In Vitro Evaluation of Heat and Moisture Exchangers Designed for Spontaneously Breathing Tracheostomized Patients

Brusasco, Claudia; Corradi, Francesco; Vargas, Maria; Bona, Margherita; Bruno, Federica; Marsili, Maria; Simonassi, Francesca; Santori, Gregorio; Severgnini, Paolo; Kacmarek, Robert M.; Pelosi, Paolo

doi:10.4187/respcare.02405

Cited by 15 publications

(7 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We recommend a simple heat and moisture exchange (HME) filter, which provides adequate humidification and does not generate aerosols. 46 Active water-based humidification might be required if secretions are thick, but their use should be assessed on an individual basis. Nebulisers can improve secretion clearance but require additional handling of ventilator circuits and can waterlog HME filters; they should therefore be used only after careful consideration.…”

Section: Optimal Management After Tracheostomymentioning

confidence: 99%

Tracheostomy in the COVID-19 era: global and multidisciplinary guidance

McGrath

Brenner

Warrillow

et al. 2020

The Lancet Respiratory Medicine

362

500

View full text Add to dashboard Cite

Global health care is experiencing an unprecedented surge in the number of critically ill patients who require mechanical ventilation due to the COVID-19 pandemic. The requirement for relatively long periods of ventilation in those who survive means that many are considered fxor tracheostomy to free patients from ventilatory support and maximise scarce resources. COVID-19 provides unique challenges for tracheostomy care: health-care workers need to safely undertake tracheostomy procedures and manage patients afterwards, minimising risks of nosocomial transmission and compromises in the quality of care. Conflicting recommendations exist about case selection, the timing and performance of tracheostomy, and the subsequent management of patients. In response, we convened an international working group of individuals with relevant expertise in tracheostomy. We did a literature and internet search for reports of research pertaining to tracheostomy during the COVID-19 pandemic, supplemented by sources comprising statements and guidance on tracheostomy care. By synthesising early experiences from countries that have managed a surge in patient numbers, emerging virological data, and international, multidisciplinary expert opinion, we aim to provide consensus guidelines and recommendations on the conduct and management of tracheostomy during the COVID-19 pandemic.

show abstract

Section: Optimal Management After Tracheostomymentioning

confidence: 99%

Tracheostomy in the COVID-19 era: global and multidisciplinary guidance

McGrath

Brenner

Warrillow

et al. 2020

The Lancet Respiratory Medicine

362

500

View full text Add to dashboard Cite

show abstract

“…Humidification and removable inner cannulae are routinely used during ventilated and non-ventilated tracheostomy care to prevent tube occlusion from respiratory secretions and reduce the need for suction [42,43]. Commencing immediate postoperative care with a simple heat and moisture exchange (HME) filter (which can be changed every 7 days in a 'dry' circuit) combined with inner tube inspection and change every 24 h appears safe [56]. However, experience from other countries suggests that secretions may become thicker over time and active, water-based humidification may become necessary.…”

Section: Tracheostomy Insertion Procedures For Patients With Covid-19mentioning

confidence: 99%

Multidisciplinary guidance for safe tracheostomy care during the COVID‐19 pandemic: the NHS National Patient Safety Improvement Programme (NatPatSIP)

et al. 2020

View full text Add to dashboard Cite

The COVID-19 pandemic is causing a significant increase in the number of patients requiring relatively prolonged invasive mechanical ventilation and an associated surge in patients who need a tracheostomy to facilitate weaning from respiratory support. In parallel, there has been a global increase in guidance from professional bodies representing staff who care for patients with tracheostomies at different points in their acute hospital journey, rehabilitation and recovery. Of concern are the risks to healthcare staff of infection arising from tracheostomy insertion and caring for patients with a tracheostomy. Hospitals are also facing extraordinary demands on critical care services such that many patients who require a tracheostomy will be managed outside established intensive care or head and neck units and cared for by staff with little tracheostomy experience. These concerns led NHS England and NHS Improvement to expedite the National Patient Safety Improvement Programme's 'Safe Tracheostomy Care' workstream as part of the NHS COVID-19 response. Supporting this workstream, UK stakeholder organisations involved in tracheostomy care were invited to develop consensus guidance based on: expert opinion; the best available published literature; and existing multidisciplinary guidelines. Topics with direct relevance for frontline staff were identified. This consensus guidance includes:

show abstract

“…Therefore, when caring for patients with a tracheostomy, health care workers should be alerted to this common limitation and take precautions to minimize risk of viral exposure. 58 The patient's hydration status and need for enteral mucolytic agents should also be assessed to minimize risk of occlusion from tenacious secretions.…”

Section: Humidificationmentioning

confidence: 99%

Critical Care Guidance for Tracheostomy Care During the COVID-19 Pandemic: A Global, Multidisciplinary Approach

Pandian

Morris

Brodsky

et al. 2020

American Journal of Critical Care

View full text Add to dashboard Cite

Purpose Critical care nurses caring for patients with a tracheostomy are at high risk because of the predilection of SARS-CoV-2 for respiratory and mucosal surfaces. This review identifies patient-centered practices that ensure safety and reduce risk of infection transmission to health care workers during the coronavirus disease 2019 (COVID-19) pandemic. Methods Consensus statements, guidelines, institutional recommendations, and scientific literature on COVID-19 and previous outbreaks were reviewed. A global interdisciplinary team analyzed and prioritized findings via electronic communications and video conferences to develop consensus recommendations. Results Aerosol-generating procedures are commonly performed by nurses and other health care workers, most notably during suctioning, tracheostomy tube changes, and stoma care. Patient repositioning, readjusting circuits, administering nebulized medications, and patient transport also present risks. Standard personal protective equipment includes an N95/FFP3 mask with or without surgical masks, gloves, goggles, and gown when performing aerosol-generating procedures for patients with known or suspected COVID-19. Viral testing of bronchial aspirate via tracheostomy may inform care providers when determining the protective equipment required. The need for protocols to reduce risk of transmission of infection to nurses and other health care workers is evident. Conclusion Critical care nurses and multidisciplinary teams often care for patients with a tracheostomy who are known or suspected to have COVID-19. Appropriate care of these patients relies on safeguarding the health care team. The practices described in this review may greatly reduce risk of infectious transmission.

show abstract

In Vitro Evaluation of Heat and Moisture Exchangers Designed for Spontaneously Breathing Tracheostomized Patients

Cited by 15 publications

References 29 publications

Tracheostomy in the COVID-19 era: global and multidisciplinary guidance

Tracheostomy in the COVID-19 era: global and multidisciplinary guidance

Multidisciplinary guidance for safe tracheostomy care during the COVID‐19 pandemic: the NHS National Patient Safety Improvement Programme (NatPatSIP)

Critical Care Guidance for Tracheostomy Care During the COVID-19 Pandemic: A Global, Multidisciplinary Approach

Contact Info

Product

Resources

About