT) is a safe technique that is performed frequently by otolaryngologists and intensivists. New challenges have been identified in order to maintain the safety of this procedure during the COVID-19 pandemic. A novel approach, using a modified demistifier canopy, was developed during the first wave of the pandemic and implemented for 17 consecutive percutaneous tracheostomies in order to enhance procedural safety. METHODS A protocol was developed after performing a literature review of tracheostomy in COVID-19 patients. A multidisciplinary tracheostomy team was established, including the departments of otolaryngology, critical care, and respiratory therapy. Simulation was performed prior to each PT, and postoperative debriefings were done. RESULTS A protocol and technical description of PT using a modified demistifier canopy covering was written and video documented. Data were collected on 17 patients who underwent this procedure safely in our tertiary care hospital. There were no procedure-related complications, and no evidence of COVID-19 transmission to any member of the health care team during the study period. CONCLUSION As patients continue to recover from COVID-19, their need for tracheostomy will increase. The technique described provides a safe, multidisciplinary method of performing PT in COVID-19 patients.
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Affiliation(s)
- Sena Turkdogan
- Department of Otolaryngology-Head and Neck surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Emily Kay-Rivest
- Department of Otolaryngology-Head and Neck surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Melanie Giroux
- Department of Respiratory Therapy, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Chantal Piché
- Department of Respiratory Therapy, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Kosar Khwaja
- Department of Critical Care Medicine, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Marco Mascarella
- Department of Otolaryngology-Head and Neck surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Sarah Khalife
- Department of Otolaryngology-Head and Neck surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Sama Alohali
- Department of Otolaryngology-Head and Neck surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Karen Kost
- Department of Otolaryngology-Head and Neck surgery, Royal Victoria Hospital, Montreal, Quebec, Canada
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14
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Gomez ED, Ceremsak JJ, Leibowitz A, Jalisi S. A Novel Cough Simulation Device for Education of Risk Mitigation Techniques During Aerosol-Generating Medical Procedures. Otolaryngol Head Neck Surg 2021; 165:816-818. [PMID: 33722105 DOI: 10.1177/01945998211000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The COVID-19 pandemic has drawn attention to aerosol-generating medical procedures (AGMPs) in health care environments as a potential mode of transmission. Many organizations and institutions have published AGMP safety guidelines, and several mention the use of simulation in informing their recommendations; however, current methods used to simulate aerosol generation are heterogenous. Creation of a high-fidelity, easily producible aerosol-generating cough simulator would meet a high-priority educational need across all medical specialties. In this communication, we describe the design, construction, and user study of a novel cough simulator, which demonstrates the utility of simulation in raising AGMP safety awareness for providers of all roles, specialties, and training levels.
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Affiliation(s)
- Ernest D Gomez
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Akiva Leibowitz
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Scharukh Jalisi
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Otolaryngology-Head and Neck Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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15
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Erdem AF, Tomak Y, Balaban O, Demir G. Percutaneous Dilational Tracheostomy in a Patient With SARS-CoV-2 (COVID-19) Disease: A Case Report With Implications in Staff Safety. Cureus 2021; 13:e13769. [PMID: 33842145 PMCID: PMC8026141 DOI: 10.7759/cureus.13769] [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] [Indexed: 12/23/2022] Open
Abstract
Some patients may need mechanical ventilation support during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease-2019, COVID-19) infection and may eventually require tracheostomy in the following days. Tracheostomy is considered as a high-risk procedure for surgeons and operative personnel in terms of air contamination. We present a case of percutaneous dilational tracheostomy performed in a patient with COVID-19 pneumonia and the methods we used to reduce contamination risks for the healthcare staff.
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Affiliation(s)
- Ali Fuat Erdem
- Anesthesiology and Reanimation, Sakarya University Training and Research Hospital, Sakarya, TUR
| | - Yakup Tomak
- Anesthesiology and Reanimation, Sakarya University Faculty of Medicine, Sakarya, TUR
| | - Onur Balaban
- Anesthesiology and Pain Medicine, Sakarya University Training and Research Hospital, Sakarya, TUR
| | - Gürkan Demir
- Anesthesiology and Reanimation, Sakarya University Training and Research Hospital, Sakarya, TUR
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16
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Shivnani D, Raman EV, Amle D. The COVID TIDE Approach: A Protocol for Safe Tracheostomy Practice in COVID Patients. Indian J Otolaryngol Head Neck Surg 2021; 73:197-206. [PMID: 33489854 PMCID: PMC7813173 DOI: 10.1007/s12070-021-02370-w] [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: 10/21/2020] [Accepted: 01/04/2021] [Indexed: 11/24/2022] Open
Abstract
We all are aware of COVID 19 pandemic. As the numbers are increasing, the critical care demand is also increasing. Tracheostomy is one of the commonest procedures which has been performed on COVID positive ventilated patients. It is important to understand and follow the utmost safe practices for the patient and the health care workers for such aerosol generating procedures. The aim of this study is to identify the lacunae in tracheostomy practices during this COVID times and suggest a systematic approach for the safe practices. An online questionnaire survey-based study was performed in September 2020. The target population was practicing otolaryngologists of India with various years of experience. The aim of the study was to evaluate the lacunae in tracheostomy safe practices and to create a systematic approach for the safety of health care workers. Data compilation and analysis was done by using Microsoft Excel. A systematic COVID TIDE tracheostomy safe practices approach was designed after reviewing various tracheostomy guidelines and recommendations. Total 114 otolaryngologists responded with a complete survey report. 72.2% responders were not up to date with their knowledge of tracheostomy safe practices. 79.8% were not performing this procedure in a negative pressure room. 15.8% were not aware of the personal protective equipment level they are using. Only 56.1% survey responders were holding the ventilation before tracheal incision. Overall, 94.7% responders were keen to know about the safe approach of tracheostomy in COVID positive patients. Tracheostomy is an aerosol generating procedure, lacunae in the knowledge can cause major risk to health care professionals. Finally, in such crises, consideration should be taken for simulation exercises, dedicated airway teams and a systematic COVID TIDE approach to improve the safety of the staff and patients.
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Affiliation(s)
- Deepa Shivnani
- Department of Otorhinolaryngology, Head and Neck Surgery, Children's Airway and Swallowing Center, Manipal Hospital, Bengaluru, Karnataka India
| | - Eshwara V Raman
- Department of Otorhinolaryngology, Head and Neck Surgery, Children's Airway and Swallowing Center, Manipal Hospital, Bengaluru, Karnataka India
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17
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Zhang N, Lechien JR, Martinez V, Carlier RY, El Hajjam M. Contribution of Interventional Radiologist in the Management of Pseudoaneurysm and Neck Hemorrhages in COVID-19 patients. EAR, NOSE & THROAT JOURNAL 2021; 100:148S-151S. [PMID: 33410706 DOI: 10.1177/0145561320987030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patients with severe coronavirus disease 2019 (COVID-19) may have endothelial inflammation, pseudoaneurysm, and an increasing risk of bleeding, especially during surgical procedures. In this article, we reported 2 cases of COVID-19 patients with neck vascular lesions. The first patient had pseudoaneurysm of the cricothyroid artery, which was treated by percutaneous glue injection through ultrasonography guidance. The second patient presented lateral neck hematoma in front of the left superior thyroid artery, which was managed by coil endovascular embolization. In the context of pandemic, the management of vascular lesions may be performed through interventional radiological procedures that may reduce the risk of virus aerosolization and health care provider contamination.
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Affiliation(s)
- Norbert Zhang
- Department of Medical Imaging and Interventional Radiology, DMU Smart Imaging. 26930Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Jérôme R Lechien
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, GH Université Paris-Saclay, Suresnes, France
| | - Valéria Martinez
- Department of Anesthesiology, 26930Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Hospital, Garches, France
| | - Robert-Yves Carlier
- Department of Medical Imaging and Interventional Radiology, DMU Smart Imaging, 26930Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Raymond Poincaré Hospital, Garches, France
| | - Mostafa El Hajjam
- Department of Medical Imaging and Interventional Radiology, DMU Smart Imaging. 26930Assistance Publique-Hôpitaux de Paris, GH Université Paris-Saclay, Ambroise Paré Hospital, Boulogne-Billancourt, France
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18
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Tan JL, Lim MY, Lee SYC, Yeo SB. Impact of COVID-19 on a Tertiary Otolaryngology Practice in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021. [PMID: 33381783 DOI: 10.47102/annals-acadmedsg.2020214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The COVID-19 pandemic has had a major impact in healthcare systems across the world, with many hospitals having to come up with protocols and measures to contain the spread of the virus. This affects various specialties' clinical practices in many ways. Since early 2020 in Singapore, the Department of Otorhinolaryngology at Tan Tock Seng Hospital had to rapidly adapt to this pandemic as we provided services to the main healthcare facility combating the virus in our country. We had to design new workflows and also remain flexible in view of the ever-changing situation. There are 6 important domains for an otolaryngology department or any clinical department in general to consider when making adjustments to their practices in an outbreak: (1) clinical work, (2) education, (3) research, (4) safety of patients and staff, (5) morale of medical staff and (6) pandemic frontline work. We hope that the sharing of our experiences and the lessons learnt will be useful for both our local and international colleagues.
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Affiliation(s)
- Jian Li Tan
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore
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19
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Yeung E, Hopkins P, Auzinger G, Fan K. Challenges of tracheostomy in COVID-19 patients in a tertiary centre in inner city London. Int J Oral Maxillofac Surg 2020; 49:1385-1391. [PMID: 32912655 PMCID: PMC7451123 DOI: 10.1016/j.ijom.2020.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/14/2020] [Accepted: 08/17/2020] [Indexed: 01/08/2023]
Abstract
The rapid global spread of SARS-CoV-2, the causative agent of COVID-19, has dominated healthcare services, with exponential numbers requiring mechanical ventilation in the intensive care unit (ICU). Tracheostomy facilitates respiratory and sedative weaning but risks potential viral transmission. This study reviewed the tracheostomy provision, techniques, and outcomes for a single-centre prospective cohort during the resource-pressured COVID-19 period. Seventy-two of 176 patients underwent tracheostomy at a median 17 days: 44 surgical (open), 28 percutaneous. Their median age was 58 years, the male to female ratio was 2.4:1, 75.1% were of BAME backgrounds, 76% had a BMI≥25kg/m2, and 65% had ≥2 major co-morbidities. Seventy-nine percent of patients were weaned from sedation at a median 2 days, 61% were weaned from mechanical ventilation at a median 10 days, 39% were discharged from the ICU at a median 11.5 days, and 19.4% were discharged home at a median 24 days. All patients survived the procedure. The mortality rate was 9.7% at a median 12 days. No clinician reported COVID-19 symptoms within 14 days of the procedure. The role of tracheostomy in COVID-19 is currently unclear. Delivery of tracheostomy by maxillofacial surgeons relieved the workload pressure from ICU clinicians. The choice of technique was influenced by the patient and resource factors, resulting in a mixed cohort of open and percutaneous tracheostomy in COVID-19 patients. Preliminary data suggest that open tracheostomy is as favourable as percutaneous tracheostomy for COVID-19 patients, and is safe for clinicians.
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Affiliation(s)
- E Yeung
- King's College London Hospital NHS Foundation Trust, Denmark Hill, London, SE1 9RT, UK
| | - P Hopkins
- King's College London Hospital NHS Foundation Trust, Denmark Hill, London, SE1 9RT, UK
| | - G Auzinger
- King's College London Hospital NHS Foundation Trust, Denmark Hill, London, SE1 9RT, UK
| | - K Fan
- King's College London Hospital NHS Foundation Trust, Denmark Hill, London, SE1 9RT, UK.
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20
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Pudszuhn A, Voegeler S, Berger C, Treskatsch S, Angermair S, Hansen S, Hofmann VM. [Elective tracheostomy in COVID-19 patients: experience with a standardized interdisciplinary approach]. HNO 2020; 68:838-846. [PMID: 32840646 PMCID: PMC7445822 DOI: 10.1007/s00106-020-00917-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Berichtet wird über die Erfahrungen mit einer interdisziplinären klinikinternen SOP (Standard Operation Procedure) zur Tracheostomie (TS) bei „Coronavirus-Disease“(COVID-19)-Patienten, unter Berücksichtigung der allgemeinen nationalen und internationalen Empfehlungen. Der interdisziplinär festgelegte operative Zeitpunkt der TS aufgrund einer prolongierten invasiven Beatmung und frustranen Weaning-Versuchen betraf Phasen sowohl hoher als auch niedriger Erkrankungsaktivität. Es wurden 5 TS bei Patienten mit einem Durchschnittsalter von 70,6 Jahren durchgeführt. Neben den Standard-COVID-19-Schutzmaßnahmen für das medizinische Personal zur Vermeidung einer nosokomialen COVID-19-Infektion führt die SOP-unterstützte Kommunikation während der TS zu einer periprozeduralen Sicherheit aller Beteiligten. COVID-19-Erkrankungen des medizinischen Personals der beteiligten Abteilungen sind bisher nicht bekannt.
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Affiliation(s)
- A Pudszuhn
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland.
| | - S Voegeler
- Klinik für Anästhesiologie und Intensivmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - C Berger
- Klinik für Anästhesiologie und Intensivmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - S Treskatsch
- Klinik für Anästhesiologie und Intensivmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - S Angermair
- Klinik für Anästhesiologie und Intensivmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - S Hansen
- Institut für Hygiene und Umweltmedizin, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - V M Hofmann
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Campus Benjamin Franklin, Charité Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland
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21
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Sleap E, Dinsmore JE. Advancing the tracheal tube cuff distal to the planned tracheostomy site: margins of safety and merits of bronchoscopic guidance. Anaesthesia 2020; 76:572-573. [PMID: 33080047 DOI: 10.1111/anae.15285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Affiliation(s)
- E Sleap
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - J E Dinsmore
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
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22
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Botti C, Lusetti F, Peroni S, Neri T, Castellucci A, Salsi P, Ghidini A. The Role of Tracheotomy and Timing of Weaning and Decannulation in Patients Affected by Severe COVID-19. EAR, NOSE & THROAT JOURNAL 2020; 100:116S-119S. [PMID: 33035129 PMCID: PMC7548540 DOI: 10.1177/0145561320965196] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives: Patients with acute respiratory failure due to coronavirus disease 2019
(COVID-19) have a high likelihood of needing prolonged intubation and may
subsequently require tracheotomy. Indications and timing for performing
tracheotomy in patients affected by severe COVID-19 pneumonia are still
elusive. The aim of this study is to analyze the role of tracheotomy in the
context of this pandemic. Moreover, we report the timing of the procedure
and the time needed to complete weaning and decannulation in our center. Methods: This retrospective, observational cohort study included adults (≥18 years)
with severe COVID-19 pneumonia who were admitted to the intensive care unit
(ICU) of the tertiary care center of Reggio Emilia (Italy). All patients
underwent orotracheal intubation with invasive mechanical ventilation,
followed by percutaneous or open surgical tracheotomy. Indications, timing
of the procedure, and time needed to complete weaning and decannulation were
reported. Results: Forty-four patients were included in the analysis. Median time from
orotracheal intubation to surgery was 7 (range 2-17) days. Fifteen (34.1%)
patients died during the follow-up period (median 22 days, range 8-68) after
the intubation. Weaning from the ventilator was first attempted on median
25th day (range 13-43) from orotracheal intubation. A median of 35 (range
18-79) days was required to complete weaning. Median duration of ICU stay
was 22 (range 10-67) days. Mean decannulation time was 36 (range 10-77) days
from surgery. Conclusions: Since it is not possible to establish an optimal timing for performing
tracheotomy, decision-making should be made on case-by-case basis. It should
be adapted to the context of the pandemic, taking into account the
availability of intensive care resources, potential risks for health care
workers, and benefits for the individual patient.
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Affiliation(s)
- Cecilia Botti
- PhD Program in Clinical and Experimental Medicine, 208968University of Modena and Reggio Emilia, Reggio Emilia, Italy.,Otolaryngology Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
| | | | - Stefano Peroni
- Intensive Care Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
| | - Tommaso Neri
- Intensive Care Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
| | | | - Pierpaolo Salsi
- Intensive Care Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
| | - Angelo Ghidini
- Otolaryngology Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
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23
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Khan E, Lal S, Hashmi J, Thomas J, Malik MA. Per-cutaneous dilatation tracheostomy (PCTD) in COVID-19 patients and peri-tracheostomy care: A case series and guidelines. Pak J Med Sci 2020; 36:1714-1718. [PMID: 33235603 PMCID: PMC7674874 DOI: 10.12669/pjms.36.7.3518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background & Objective: COVID 19 patients with severe respiratory failure may require prolonged mechanical ventilation. Placement of a tracheostomy tube often becomes necessary for such patients. The steps of tracheostomy procedure and post tracheostomy care of these patients can be classified as aerosol generating. We wish to highlight our modified technique to address these issues. Methodology: We performed percutaneous dilation tracheostomy in three clinically challenging COVID-19 patients in our ICU and developed guidelines aiming to minimise aerosolisation during and after the tracheostomy procedure to safeguard healthcare workers. Results: Percutaneous tracheostomy was performed by a team of three experienced anaesthetists and an ICU nurse. Conclusion: The decision of surgical or percutaneous tracheostomy should be dependent on the experience of the tracheostomy performer, health-care worker safety, resource availability, and patient-centred care. We believe our modified strategic approach of brief bronchoscopy, minimum PEEP and gas flows and step-wise planned approach for PCDT offers an extra level of safety to healthcare workers.
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Affiliation(s)
- Ehtesham Khan
- Dr. Ehtesham Khan, CAI MSc, FCPS, FCARCSI, FJFI CMI, EDIC, DMMD, Dip Pain RCSI. Department of Anaesthesia and Critical Care Medicine, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Shankar Lal
- Dr. Shankar Lal, FCPS. Department of Anaesthesia and Critical Care Medicine, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Junaid Hashmi
- Dr. Junaid Hashmi, FCIA. Department of Anaesthesia and Critical Care Medicine, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Jubil Thomas
- Dr. Jubil Thomas, MBBS, MD, FCARCSI, FJFICMI, CCST, CHCM, Department of Anaesthesia and Critical Care Medicine, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Muhammad Anwar Malik
- Dr. Muhammad Anwar Malik, MBBS, FCPS, FCAI, Dip Pain RCSI Department of Anaesthesia and Critical Care Medicine, Our Lady of Lourdes Hospital, Drogheda, Ireland
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24
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Smith D, Montagne J, Raices M, Dietrich A, Bisso IC, Las Heras M, San Román JE, García Fornari G, Figari M. Tracheostomy in the intensive care unit: Guidelines during COVID-19 worldwide pandemic. Am J Otolaryngol 2020; 41:102578. [PMID: 32505993 PMCID: PMC7832100 DOI: 10.1016/j.amjoto.2020.102578] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/25/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE COVID-19 has become a pandemic with significant consequences worldwide. About 3.2% of patients with COVID-19 will require intubation and invasive ventilation. Moreover, there will be an increase in the number of critically ill patients, hospitalized and intubated due to unrelated acute pathology, who will present underlying asymptomatic or mild forms of COVID-19. Tracheostomy is one of the procedures associated with an increased production of aerosols and higher risk of transmission of the virus to the health personnel. The aim of this paper is to describe indications and recommended technique of tracheostomy in COVID-19 patients, emphasizing the safety of the patient but also the medical team involved. MATERIALS AND METHODS A multidisciplinary group made up of surgeons with privileges to perform tracheostomies, intensive care physicians, infectious diseases specialists and intensive pulmonologists was created to update previous knowledge on performing a tracheostomy in critically ill adult patients (>18 years) amidst the SARS-CoV-2 pandemic in a high-volume referral center. Published evidence was collected using a systematic search and review of published studies. RESULTS A guideline comprising indications, surgical technique, ventilator settings, personal protective equipment and timing of tracheostomy in COVID-19 patients was developed. CONCLUSIONS A safe approach to performing percutaneous dilational bedside tracheostomy with bronchoscopic guidance is feasible in COVID-19 patients of appropriate security measures are taken and a strict protocol is followed. Instruction of all the health care personnel involves is key to ensure their safety and the patient's favorable recovery.
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Affiliation(s)
- David Smith
- Department of Thoracic Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina
| | - Juan Montagne
- Department of Thoracic Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina
| | - Micaela Raices
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina.
| | - Agustín Dietrich
- Department of Thoracic Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina
| | - Indalecio Carboni Bisso
- Department of Intensive Care Medicine and Critical Pulmonology, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina
| | - Marcos Las Heras
- Department of Intensive Care Medicine and Critical Pulmonology, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina
| | - Juan E San Román
- Department of Intensive Care Medicine and Critical Pulmonology, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina
| | - Gustavo García Fornari
- Department of Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina
| | - Marcelo Figari
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABD Buenos Aires, Argentina
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25
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Wielogórska NL, Ekwobi CC. COVID-19: What are the challenges for NHS surgery? Curr Probl Surg 2020; 57:100856. [PMID: 32948255 PMCID: PMC7329670 DOI: 10.1016/j.cpsurg.2020.100856] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/29/2020] [Indexed: 12/15/2022]
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26
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Krajewska Wojciechowska J, Krajewski W, Zub K, Zatoński T. Review of practical recommendations for otolaryngologists and head and neck surgeons during the COVID-19 pandemic. Auris Nasus Larynx 2020; 47:544-558. [PMID: 32540054 PMCID: PMC7275141 DOI: 10.1016/j.anl.2020.05.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Otolaryngologists are at very high risk of COVID-19 infection while performing examination or surgery. Strict guidelines for these specialists have not already been provided, while currently available recommendations could presumably change in course of COVID-19 pandemic as the new data increases. OBJECTIVES This study aimed to synthesize evidence concerning otolaryngology during COVID-19 pandemic. It presents a review of currently existing guidelines and recommendations concerning otolaryngological procedures and surgeries during COVID-19 pandemic, and provides a collective summary of all crucial information for otolaryngologists. It summarizes data concerning COVID-19 transmission, diagnosis, and clinical presentation highlighting the information significant for otolaryngologists. METHODS The Medline and Web of Science databases were searched without time limit using terms ''COVID-19", "SARS-CoV-2" in conjunction with "head and neck surgery", "otorhinolaryngological manifestations". RESULTS Patients in stable condition should be consulted using telemedicine options. Only emergency consultations and procedures should be performed during COVID-19 pandemic. Mucosa-involving otolaryngologic procedures are considered high risk procedures and should be performed using enhanced PPE (N95 respirator and full face shield or powered air-purifying respirator, disposable gloves, surgical cap, gown, shoe covers). Urgent surgeries for which there is not enough time for SARS-CoV-2 screening are also considered high risk procedures. These operations should be performed in a negative pressure operating room with high-efficiency particulate air filtration. Less urgent cases should be tested for COVID-19 twice, 48 h preoperatively in 24 h interval. CONCLUSIONS This review serves as a collection of current recommendations for otolaryngologists for how to deal with their patients during COVID-19 pandemic.
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Affiliation(s)
- Joanna Krajewska Wojciechowska
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Medical University in Wroclaw, Borowska 213 Street, 50556 Wroclaw, Poland.
| | - Wojciech Krajewski
- Department and Clinic of Urology and Urological Oncology, Medical University in Wroclaw, Poland
| | - Krzysztof Zub
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Medical University in Wroclaw, Borowska 213 Street, 50556 Wroclaw, Poland
| | - Tomasz Zatoński
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Medical University in Wroclaw, Borowska 213 Street, 50556 Wroclaw, Poland
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27
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Williamson A, Roberts MT, Phillips J, Saha R. Early percutaneous tracheostomy for patients with COVID-19. Anaesthesia 2020; 76:138-139. [PMID: 32652565 PMCID: PMC7405139 DOI: 10.1111/anae.15197] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - R Saha
- Princess Alexandra Hospital, Harlow, UK
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28
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Kulcsar MA, Montenegro FL, Santos AB, Tavares MR, Arap SS, Kowalski LP. Recommendations for head and neck surgical procedures during the COVID-19 pandemic. Clinics (Sao Paulo) 2020; 75:e2084. [PMID: 32638909 PMCID: PMC7333519 DOI: 10.6061/clinics/2020/e2084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/05/2020] [Indexed: 12/19/2022] Open
Abstract
The coronavirus disease (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread exponentially worldwide. In Brazil, the number of infected people diagnosed has been increasing and, as in other countries, it has been associated with a high risk of contamination in healthcare teams. For healthcare professionals, the full use of personal protective equipment (PPE) is mandatory, such as wearing surgical or filtering facepiece class 2 (FFP2) masks, waterproof aprons, gloves, and goggles, in addition to training in care processes. A reduction in the number of face-to-face visits and non-essential elective procedures is also recommended. However, surgery should not be postponed in the case of the most essential elective indications (mostly associated with head and neck cancers). As malignant tumors of the head and neck are clinically time sensitive, neither consultations for these tumors nor their treatment should be postponed. Postponing surgical treatment can result in a change in the disease stage and alter an individual's chance of survival. In this situation, planning of all treatments must begin with the request for, in addition to routine examinations, a nasal swab polymerase chain reaction for SARS-CoV-2 and chest computed tomography. Only if the results of these tests are positive or if fever or other symptoms suggestive of COVID-19 are present should the surgical procedure be postponed until the patient completely recovers. This is mandatory not only because of the risk of contamination of the surgical team but also because of the increased risk of postoperative complications and high risk of death. During this pandemic, the most effective safety measures are social distancing for the general public and the adequate availability and use of PPE in the healthcare field. The treatment of other chronic diseases, such as cancer, should be continued, as the damming of cases of these diseases will have a deleterious effect on the public healthcare system.
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Affiliation(s)
- Marco A.V. Kulcsar
- Servico de Cirurgia de Cabeca e Pescoco, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Servico de Cirurgia de Cabeca e Pescoco, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fabio L.M. Montenegro
- Servico de Cirurgia de Cabeca e Pescoco, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - André B.O. Santos
- Servico de Cirurgia de Cabeca e Pescoco, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcos R. Tavares
- Servico de Cirurgia de Cabeca e Pescoco, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Sergio S. Arap
- Servico de Cirurgia de Cabeca e Pescoco, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luiz P. Kowalski
- Servico de Cirurgia de Cabeca e Pescoco, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Servico de Cirurgia de Cabeca e Pescoco, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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29
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Lim MY, Gan YJ, Tan BH, Kwan KM, Lim QQR, Lee SF, Chong YK. Practical considerations for the operative team in performing tracheostomy during the COVID-19 pandemic. Singapore Med J 2020; 62:204-206. [PMID: 32588580 DOI: 10.11622/smedj.2020092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Ming Yann Lim
- Department of Otolaryngology, Head and Neck Surgery, Tan Tock Seng Hospital, Singapore
| | - Yijin Jereme Gan
- Department of Otolaryngology, Head and Neck Surgery, Tan Tock Seng Hospital, Singapore
| | - Bin Hui Tan
- Department of Anaesthesia, Woodlands Health Campus, Singapore
| | - Kim Meng Kwan
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Singapore
| | | | - Sow Fong Lee
- Healthcare Management, Tan Tock Seng Hospital, Singapore
| | - Yaw Khian Chong
- Department of Otolaryngology, Head and Neck Surgery, Tan Tock Seng Hospital, Singapore
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30
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Choi SY, Shin J, Park W, Choi N, Kim JS, Choi CI, Ko JH, Chung CR, Son YI, Jeong HS. Safe surgical tracheostomy during the COVID-19 pandemic: A protocol based on experiences with Middle East Respiratory Syndrome and COVID-19 outbreaks in South Korea. Oral Oncol 2020; 109:104861. [PMID: 32590297 PMCID: PMC7298512 DOI: 10.1016/j.oraloncology.2020.104861] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND A subset of patients with COVID-19 require intensive respiratory care and tracheostomy. Several guidelines on tracheostomy procedures and care of tracheostomized patients have been introduced. In addition to these guidelines, further details of the procedure and perioperative care would be helpful. The purpose of this study is to describe our experience and tracheostomy protocol for patients with MERS or COVID-19. MATERIALS AND METHODS Thirteen patients with MERS were admitted to the ICU, 9 (69.2%) of whom underwent surgical tracheostomy. During the COVID-19 outbreak, surgical tracheostomy was performed in one of seven patients with COVID-19. We reviewed related documents and collected information through interviews with healthcare workers who had participated in designing a tracheostomy protocol. RESULTS Compared with previous guidelines, our protocol consisted of enhanced PPE, simplified procedures (no limitation in the use of electrocautery and wound suction, no stay suture, and delayed cannula change) and a validated screening strategy for healthcare workers. Our protocol allowed for all associated healthcare workers to continue their routine clinical work and daily life. It guaranteed safe return to general patient care without any related complications or nosocomial transmission during the MERS and COVID-19 outbreaks. CONCLUSION Our protocol and experience with tracheostomies for MERS and COVID-19 may be helpful to other healthcare workers in building an institutional protocol optimized for their own COVID-19 situation.
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Affiliation(s)
- Sung Yong Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joongbo Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Woori Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Nayeon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Sei Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chan I Choi
- Department of Critical Care Medicine and Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae-Hoon Ko
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine and Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Ik Son
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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31
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Lagos AE, Ramos PH, Andrade T. Protection for Otolaryngologic Surgery in the COVID-19 Pandemic. OTO Open 2020; 4:2473974X20934734. [PMID: 32551408 PMCID: PMC7281886 DOI: 10.1177/2473974x20934734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/13/2022] Open
Abstract
Objective The coronavirus disease 2019 (COVID-19) has placed unprecedented challenges on the world and the medical community. It is transmitted through droplets, contact, the fecal-oral route, and airborne transmission under certain conditions that allow droplets to combine with air particles to form an aerosol. Viral loads are higher in the nasal area and similar in symptomatic and asymptomatic patients. Medical situations have been classified into high and low risk of generating aerosols. Most procedures and surgery in otolaryngology correspond to high-risk medical situations. This review aims to gather the vast amount of available information and generate recommendations for different surgical procedures according to aerosolization risk and COVID-19 status, with use of specific personal protective equipment in each case. Data Sources PubMed, MEDLINE, and Embase. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, and Food and Drug Administration. Review Methods We conducted a review on the literature on personal protective equipment for otolaryngologic surgery and surgical indication restrictions during the COVID-19 pandemic. Conclusions SARS-CoV-2 is an easily transmitted virus. Asymptomatic and symptomatic patients with COVID-19 present an upper airway high viral load, conferring otolaryngologic procedures a high risk of aerosolization. Surgical procedures must be categorized according to aerosolization risk and the possibility of COVID-19 diagnosis, according to use of personal protective equipment. Implications for Practice This review contributes to scientific knowledge regarding the detailed description of protective personal equipment and, most important, surgical recommendations to reduce the risk of infection in the otolaryngology community during the COVID-19 pandemic.
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Affiliation(s)
- Antonia E Lagos
- Otolaryngology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Phoebe H Ramos
- Otolaryngology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tomás Andrade
- Otolaryngology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
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32
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Riestra-Ayora J, Yanes-Diaz J, Penuelas O, Molina-Quiros C, Sanz-Fernández R, Martin-Sanz E. Safety and Prognosis in Percutaneous vs Surgical Tracheostomy in 27 Patients With COVID-19. Otolaryngol Head Neck Surg 2020; 163:462-464. [PMID: 32450761 DOI: 10.1177/0194599820931801] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
During the SARS-CoV-2 pandemic, patients in intensive care units who are undergoing long-term intubation may require tracheostomy. There is controversy about indication and health care professionals' safety regarding the conventional or percutaneous technique. We performed a prospective analysis of a series of 27 consecutive patients with COVID-19 comparing both tracheostomy techniques, safety, and prognosis clinical markers. The results show that the techniques are equally safe, without cases of infection in surgeons. The Sequential Organ Failure Assessment score before surgery and the progression in ventilation support during the first 72 hours after tracheostomy are optimal prognostic markers for these patients.
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Affiliation(s)
- Juan Riestra-Ayora
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Getafe, Madrid, Spain
| | - Joaquin Yanes-Diaz
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Getafe, Madrid, Spain
| | - Oscar Penuelas
- Department of Intensive Care Unit, University Hospital of Getafe, Madrid, Spain
- Respiratory Diseases CIBER, Carlos III Health Institute, Madrid, Spain
| | - Cristina Molina-Quiros
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Getafe, Madrid, Spain
| | - Ricardo Sanz-Fernández
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Getafe, Madrid, Spain
| | - Eduardo Martin-Sanz
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Getafe, Madrid, Spain
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