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

Majid, Adnan; Ayala, Alvaro; Uribe, Juan Pablo; Abdelghani, Ramsy; Patel, Priya; Chee, Alex; Parikh, Mihir; Kheir, Fayez

doi:10.1513/annalsats.202004-372rl

Cited by 4 publications

(5 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…19,20 In our protocol the bronchoscope is placed inside the ETT, which decreases the hypothetical technical difficulties of passing the scope adjacent to the ETT when comparing against the technique described by Angel et al In the other hand, having the bronchoscope along side the ETT allows to reduce the expiratory ventilator pauses that would be beneficial in patients with significant degree of hypoxia. 16 Nevertheless, these techniques have not been compared in a clinical setting.…”

Section: Discussionmentioning

confidence: 99%

“…The goal of these techniques is to decrease the risk on infection in health care providers. 15,16 Drawing from these experiences, and using collaboration between interventional pulmonology (IP), respiratory therapy (RT) and thoracic surgery services, we developed our own percutaneous tracheostomy protocol for patients with confirmed COVID-19 infection.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Healthcare Personnel Safety During Percutaneous Tracheostomy in Patients With COVID-19: Proof-of-Concept Study

Sood

Dudiki

Alape

et al. 2020

J Intensive Care Med

View full text Add to dashboard Cite

Background: Covid-19 pandemic has resulted in the development of severe and persistent respiratory failure requiring long term ventilatory support. This necessitates the need for a reliable and easy to implement tracheostomy protocol given the concern for viral transmission risk to the involved healthcare personnel due to the aerosol generating nature of the procedure. We describe a protocol with unique and novel modifications to the Ciaglia dilatational percutaneous tracheostomy, effectively implemented during the Covid-19 pandemic at our institution. Methods: We describe the baseline characteristics of our initial 11 patients who underwent the procedure. Outlined are the healthcare personnel involved and the steps which are organized into 4 phases: planning, pre-procedure, intra-procedure and post-procedure. We have tracked procedural duration, provider safety as well as the development of new complications. Results: We describe use of this protocol for 11 bedside percutaneous tracheostomies performed on patients with COVID-19. The average total procedural duration as well as incision to tracheostomy tube placement times was 32.6 minutes and 5.8 minutes respectively. All 3 providers performing the tracheostomies remained asymptomatic with negative COVID-19 RT-PCR testing at 3 weeks. Conclusions: We report an efficacious and adaptable protocol for elective bedside percutaneous tracheostomies for patients with persistent ventilatory requirements due to COVID-19 with an intent to provide standardized and safe care for the patient and the involved healthcare personnel.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Healthcare Personnel Safety During Percutaneous Tracheostomy in Patients With COVID-19: Proof-of-Concept Study

Sood

Dudiki

Alape

et al. 2020

J Intensive Care Med

View full text Add to dashboard Cite

show abstract

“…GloGerm comes in multiple formulations - oil, liquid (mist), and powder. Majid et al mixed GloGerm liquid with tonic water under 8 L/min to visualize aerosolization during percutaneous tracheostomy as a solution [ 14 ]. Patel et al used a spray gun to disperse liquid GloGerm, which simulated a burst pattern similar to coughing [ 15 ].…”

Section: Technical Reportmentioning

confidence: 99%

Development of a Mannequin for Simulation-Based Trials Involving Respiratory Viral Spread During Respiratory Arrest and Cardiopulmonary Arrest Scenarios

Luu¹,

Chan²,

Langga³

et al. 2021

Cureus

View full text Add to dashboard Cite

During the coronavirus disease 2019 (COVID-19) pandemic, mannequin models have been developed to mimic viral spread using fluorescent particles. These models use contraptions such as a spray gun or an exploding latex balloon to emanate a sudden acceleration of particles, simulating a "cough" reflex. No models have been developed to mimic passive aerosolization of viral particles during a cardiopulmonary arrest simulation. Our novel approach to aerosolization of simulated viral spread allows for a continuous flow of particles, which allows us to maintain components of high-fidelity team-based simulations. Our simulated model emanated GloGerm (Moab, UT) from the respiratory tract using a continuous nebulization chamber. Uniquely, the construction of our apparatus allowed for the ability to perform full, simulated cardiopulmonary resuscitation scenarios (such as chest compressions, bag-mask ventilation, and endotracheal intubation) on a high-fidelity mannequin while visualizing potential contamination spread at the conclusion of the simulation.Positive feedback from users included the ability to visualize particulate contamination after cardiopulmonary resuscitations in the context of personal protective equipment usage and roles in resuscitation (i.e. physician, respiratory therapist, nurse). Negative criticism towards the simulation included the lack of certain high-fidelity feedback markers of the mannequin (auscultating breath sounds and checking pulses) due to the construction of the particle aerosolization mechanism.

show abstract

“…It offered significant mitigation of the risk of virus aerosolization during the procedure. Another modification described is percutaneous tracheostomy using an acrylic box as an aerosol shield ( Figure 2 ) ( 66 ). This technique had the least aerosolization and contamination but has a long procedure time compared to standard technique with or without a ventilator pause.…”

Section: Introductionmentioning

confidence: 99%

What Have We Learned About Transmission of Coronavirus Disease-2019

Kaminsky

Husnain

Khemasuwan

2023

Clinics in Chest Medicine

View full text Add to dashboard Cite

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

Cited by 4 publications

References 5 publications

Healthcare Personnel Safety During Percutaneous Tracheostomy in Patients With COVID-19: Proof-of-Concept Study

Healthcare Personnel Safety During Percutaneous Tracheostomy in Patients With COVID-19: Proof-of-Concept Study

Development of a Mannequin for Simulation-Based Trials Involving Respiratory Viral Spread During Respiratory Arrest and Cardiopulmonary Arrest Scenarios

What Have We Learned About Transmission of Coronavirus Disease-2019

Contact Info

Product

Resources

About