Tracheotomy in the <scp>SARS‐CoV</scp>‐2 pandemic

Skoog, Hunter; Withrow, Kirk; Jeyarajan, Harishanker; Greene, Bruce M.; Batra, Hitesh; Cox, Daniel; Pierce, Albert; Grayson, Jessica W.; Carroll, William R.

doi:10.1002/hed.26214

Cited by 26 publications

(36 citation statements)

References 10 publications

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“…As exposure to aerosol generated by tracheotomy poses healthcare professionals to serious risks of infection [27] , many authors have established recommendations regarding tracheotomy during the COVID-19 pandemic [28 , 29] . In published case series [30] , tracheostomy technique is chosen on the basis of local expertise and resources.…”

Section: Discussionmentioning

confidence: 99%

Comparison of percutaneous dilatational tracheotomy versus open surgical technique in severe COVID-19: Complication rates, relative risks and benefits

et al. 2021

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Objective Patients with acute respiratory failure due to COVID-19 have a high likelihood of needing prolonged intubation and may subsequently require tracheotomy. Usually, the choice of technique (percutaneous dilatational tracheotomy [PDT] versus open surgical tracheotomy [OST]) depends on the preference of surgeons and patient-related factors. In case of COVID-19, airborne spread of viral particles and limited time of apnea must be considered in the choice of the safest technique. The aim of this study is to compare the complication rates and offer an assessment of relative risks and benefits of PDT versus OST in patients with severe COVID-19. Methods We performed a retrospective study considering 47 consecutive patients affected by severe acute respiratory distress syndrome due to SARS-CoV-2 infection, needing invasive mechanical ventilation and subsequent tracheostomy. This study was performed at the Intensive Care Unit of our tertiary referral center. Complication rates were analyzed. Results Seventeen patients underwent PDT and 30 patients were submitted to OST. Twenty-six patients (55.3%) had post-operative complications (local infection, hemorrhage, subcutaneous emphysema) with no significant difference between PDT and OST. Conclusion PDT and OST are characterized by similar postoperative complication rates in severe COVID-19 patients. These findings suggest that OST might be preferred if expert ENT surgeons are available, as PDT could result in longer apnea and exposure to generated aerosol. However, authors recommend considering either OST or PDT at the discretion of the medical staff involved, according to the personal experience of the operators performing the procedure.

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Section: Discussionmentioning

confidence: 99%

Comparison of percutaneous dilatational tracheotomy versus open surgical technique in severe COVID-19: Complication rates, relative risks and benefits

et al. 2021

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“…The 2019 novel coronavirus disease (COVID-19) pandemic continues to infect a large number of patients, with fever, dry cough, fatigue, and shortness of breath, acute respiratory distress syndrome (ARDS) as major symptoms. These symptoms are also the risk factors for ventilator dependence [1] . As of October 5, 2020, over 36,600,000 cases and 1,000,000 deaths related to COVID-19 have been reported in at least 200 countries [2] .…”

Section: Introductionmentioning

confidence: 99%

Factors affecting the mortality of patients with COVID-19 undergoing surgery and the safety of medical staff: A systematic review and meta-analysis

Wang¹,

Wu²,

Xu³

et al. 2020

EClinicalMedicine

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Background The 2019 novel coronavirus disease (COVID-19) can complicate the perioperative course to increase postoperative mortality in operative patients, and also is a serious threat to medical staff. However, studies summarizing the impact of COVID-19 on the perioperative mortality of patients and on the safety of medical staff are lacking. Methods We searched PubMed, Cochrane Library, Embase and Chinese database National Knowledge Infrastructure (CNKI) with the search terms “COVID-19″ or “SARS-CoV-2″ and “Surgery” or “Operation” for all published articles on COVID-19 from December 1, 2019 to October 5, 2020. Findings A total of 269 patients from 47 studies were included in our meta-analysis. The mean age of operative patients with COVID-19 was 50.91 years, and 49% were female. A total of 28 patients were deceased, with the overall mortality of 6%. All deceased patients had postoperative complications associated with operation or COVID-19, including respiratory failure, acute respiratory distress syndrome (ARDS), short of breath, dyspnea, fever, cough, fatigue or myalgia, cardiopulmonary system, shock/infection, acute kidney injury and severe lymphopenia. Patients who presented any or more of the symptoms of respiratory failure, ARDS, short of breath and dyspnea after operation were associated with significantly higher mortality ( r = 0.891, p < 0.001), while patients whose symptoms were presented as fever, cough, fatigue or myalgia only demonstrated marginally significant association with postoperative mortality ( r = 0.675, p = 0.023). Twenty studies reported the information of medical staff infection, and a total of 38 medical staff were infected, and medical staff who used biosafety level 3 (BSL-3) protective equipment did not get infected. Interpretation COVID-19 patients, in particular those with severe respiratory complications, may have high postoperative mortality. Medical staff in close contact with infected patients is suggested to take high level personal protective equipment (PPE). Funding Heilongjiang postdoctoral scientific research developmental fund and the National Natural Science Foundation of China.

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“…Study characteristics are summarized in Table 1. 3,[19][20][21][22] When searching the websites of professional organizations, we found that 3 had produced relevant guidance documents. [13][14][15] Following data extraction and synthesis, the results were categorized according to practice domains for tracheostomy and laryngectomy.…”

Section: Results and Observationsmentioning

confidence: 99%

“…The main recommendations according to each practice area are shown in Table 2. 3,13,14,[19][20][21][22][23][24][25]…”

Section: Results and Observationsmentioning

confidence: 99%

Swallowing and Communication Management of Tracheostomy and Laryngectomy in the Context of COVID-19

Vergara

Starmer

Wallace

et al. 2021

JAMA Otolaryngol Head Neck Surg

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e are in the midst of a pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). Management of patients with surgically modified airways, such as tracheostomy and laryngectomy, is challenging for the health care team in this novel context. Although there are few studies detailing infection rates and level of risk in the management, 1 those with tracheostomy and laryngectomy represent a potential transmission and infection risk for health care professionals 2,3 owing to the high viral load present in the upper aerodigestive tract. 4-6 Several professional organizations worldwide have published guidelines on the management of these patients for otorhinolaryngologists and head and neck surgeons. 7 Urgent and essential care provision is still required for these patients during the current pandemic, 8 and many more patients are requiring tracheostomy insertion as part of their recovery from severe COVID-19. 9 Multidisciplinary teams involved in the treatment of patients with tracheostomy or laryngectomy often include allied health professionals, such as speech-language pathologists (SLPs), who are responsible for the therapeutic restoration of swallowing and communication. 10,11 Speech-language pathologists are routinely involved with stoma and voice prosthe-sis care procedures and may perform suctioning of the lower airways. The objective of this study is to review and synthesize the literature regarding tracheostomy and laryngectomy management in the context of the COVID-19 pandemic to inform best practice and provide guidance for SLPs and the multidisciplinary team managing care for this population. Methods Using elements from a rapid review approach, 12 a comprehensive search of a single database and guidance documents published by relevant professional societies/organizations was completed. Guidelines unrelated to those of the current pandemic were also considered for synthesis. Two searches were conducted simultaneously using the PubMed database on May 15, 2020, using descriptors relevant to our objective-specifically, (1) tracheostomy, COVID-19, and SARS-CoV-2 using the Boolean operator and; and (2) laryngectomy, COVID-19, and SARS-CoV-2, also using the Boolean operator and. Using the selection criteria, a single reviewer (J.V.) screened all titles and abstracts for possible inclusion. Those meeting the criteria were selected for a full-text IMPORTANCE The care of patients with a surgically modified airway, such as tracheostomy or laryngectomy, represents a challenge for speech-language pathologists (SLPs) in the context of the coronavirus disease 2019 (COVID-19) pandemic. The objective was to review available publications and practice guidelines on management of tracheostomy and laryngectomy in the context of COVID-19. This study performed a review and synthesis of information available in the PubMed database and from national SLP organizations across 6 countries. OBSERVATIONS From the search, 22 publications on tracheostomy and...

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Tracheotomy in the SARS‐CoV‐2 pandemic

Cited by 26 publications

References 10 publications

Comparison of percutaneous dilatational tracheotomy versus open surgical technique in severe COVID-19: Complication rates, relative risks and benefits

Comparison of percutaneous dilatational tracheotomy versus open surgical technique in severe COVID-19: Complication rates, relative risks and benefits

Factors affecting the mortality of patients with COVID-19 undergoing surgery and the safety of medical staff: A systematic review and meta-analysis

Swallowing and Communication Management of Tracheostomy and Laryngectomy in the Context of COVID-19

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