Elective Tracheotomy in COVID-19 Patients: A Team-Based Approach

Ander, Michael; Yang, Sara; Thorpe, Eric; Goyal, Amit; Bier‐Laning, Carol M.

doi:10.1213/ane.0000000000005106

Cited by 1 publication

(2 citation statements)

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“…This period means the acute phase of SARS-CoV-2 infection to pass, viral load to decrease, and the risk of transmission to lower. If available, the test of SARS-CoV-2 viral load in the (51,52). IMV can be resumed after the tracheotomy tube is confirmed in place and the cuff is properly inflated.…”

Section: Discussionmentioning

confidence: 99%

“…Second, ideal protection for operators is achieved when PDT is performed under deep sedation and muscle relaxation to inhibit coughing reflex, since the spread of viral aerosols after cough is practically unstoppable, reaching up to 3.6 km/h (2.25 miles/h), and viral aerosols are almost vertically exposed towards the facial area of operators in less than a second within the range of 7–8 m ( 18 , 50 ). Third, prior to opening the anterior wall of the trachea, IMV should be suspended for a short time to reduce the production of viral aerosols, if tolerated ( 51 , 52 ). IMV can be resumed after the tracheotomy tube is confirmed in place and the cuff is properly inflated.…”

Section: Discussionmentioning

confidence: 99%

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A safer and more practical tracheotomy in invasive mechanical ventilated patients with COVID-19: A quality improvement study

Kang

Wang²,

Du³

et al. 2022

Front. Surg.

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ImportanceThe number of infections and deaths caused by the global epidemic of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) invasion is steadily increasing daily. In the early stages of outbreak, approximately 15%–20% of patients with coronavirus disease 2019 (COVID-19) inevitably developed severe and critically ill forms of the disease, especially elderly patients and those with several or serious comorbidities. These more severe forms of disease mainly manifest as dyspnea, reduced blood oxygen saturation, severe pneumonia, acute respiratory distress syndrome (ARDS), thus requiring prolonged advanced respiratory support, including high-flow nasal cannula (HFNC), non-invasive mechanical ventilation (NIMV), and invasive mechanical ventilation (IMV).ObjectiveThis study aimed to propose a safer and more practical tracheotomy in invasive mechanical ventilated patients with COVID-19.DesignThis is a single center quality improvement study.ParticipantsTracheotomy is a necessary and important step in airway management for COVID-19 patients with prolonged endotracheal intubation, IMV, failed extubation, and ventilator dependence. Standardized third-level protection measures and bulky personal protective equipment (PPE) may hugely impede the implementation of tracheotomy, especially when determining the optimal pre-surgical positioning for COVID-19 patients with ambiguous surface position, obesity, short neck or limited neck extension, due to vision impairment, reduced tactile sensation and motility associated with PPE. Consequently, the aim of this study was to propose a safer and more practical tracheotomy, namely percutaneous dilated tracheotomy (PDT) with delayed endotracheal intubation withdrawal under the guidance of bedside ultrasonography without the conventional use of flexible fiberoptic bronchoscopy (FFB), which can accurately determine the optimal pre-surgical positioning, as well as avoid intraoperative damage of the posterior tracheal wall and prevent the occurrence of tracheoesophageal fistula (TEF).

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Section: Discussionmentioning

confidence: 99%