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.
Introducción: La criobiopsia pulmonar transbronquial (TBCB) se ha convertido en una alternativa diagnóstica a la biopsia pulmonar quirúrgica, principalmente en la enfermedad pulmonar intersticial. A pesar de su naturaleza menos invasiva y de un mayor rendimiento diagnóstico, se han descrito algunas complicaciones asociadas, como el neumotórax. En pocas oportunidades se ha comparado la TBCB y la biopsia transbronquial con fórceps (TBFB). El objetivo del presente estudio es evaluar la incidencia de neumotórax después de TBFB y TBCB y la necesidad de drenaje pleural.
Métodos: Estudio retrospectivo de pacientes que se sometieron a TBCB y TBFB, específicamente aquellos que desarrollaron neumotórax postoperatorio.
Resultados: Se realizaron un total de 181 biopsias pulmonares transbronquiales. Sesenta y tres (35%) fueron TBFB y 118 (65%) fueron TBCB. Tres pacientes en el grupo TBFB (5%) presentaron neumotórax postoperatorio, mientras que 16 pacientes (14%) presentaron neumotórax en el grupo TBCB (p 0,051). El análisis univariado reveló una asociación estadísticamente significativa entre el diagnóstico preoperatorio de fibrosis y un mayor riesgo de neumotórax postoperatorio después de TBCB (p 0.027), mientras que otras variables no arrojaron un resultado significativo.
Conclusión: Aunque se necesitan más estudios comparativos de alto volumen, este documento destaca la relevancia del neumotórax después de la TBCB. Esto deriva en una fuerte necesidad de protocolos de procedimientos claramente estandarizados para TBCB y una evaluación cuidadosa de sus complicaciones versus su rendimiento diagnóstico
The most frequent sites of distant metastasis of colorectal cancer (CRC) are primarily liver and lung, followed by brain and bone metastases. Infrequently, metastases are found in the adrenal glands. They usually have a metachronous and homolateral character. We present a case of contralateral synchronic adrenal metastasis of CRC and its surgical resolution.
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