Emergency Tracheostomy in Two Airway Trauma Patients Suspected of COVID-19: A Case Report

Hassani, Valiollah; Amniati, Saied; Ahmadi, Aslan; Mohseni, Masood; Sehat-Kashani, Saloome; Nikoubakht, Nasim; Derakhshan, Pooya; Rad, Reza Farahmand; Habibi, Azadeh

doi:10.5812/aapm.104648

Cited by 15 publications

(21 citation statements)

References 8 publications

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“…Previous studies reported a wide range of mortality rates among critically ill patients admitted to ICU, from 16% to 38%, 62%, 67%, and 80% (12)(13)(14)(15)(22)(23)(24). In our study, overall outcomes were poor in severe patients who received ICU care, and the mortality rate (84.6%) was considerably higher than other studies.…”

Section: Discussioncontrasting

confidence: 60%

Clinical Features and Prognosis of Invasive Ventilation in Hospitalized Patients with COVID-19: A Retrospective Study

et al. 2020

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Background: World Health Organization (WHO) declared that the outbreak of COVID-19 constituted a public health emergency of global concern. Objectives: Owing to limited data on critically ill patients admitted to ICU, we aimed to describe the clinical characteristics and prognosis of these patients based on ventilatory variables and clinical features. Methods: In this retrospective study, 45 critically ill patients with laboratory-confirmed COVID-19 who were admitted to Intensive Care Unit (ICU) wards of the hospital from April 8 to May 9, 2020, were enrolled. Medical files of the patients were reviewed, and demographic and clinical characteristics, laboratory data, lung CT scan findings, causes of intubation, and outcomes of the patients were all collected. Results: The median age of the patients was 67 years (range 22 to 91), 64% were men, and hypertension was the most common comorbidity. History of close contact with previously confirmed patients was positive in 62.2% of the patients. The mean time from symptom onset to hospital admission was 5.98 ± 2.93 days. The most common symptoms at the onset of illness were dyspnea (95.6%), and gastrointestinal symptoms (22.2%) were rare. The average length of the intubation was 4.84 ± 3.28 days. The distribution of intubation causes in the deceased patients was significantly more than the recovered patients (P = 0.031). The mean score of lung CT involvement in deaths (370.26 ± 207.50) was significantly higher than the recovered patients (235.71 ± 81.21) (P = 0.042). Length of the intubation had a statistically direct correlation with respiratory rate (P = 0.03). Conclusions: Most of the critically ill patients admitted to ICU were older men and had poor outcomes with a high mortality rate. Furthermore, the score of chest CT involvement and respiratory rate are important prognostic factors in determining the severity of the illness, requiring ventilatory support, and outcome.

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Section: Discussioncontrasting

confidence: 60%

Clinical Features and Prognosis of Invasive Ventilation in Hospitalized Patients with COVID-19: A Retrospective Study

et al. 2020

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“…The distance between patients during recovery should be at least six feet. The number of the medical crew should be kept minimum, and, if possible, the procedure should be conducted in a negative pressure room (16,17).…”

Section: Discussionmentioning

confidence: 99%

Electroconvulsive Therapy for a Patient with Suicide by Drinking Bleach During Treatment of COVID-19: A Case Report

et al. 2020

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: Electroconvulsive therapy (ECT) was first experienced in 1938 and had been conducting without anesthesia for 30 years. In this study, the most common indication for ECT was mood disorder (major depressive disorder and bipolar I disorder). We introduce a patient with a history of COVID-19 and suicide who required emergency ECT. Electroconvulsive therapy can be life-saving in patients with suicide history or catatonic schizophrenia. Health workers are at the front line of the COVID-19 outbreak control and must follow health instructions. Aerosol-producing procedures such as suction in anesthesia for ECT may facilitate the transmission of infectious diseases such as COVID-19. When performing aerosol-producing procedures during the pandemic of novel coronavirus, every patient should be considered suspicious.

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“…both in the case of patients with a definitive diagnosis as well as to those with undetermined COVID-19 status [49,50]. The primary aim of these recommendations is twofold: first, to give evidence about the most appropriate management with a systematic description of procedures that proved to be effective in the case of CICO scenario in this particular subset of patients.…”

Section: F I G U R E 2 Flowchart Of Management Of Difficult Airway Imentioning

confidence: 99%

“…Protection from droplets and aerosols generated in the course of OST was provided with N95 masks in most of the studies present in the literature. Among PPE, this device is generally considered as a baseline ensuring an acceptable balance between healthcare personnel safety, availability, and costs [33,43,46,50,52,62]. Considering the difficulties related to the continuous supply of PPE in some areas, it could be advisable to wear a surgical mask over the N95 respirator to prevent contamination of the device during its period of activity [62].…”

Section: Ppementioning

confidence: 99%

Emergency surgical tracheotomy in the era of COVID-19 pandemic

Muriana¹,

Ciriaco²,

Carretta³

et al. 2021

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At the beginning of 2020 a novel variant of coronavirus, named SARS-CoV-2, was identified as responsible for the development of severe pneumonia and acute respiratory distress syndrome (ARDS) with very high mortality, exceeding 30%. The disease caused by SARS-CoV-2, called Coronavirus Disease 2019 (COVID-19), was declared a pandemic by WHO on March 11th, 2020. Patients affected by COVID-19 may present with subtle, specific symptoms, but the sudden onset of life-threatening acute respiratory failure is not uncommon. The peculiarities of the disease combined with the single patient’s comorbidities, e.g. advanced age and cardiovascular diseases, plus hypoxia and hypotension secondary to ARDS, and multiorgan failure, may lead to unexpected difficulties in the case of tracheal intubation. The occurrence of the ‘Cannot-Intubate-Cannot-Oxygenate’ (CICO) scenario in COVID-19 patients represents a hazard not only for the patients but also for the assisting healthcare workers due to the high risk of aerosol-generating infected particles during conventional rescue airway procedures. While international consensus guidelines on the management of CICO scenario in COVID-19 patients are still lacking, there is evidence that both scalpel cricothyrotomy (CT) and open surgical tracheotomy (OST) represent valid alternatives for the establishment of a front-of-neck emergency airway. Primary CT requires a staged conversion to formal tracheotomy; conversely, OST represents a definitive mastery of the airway in COVID-19 patients in case of prolonged mechanical ventilation dependency, avoiding a second procedure and further exposure to aerosols. Furthermore, in patients with facial trauma and/or head and neck tumors, OST allows obtaining safe airway control. In the context of the current pandemic, emergency OST procedure in SARS-CoV-2 positives (or with unknown status) requires adequate arrangements and the use of proper personal protective equipment to limit risks for clinicians.

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Emergency Tracheostomy in Two Airway Trauma Patients Suspected of COVID-19: A Case Report

Cited by 15 publications

References 8 publications

Clinical Features and Prognosis of Invasive Ventilation in Hospitalized Patients with COVID-19: A Retrospective Study

Clinical Features and Prognosis of Invasive Ventilation in Hospitalized Patients with COVID-19: A Retrospective Study

Electroconvulsive Therapy for a Patient with Suicide by Drinking Bleach During Treatment of COVID-19: A Case Report

Emergency surgical tracheotomy in the era of COVID-19 pandemic

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