Novel Percutaneous Tracheostomy for Critically Ill Patients With COVID-19

Angel, Luis F.; Kon, Zachary N.; Chang, Stephanie H.; Rafeq, Samaan; Shekar, Suman; Mitzman, Brian; Amoroso, Nancy; Goldenberg, Ronald; Sureau, Kimberly; Smith, Deane E.; Cerfolio, Robert J.

doi:10.1016/j.athoracsur.2020.04.010

Cited by 154 publications

(243 citation statements)

References 8 publications

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“…Several articles regarding tracheostomy in COVID-19 patients has been published [13][14][15][16][17][18][19][20]. Martin-Villares et al [13] performed a multicenter prospective observational study of 1890 COVID-19 patients undergoing tracheostomy (81.3% surgical and 22.7% percutaneous) performed by otolaryngologists across 120 hospitals in Spain.…”

Section: Plos Onementioning

confidence: 99%

“…However, tracheostomy is an aerosol-generating procedure and several concerns in COVID-19 patients on to its safety has been raised [10][11][12]. Despite some studies published during COVID-19 pandemic [13][14][15][16][17][18][19][20], more data are necessary to better elucidate the role of tracheostomy in this setting. The aim of this study was therefore to evaluate the safety of bedside surgical tracheostomy in COVID-19 patients admitted to ICU.…”

Section: Introductionmentioning

confidence: 99%

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Safety of bedside surgical tracheostomy during COVID-19 pandemic: A retrospective observational study

et al. 2020

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Data regarding safety of bedside surgical tracheostomy in novel coronavirus 2019 (COVID-19) mechanically ventilated patients admitted to the intensive care unit (ICU) are lacking. We performed this study to assess the safety of bedside surgical tracheostomy in COVID-19 patients admitted to ICU. This retrospective, single-center, cohort observational study (conducted between February, 23 and April, 30, 2020) was performed in our 45-bed dedicated COVID-19 ICU. Inclusion criteria were: a) age over 18 years; b) confirmed diagnosis of COVID-19 infection (with nasopharyngeal/oropharyngeal swab); c) invasive mechanical ventilation and d) clinical indication for tracheostomy. The objectives of this study were to describe: 1) perioperative complications, 2) perioperative alterations in respiratory gas exchange and 3) occurrence of COVID-19 infection among health-care providers involved into the procedure. A total of 125 COVID-19 patients were admitted to the ICU during the study period. Of those, 66 (53%) underwent tracheostomy. Tracheostomy was performed after a mean of 6.1 (± 2.1) days since ICU admission. Most of tracheostomies (47/66, 71%) were performed by intensivists and the mean time of the procedure was 22 (± 4.4) minutes. No intraprocedural complications was reported. Stoma infection and bleeding were reported in 2 patients and 7 patients, respectively, in the post-procedure period, without significant clinical consequences. The mean PaO 2 / FiO 2 was significantly lower at the end of tracheostomy (117.6 ± 35.4) then at the beginning (133.4 ± 39.2) or 24 hours before (135.8 ± 51.3) the procedure. However, PaO 2 /FiO 2 progressively increased at 24 hours after tracheostomy (142 ± 50.7). None of the members involved in the tracheotomy procedures developed COVID-19 infection. Bedside surgical tracheostomy appears to be feasible and safe, both for patients and for health care workers, during COVID-19 pandemic in an experienced center.

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Section: Plos Onementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety of bedside surgical tracheostomy during COVID-19 pandemic: A retrospective observational study

et al. 2020

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“…Acute respiratory failure along with acute hypoxemia is the major leading cause of death in COVID-19 patients [12]. According to recent guidelines, tracheostomy is not recommended because of the high risk of virus aerosolization to healthcare workers, and transmission through health care facilities [13]. There is the same potential risk for the endotracheal intubation, as a hazardous and high-risk aerosol-generating procedure [14].…”

Section: Resultsmentioning

confidence: 99%

Respiratory Rehabilitation After Blood Transfusion in a COVID-19 Patient: A Case Report

Mousavi

Obeidi

Keshmiri

et al. 2020

Preprint

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Background: The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been identified as the most crucial threat of the century. Due to severe pneumonia and acute respiratory distress syndrome (ARDS), the SARS-CoV-2 can cause shortness of breath, hypoxemia, and the need to mechanical ventilation, intensive care unit (ICU) management, and eventual death. We have tried to use a non-invasive approach to prevent patient from needing respiratory support with invasive ventilation (IV). Here, for the first time, improvement of oxygen delivery and oxygen saturation levels were observed in a COVID-19 patient using packed red blood cells (PRBCs) transfusion.Case presentation: A 63-year-old man with a history of smoking and addiction who came to our hospital facility with fever, shortness of breath and decreased blood oxygen saturation. High-resolution chest CT revealed bilateral and multifocal ground-glass opacities consistent with COVID-19. Subsequently, the COVID-19 infection was confirmed by real-time polymerase chain reaction (qRT-PCR) assay of the upper respiratory tract. Conclusions: Oxygen delivery and oxygen saturation improvement were observed in the COVID-19 patient, after PRBCs transfusions.

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“…In the modified PDT technique developed by Angel and colleagues, the bronchoscope is passed along the side of the endotracheal tube (ETT) and under direct bronchoscopic guidance; the ETT is then advanced to the distal trachea, allowing the patient to be ventilated until the creation of a stoma. Afterward, the ETT is pulled back to the conus elasticus while the ventilation is on hold, and then the tracheostomy tube is advanced into the airway under direct bronchoscopic guidance ( 6 ). The acrylic box was customized to allow the bronchoscopist and the proceduralist to perform the procedure in a comfortable manner while having an additional PPE barrier.…”

mentioning

confidence: 99%

“…However, we admit that the modified technique could potentially encounter technical difficulties, especially when inserting the dilator concomitantly with the ETT. Although the bronchoscopic view clearly reflects a lack of space while inserting the dilator, this has not been an issue in real clinical scenarios when this technique has been recently published ( 6 ). Finally, we showed that a customized aerosol box can be used when performing a PDT on a mannequin and may represent an additional protection to the operator from unperceivable particles expelled during the procedure.…”

mentioning

confidence: 99%

Protective Strategies in a Simulated Model When Performing Percutaneous Tracheostomies in the COVID-19 Era

et al. 2020

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Novel Percutaneous Tracheostomy for Critically Ill Patients With COVID-19

Cited by 154 publications

References 8 publications

Safety of bedside surgical tracheostomy during COVID-19 pandemic: A retrospective observational study

Safety of bedside surgical tracheostomy during COVID-19 pandemic: A retrospective observational study

Respiratory Rehabilitation After Blood Transfusion in a COVID-19 Patient: A Case Report

Protective Strategies in a Simulated Model When Performing Percutaneous Tracheostomies in the COVID-19 Era

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