A Technique to Minimize Aerosolization During Percutaneous Tracheostomy in COVID-19 Patients

Betancourt-Ramírez, Alejandro; Yelon, Jay A.; Boland, Paul; Amaturo, Michael

doi:10.1177/0003134820943102

Cited by 4 publications

(3 citation statements)

References 6 publications

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“…The database search generated 1877 citations, of which 156 (8.3%) underwent full-text review (Figure 1). Overall, 69 studies (N = 4669 patients) were included within the qualitative synthesis, and 14 studies were included in the meta-analyses . Interrater reliability between independent reviewers was 0.81 and 0.64 for the abstract screening and full-text stages, respectively.…”

Section: Resultsmentioning

confidence: 99%

Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals

Staibano

Levin

McHugh

et al. 2021

JAMA Otolaryngol Head Neck Surg

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Section: Resultsmentioning

confidence: 99%

Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals

Staibano

Levin

McHugh

et al. 2021

JAMA Otolaryngol Head Neck Surg

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“…Proof-of-concept enclosures have been designed to reduce aerosolization during surgery. [13][14][15][16] Betancourt-Ramirez et al 17 suggested a percutaneous tracheostomy technique to minimize aerosolization in which mechanical ventilation is stopped until tracheostomy tube insertion and balloon inflation. During ventilation and weaning, closed circuit ventilation systems have also been proposed to reduce aerosolization from patients with a tracheostomy.…”

mentioning

confidence: 99%

Quantifying Viral Particle Aerosolization Risk During Tracheostomy Surgery and Tracheostomy Care

Berges

Lina

Ospino

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE During respiratory disease outbreaks such as the COVID-19 pandemic, aerosol-generating procedures, including tracheostomy, are associated with the risk of viral transmission to health care workers.OBJECTIVE To quantify particle aerosolization during tracheostomy surgery and tracheostomy care and to evaluate interventions that minimize the risk of viral particle exposure. DESIGN, SETTING, AND PARTICIPANTSThis comparative effectiveness study was conducted from August 2020 to January 2021 at a tertiary care academic institution. Aerosol generation was measured in real time with an optical particle counter during simulated (manikin) tracheostomy surgical and clinical conditions, including cough, airway nebulization, open suctioning, and electrocautery. Aerosol sampling was also performed during in vivo swine tracheostomy procedures (n = 4), with or without electrocautery. Fluorescent dye was used to visualize cough spread onto the surgical field during swine tracheostomy. Finally, 6 tracheostomy coverings were compared with no tracheostomy covering to quantify reduction in particle aerosolization. MAIN OUTCOMES AND MEASURES Respirable aerosolized particle concentration. RESULTS Cough, airway humidification, open suctioning, and electrocautery produced aerosol particles substantially above baseline. Compared with uncovered tracheostomy, decreased aerosolization was found with the use of tracheostomy coverings, including a cotton mask (73.8% [(95% CI, 63.0%-84.5%]; d = 3.8), polyester gaiter 79.5% [95% CI, 68.7%-90.3%]; d = 7.2), humidification mask (82.8% [95% CI, 72.0%-93.7%]; d = 8.6), heat moisture exchanger (HME) (91.0% [95% CI, 80.2%-101.7%]; d = 19.0), and surgical mask (89.9% [95% CI, 79.3%-100.6%]; d = 12.8). Simultaneous use of a surgical mask and HME decreased the particle concentration compared with either the HME (95% CI, 1.6%-12.3%; Cohen d = 1.2) or surgical mask (95% CI, 2.7%-13.2%; d = 1.9) used independently. Procedures performed with electrocautery increased total aerosolized particles by 1500 particles/m 3 per 5-second interval (95% CI, 1380-1610 particles/m 3 per 5-second interval; d = 1.8). CONCLUSIONS AND RELEVANCEThe findings of this laboratory and animal comparative effectiveness study indicate that tracheostomy surgery and tracheostomy care are associated with significant aerosol generation, putting health care workers at risk for viral transmission of airborne diseases. Combined HME and surgical mask coverage of the tracheostomy was associated with decreased aerosolization, thereby reducing the risk of viral transmission to health care workers.

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“…9 Aerosolization might also increase by bronchoscopy utilization, which is a serious concern in serious situations. 16 However, during PDT performance regardless of bronchoscopy aerosolization is not absent, and entry into the trachea remains blind, but by using this modified method, the tube is gradually removed to reduce airway loss, desaturation, and hypercapnia, moreover reducing aerosolization time.…”

Section: Discussionmentioning

confidence: 99%

A Modified Technique for Percutaneous Dilatational Tracheostomy

Ghotbi,

Estakhr,

Nikandish

et al. 2023

J Intensive Care Med

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Purpose: Percutaneous dilatational tracheostomy (PDT) is widely used in mechanical ventilation patients to facilitate weaning. This modified technique aims to reduce accidental intraprocedural airway loss and desaturation associated with current PDT techniques. Materials and Methods: This is a single-center, prospective cohort study of 100 patients who underwent a modified technique between September 8, 2022, and January 18, 2023. The procedure was performed at Shiraz University of medical science at the tertiary center, Namazi teaching hospital. In this method instead of withdrawing the endotracheal tube (ETT) up close to the vocal cord and subglottic area at the beginning of the procedure, which is a common theme in PDT techniques with accidental extubation risk, we kept the ETT and gradually withdraw it. Results: Of the 100 patients, the average age was 53.5 years, and 66% were males. On average, the procedure lasted 255 (67) seconds. All patients successfully underwent PDT with no life-threatening complications, accidental intraprocedural airway loss, or desaturation. Conclusions: As a result of this modified technique, PDT for airway management can be a safe and low-complication procedure without the risk of accidental intraprocedural airway loss. Moreover, omitting bronchoscopy and sonography during these procedures is cost-effective and secure.

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A Technique to Minimize Aerosolization During Percutaneous Tracheostomy in COVID-19 Patients

Cited by 4 publications

References 6 publications

Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals

Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals

Quantifying Viral Particle Aerosolization Risk During Tracheostomy Surgery and Tracheostomy Care

A Modified Technique for Percutaneous Dilatational Tracheostomy

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