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Takhar A, Surda P, Ahmad I, Amin N, Arora A, Camporota L, Denniston P, El-Boghdadly K, Kvassay M, Macekova D, Munk M, Ranford D, Rabcan J, Tornari C, Wyncoll D, Zaitseva E, Hart N, Tricklebank S. Timing of Tracheostomy for Prolonged Respiratory Wean in Critically Ill Coronavirus Disease 2019 Patients: A Machine Learning Approach. Crit Care Explor 2020; 2:e0279. [PMID: 33225305 PMCID: PMC7673767 DOI: 10.1097/cce.0000000000000279] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To propose the optimal timing to consider tracheostomy insertion for weaning of mechanically ventilated patients recovering from coronavirus disease 2019 pneumonia. We investigated the relationship between duration of mechanical ventilation prior to tracheostomy insertion and in-hospital mortality. In addition, we present a machine learning approach to facilitate decision-making. DESIGN Prospective cohort study. SETTING Guy's & St Thomas' Hospital, London, United Kingdom. PATIENTS Consecutive patients admitted with acute respiratory failure secondary to coronavirus disease 2019 requiring mechanical ventilation between March 3, 2020, and May 5, 2020. INTERVENTIONS Baseline characteristics and temporal trends in markers of disease severity were prospectively recorded. Tracheostomy was performed for anticipated prolonged ventilatory wean when levels of respiratory support were favorable. Decision tree was constructed using C4.5 algorithm, and its classification performance has been evaluated by a leave-one-out cross-validation technique. MEASUREMENTS AND MAIN RESULTS One-hundred seventy-six patients required mechanical ventilation for acute respiratory failure, of which 87 patients (49.4%) underwent tracheostomy. We identified that optimal timing for tracheostomy insertion is between day 13 and day 17. Presence of fibrosis on CT scan (odds ratio, 13.26; 95% CI [3.61-48.91]; p ≤ 0.0001) and Pao2:Fio2 ratio (odds ratio, 0.98; 95% CI [0.95-0.99]; p = 0.008) were independently associated with tracheostomy insertion. Cox multiple regression analysis showed that chronic obstructive pulmonary disease (hazard ratio, 6.56; 95% CI [1.04-41.59]; p = 0.046), ischemic heart disease (hazard ratio, 4.62; 95% CI [1.19-17.87]; p = 0.027), positive end-expiratory pressure (hazard ratio, 1.26; 95% CI [1.02-1.57]; p = 0.034), Pao2:Fio2 ratio (hazard ratio, 0.98; 95% CI [0.97-0.99]; p = 0.003), and C-reactive protein (hazard ratio, 1.01; 95% CI [1-1.01]; p = 0.005) were independent late predictors of in-hospital mortality. CONCLUSIONS We propose that the optimal window for consideration of tracheostomy for ventilatory weaning is between day 13 and 17. Late predictors of mortality may serve as adverse factors when considering tracheostomy, and our decision tree provides a degree of decision support for clinicians.
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Affiliation(s)
- Arunjit Takhar
- Department of Otolaryngology and Head and Neck Surgery, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Pavol Surda
- Department of Otolaryngology and Head and Neck Surgery, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Imran Ahmad
- Department of Anaesthesia, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
- Kings College London, United Kingdom
| | - Nikul Amin
- Department of Otolaryngology and Head and Neck Surgery, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Asit Arora
- Department of Otolaryngology and Head and Neck Surgery, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Luigi Camporota
- Department of Critical Care, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Poppy Denniston
- Department of Respiratory Medicine, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kariem El-Boghdadly
- Department of Anaesthesia, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
- Kings College London, United Kingdom
| | - Miroslav Kvassay
- Department of Informatics, Faculty of Management Science and Informatics, University of Zilina, Zilina, Slovakia
| | - Denisa Macekova
- Department of Informatics, Faculty of Management Science and Informatics, University of Zilina, Zilina, Slovakia
| | - Michal Munk
- Department of Informatics, Constantine the Philosopher University, Nitra, Slovakia
| | - David Ranford
- Department of Critical Care, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jan Rabcan
- Department of Informatics, Faculty of Management Science and Informatics, University of Zilina, Zilina, Slovakia
| | - Chysostomos Tornari
- Department of Otolaryngology and Head and Neck Surgery, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Duncan Wyncoll
- Department of Critical Care, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Elena Zaitseva
- Department of Informatics, Constantine the Philosopher University, Nitra, Slovakia
| | - Nicholas Hart
- Lane Fox Respiratory Unit, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
- Kings College London, United Kingdom
| | - Stephen Tricklebank
- Department of Critical Care, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
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Botti C, Lusetti F, Peroni S, Neri T, Castellucci A, Salsi P, Ghidini A. The Role of Tracheotomy and Timing of Weaning and Decannulation in Patients Affected by Severe COVID-19. EAR, NOSE & THROAT JOURNAL 2020; 100:116S-119S. [PMID: 33035129 PMCID: PMC7548540 DOI: 10.1177/0145561320965196] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives: Patients with acute respiratory failure due to coronavirus disease 2019
(COVID-19) have a high likelihood of needing prolonged intubation and may
subsequently require tracheotomy. Indications and timing for performing
tracheotomy in patients affected by severe COVID-19 pneumonia are still
elusive. The aim of this study is to analyze the role of tracheotomy in the
context of this pandemic. Moreover, we report the timing of the procedure
and the time needed to complete weaning and decannulation in our center. Methods: This retrospective, observational cohort study included adults (≥18 years)
with severe COVID-19 pneumonia who were admitted to the intensive care unit
(ICU) of the tertiary care center of Reggio Emilia (Italy). All patients
underwent orotracheal intubation with invasive mechanical ventilation,
followed by percutaneous or open surgical tracheotomy. Indications, timing
of the procedure, and time needed to complete weaning and decannulation were
reported. Results: Forty-four patients were included in the analysis. Median time from
orotracheal intubation to surgery was 7 (range 2-17) days. Fifteen (34.1%)
patients died during the follow-up period (median 22 days, range 8-68) after
the intubation. Weaning from the ventilator was first attempted on median
25th day (range 13-43) from orotracheal intubation. A median of 35 (range
18-79) days was required to complete weaning. Median duration of ICU stay
was 22 (range 10-67) days. Mean decannulation time was 36 (range 10-77) days
from surgery. Conclusions: Since it is not possible to establish an optimal timing for performing
tracheotomy, decision-making should be made on case-by-case basis. It should
be adapted to the context of the pandemic, taking into account the
availability of intensive care resources, potential risks for health care
workers, and benefits for the individual patient.
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Affiliation(s)
- Cecilia Botti
- PhD Program in Clinical and Experimental Medicine, 208968University of Modena and Reggio Emilia, Reggio Emilia, Italy.,Otolaryngology Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
| | | | - Stefano Peroni
- Intensive Care Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
| | - Tommaso Neri
- Intensive Care Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
| | | | - Pierpaolo Salsi
- Intensive Care Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
| | - Angelo Ghidini
- Otolaryngology Unit, 9242Azienda USL-IRCCS, di Reggio Emilia, Italy
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53
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Picetti E, Fornaciari A, Taccone FS, Malchiodi L, Grossi S, Di Lella F, Falcioni M, D’Angelo G, Sani E, Rossi S. Safety of bedside surgical tracheostomy during COVID-19 pandemic: A retrospective observational study. PLoS One 2020; 15:e0240014. [PMID: 32997704 PMCID: PMC7526872 DOI: 10.1371/journal.pone.0240014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/18/2020] [Indexed: 01/08/2023] Open
Abstract
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 PaO2 / FiO2 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, PaO2/FiO2 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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Affiliation(s)
- Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
- * E-mail:
| | - Anna Fornaciari
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Malchiodi
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Silvia Grossi
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Filippo Di Lella
- Department of Otolaryngology, Parma University Hospital, Parma, Italy
| | - Maurizio Falcioni
- Department of Otolaryngology, Parma University Hospital, Parma, Italy
| | - Giulia D’Angelo
- Department of Otolaryngology, Parma University Hospital, Parma, Italy
| | - Emanuele Sani
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Sandra Rossi
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
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Mannelli G, Ralli M, Bonali M, Capasso P, Guarino P, Iannini V, Mevio N, Russo G, Scarpa A, Spinato G, Topazio D, Molteni G. Impact of COVID-19 pandemic on Italian Otolaryngology Units: a nationwide study. ACTA ACUST UNITED AC 2020; 40:325-331. [PMID: 32970046 PMCID: PMC7726641 DOI: 10.14639/0392-100x-n0832] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/21/2020] [Indexed: 12/23/2022]
Abstract
Objective The aim of this study was to provide an accurate picture of the changes which have occurred during the COVID-19 pandemic, and the contributions given by Italian Otolaryngology Units. Methods A 29-item questionnaire was completed and returned by 154 Otorhinolaryngology Units across Italy that investigated geographic distribution, the main changes which occurred in workload management and in clinical and surgical activities and screening procedures for COVID-19 in healthcare personnel and patients. Results Nearly half of the Otolaryngology Units that responded to the questionnaire were merged with other units, while 22% were converted into COVID-19 units or temporarily closed. A reduction of 8.55% in the number of team members was reported, and about 50% of the units applied uniform work shifts for all staff. Elective activities were uniformly stopped or delayed, passing from 30,295 (pre-COVID data) to 5,684 (COVID data) weekly procedures, with a mean decrease of 81.24% (p < 0.001). Conclusions Most of the elective otolaryngology activities were suspended during the pandemic; the only procedures were for oncology and emergency patients. Italian Otolaryngologists have demonstrated a high availability to collaborate with non-surgical colleagues.
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Affiliation(s)
- Giuditta Mannelli
- COVID-19 Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology Head and Neck Surgery.,Head and Neck Oncology and Robotic Surgery, Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Massimo Ralli
- COVID-19 Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology Head and Neck Surgery.,Department of Sense Organs, Sapienza University of Rome, Italy
| | - Marco Bonali
- COVID-19 Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology Head and Neck Surgery.,Otolaryngology Head and Neck Surgery Department, University of Modena, Italy
| | - Pasquale Capasso
- COVID-19 Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology Head and Neck Surgery.,Otolaryngology, Head and Neck Surgery Unit AO dei Colli, Monaldi Hospital, Napoli, Italy
| | - Pierre Guarino
- COVID-19 Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology Head and Neck Surgery.,Otorhinolaryngology, Head and Neck Surgery Unit "Santo Spirito" Hospital of Pescara, Italy
| | - Valeria Iannini
- COVID-19 Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology Head and Neck Surgery.,Otolaryngology Department, Dipartimento Strutturale Ospedaliero Chirurgico di Rovigo ULSS 5, Rovigo, Italy
| | - Niccolò Mevio
- COVID-19 Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology Head and Neck Surgery.,Department of Otolaryngology Niguarda Hospital, Milano, Italy
| | - Gennaro Russo
- COVID-19 Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology Head and Neck Surgery.,Otolaryngology, Head and Neck Surgery Unit AO dei Colli, Monaldi Hospital, Napoli, Italy
| | - Alfonso Scarpa
- COVID-19 Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology Head and Neck Surgery.,Department of Medicine and Surgery, University of Salerno, Italy
| | - Giacomo Spinato
- COVID-19 Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology Head and Neck Surgery.,Department of Neurosciences, Section of Otolaryngology and Regional Centre for Head and Neck Cancer, University of Padova, Treviso, Italy - Department of Surgery, Oncology and Gastroenterology, Section of Oncology and Immunology, University of Padova, Italy
| | - Davide Topazio
- COVID-19 Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology Head and Neck Surgery.,Otolaryngology Department, Ospedale Mazzini, Teramo, Italy
| | - Gabriele Molteni
- COVID-19 Task Force of the Young Otolaryngologists of the Italian Society of Otolaryngology Head and Neck Surgery.,Otolaryngology, Head and Neck Surgery Unit, University Hospital of Verona Borgo Trento, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Italy
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55
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Omari AA, Al-Ashqar R, Nuseir A, AL Balas H, Allan H, Kanaan Y, Alzoubi F. Overview of Upper Airway Management During COVID-19 Outbreak: Head and Neck Surgeon's Perspective. J Craniofac Surg 2020; 31:e644-e649. [PMID: 32649566 PMCID: PMC7382411 DOI: 10.1097/scs.0000000000006798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/27/2020] [Indexed: 01/08/2023] Open
Abstract
At the end of December, 2019, a new virus was named severe acute respiratory syndrome coronavirus 2 appeared in Wuhan, China, and the disease caused is called as coronavirus disease 2019 (COVID-19) by World Health Organization, which to date having infected more than 3,588,773 people worldwide, as well as causing 247,503 deaths. A human to human transmission is thought to be predominantly by droplet spread, and direct contact with the patient or contaminated surfaces. This study aims to provide a comprehensive overview as well as to highlight essential evidence-based guidelines for how head and neck surgeon and healthcare providers need to take into consideration during their management of the upper airway during the COVID-19 pandemic safely and effectively to avoid the spread of the virus to the health provider.
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Affiliation(s)
- Ahmad Al Omari
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology
| | - Ra’ed Al-Ashqar
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology
| | - Amjad Nuseir
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology
| | | | - Hadeel Allan
- Family Medicine Department, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yazan Kanaan
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology
| | - Firas Alzoubi
- Otolaryngology Department, Faculty of Medicine, Jordan University of Science and Technology
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56
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Krajewska Wojciechowska J, Krajewski W, Zub K, Zatoński T. Review of practical recommendations for otolaryngologists and head and neck surgeons during the COVID-19 pandemic. Auris Nasus Larynx 2020; 47:544-558. [PMID: 32540054 PMCID: PMC7275141 DOI: 10.1016/j.anl.2020.05.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/26/2020] [Accepted: 06/02/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Otolaryngologists are at very high risk of COVID-19 infection while performing examination or surgery. Strict guidelines for these specialists have not already been provided, while currently available recommendations could presumably change in course of COVID-19 pandemic as the new data increases. OBJECTIVES This study aimed to synthesize evidence concerning otolaryngology during COVID-19 pandemic. It presents a review of currently existing guidelines and recommendations concerning otolaryngological procedures and surgeries during COVID-19 pandemic, and provides a collective summary of all crucial information for otolaryngologists. It summarizes data concerning COVID-19 transmission, diagnosis, and clinical presentation highlighting the information significant for otolaryngologists. METHODS The Medline and Web of Science databases were searched without time limit using terms ''COVID-19", "SARS-CoV-2" in conjunction with "head and neck surgery", "otorhinolaryngological manifestations". RESULTS Patients in stable condition should be consulted using telemedicine options. Only emergency consultations and procedures should be performed during COVID-19 pandemic. Mucosa-involving otolaryngologic procedures are considered high risk procedures and should be performed using enhanced PPE (N95 respirator and full face shield or powered air-purifying respirator, disposable gloves, surgical cap, gown, shoe covers). Urgent surgeries for which there is not enough time for SARS-CoV-2 screening are also considered high risk procedures. These operations should be performed in a negative pressure operating room with high-efficiency particulate air filtration. Less urgent cases should be tested for COVID-19 twice, 48 h preoperatively in 24 h interval. CONCLUSIONS This review serves as a collection of current recommendations for otolaryngologists for how to deal with their patients during COVID-19 pandemic.
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Affiliation(s)
- Joanna Krajewska Wojciechowska
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Medical University in Wroclaw, Borowska 213 Street, 50556 Wroclaw, Poland.
| | - Wojciech Krajewski
- Department and Clinic of Urology and Urological Oncology, Medical University in Wroclaw, Poland
| | - Krzysztof Zub
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Medical University in Wroclaw, Borowska 213 Street, 50556 Wroclaw, Poland
| | - Tomasz Zatoński
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Medical University in Wroclaw, Borowska 213 Street, 50556 Wroclaw, Poland
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Pasero D, Rizzo D, Piras A, Floris L, Parrilla C, Riu F, Terragni P, Bussu F. Tracheotomy in COVID-19 patients: preliminary experience and technical refinements. Br J Surg 2020; 107:e304. [PMID: 32542655 PMCID: PMC7323130 DOI: 10.1002/bjs.11757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 12/23/2022]
Affiliation(s)
- D Pasero
- Intensive Care Unit, Rome, Italy
- Department of Medical, Surgical and Experimental Sciences, Università di Sassari, Rome, Italy
| | - D Rizzo
- Otolaryngology Division, Azienda Ospedaliero Universitaria Sassari, Rome, Italy
| | - A Piras
- Otolaryngology Division, Azienda Ospedaliero Universitaria Sassari, Rome, Italy
| | - L Floris
- Intensive Care Unit, Rome, Italy
| | - C Parrilla
- Otolaryngology Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - F Riu
- Otolaryngology Division, Azienda Ospedaliero Universitaria Sassari, Rome, Italy
| | - P Terragni
- Intensive Care Unit, Rome, Italy
- Department of Medical, Surgical and Experimental Sciences, Università di Sassari, Rome, Italy
| | - F Bussu
- Otolaryngology Division, Azienda Ospedaliero Universitaria Sassari, Rome, Italy
- Department of Medical, Surgical and Experimental Sciences, Università di Sassari, Rome, Italy
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Marudi A, Branchetti G, Bertellini E. Permissive Apnea in COVID-19 Tracheostomy: Alternative Health Worker Safe Procedure in Intensive Care Unit. Ann Thorac Surg 2020; 111:730. [PMID: 32653361 PMCID: PMC7347472 DOI: 10.1016/j.athoracsur.2020.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Andrea Marudi
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria di Modena, Via del Pozzo 71, Modena, Italy.
| | - Giacomo Branchetti
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria di Modena, Via del Pozzo 71, Modena, Italy
| | - Elisabetta Bertellini
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria di Modena, Via del Pozzo 71, Modena, Italy
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59
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Piątkowski J, Klecha M, Tretiakow D, Skorek A. Tracheotomy in the age of the COVID-19
pandemic: up-to-date review. ACTA ACUST UNITED AC 2020. [DOI: 10.5604/01.3001.0014.2318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Introduction:</b> The SARS-CoV-2 pandemic is one of the biggest healthcare challenges that the medical environment has needed to face since many, many years. Clinicians all over the world present their recommendations for everyday procedures in order to provide safety to the medical staff as well as to patients. The disease leads to ARDS in many cases and some patients will require prolonged intubation; therefore, to avoid the negative aspects of this condition, a number of patients will undergo tracheostomy. Tracheostomy is an aerosol-generating procedure, therefore, when performed on a SARS-CoV-2-positive patient, there is a high risk of contamination both of the medical team and the operating theatre. <br><b>Aim:</b> We describe a set of guidelines that we believe should minimize those risks. We focus on aspects like: presurgical testing, proper preparation of the operating theatre prior to the patients’ arrival, initial education of the medical staff participating in the surgery, patient’ transport and tracheostomy. We describe the critical points during every step and suggest ways to minimalize the risk of viral transmission.
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Affiliation(s)
| | - Martyna Klecha
- Otolaryngology Clinic of the Medical University of Gdansk
| | | | - Andrzej Skorek
- Otolaryngology Clinic of the Medical University of Gdansk
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Mattioli F, Marudi A, Ghirelli M, Molteni G, Sgarbi N, Valerini S, Girardis M, Presutti L, Fermi M. Reply to "Indications and timing for tracheostomy in patients with SARS CoV2-related" by Ferri et al. Eur Arch Otorhinolaryngol 2020; 277:2405-2406. [PMID: 32556782 PMCID: PMC7297929 DOI: 10.1007/s00405-020-06134-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/12/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Francesco Mattioli
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - Andrea Marudi
- Department of Anesthesiology, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - Michael Ghirelli
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - Gabriele Molteni
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Verona, Piazzale Aristide Stefani, 41100, Verona, Italy
| | - Nicola Sgarbi
- Department of Anesthesiology, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - Sara Valerini
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - Massimo Girardis
- Department of Anesthesiology, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - Livio Presutti
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
| | - Matteo Fermi
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy.
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Dhanani R, Wasif M, Pasha HA, Hussain M, Ghaloo SK, Shah Vardag AB, Mahmood K, Hussain R. COVID-19: Implications, Reactions and Future Directions. Turk Arch Otorhinolaryngol 2020; 58:122-126. [PMID: 32783040 PMCID: PMC7397537 DOI: 10.5152/tao.2020.5452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/03/2020] [Indexed: 12/21/2022] Open
Abstract
Humanity has faced several foes over the centuries, a formidable one amongst them is the current pandemic of COVID-19. The symptoms of COVID-19 are more or less related to the nose and throat. Therefore, patients more often present to Ear Nose Throat (ENT) clinics with symptoms including cough, sore throat, fever and shortness of breath. In the management of head and neck pathologies, as the airway is a direct source of infection, the impact of COVID-19 holds special significance. This review has attempted to explain the various aspects of the disease itself, its diagnosis, the use of personal protective equipment (PPE) to provide an overview of the evolving recommendations in head and neck patients, the future outlook and the limitations faced in developing countries specifically for ENT patients.
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Affiliation(s)
- Rahim Dhanani
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Muhammad Wasif
- Department of Otolaryngology, Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Hamdan Ahmed Pasha
- Department of Otolaryngology Head and Neck Surgery, Jinnah Medical College Hospital, Karachi, Pakistan
| | - Muntazir Hussain
- Clinic of Head and Neck Surgery, Cancer Foundation Hospital, Karachi, Pakistan
| | - Shayan Khalid Ghaloo
- Department of Otolaryngology, Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Abdul Basit Shah Vardag
- Department of Otolaryngology, Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Khadija Mahmood
- Clinic of Medicine, Abbasi Shaheed Hospital, Karachi, Pakistan
| | - Raza Hussain
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
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Indications and timing for tracheostomy in patients with SARS CoV2-related. Eur Arch Otorhinolaryngol 2020; 277:2403-2404. [PMID: 32458121 PMCID: PMC7250256 DOI: 10.1007/s00405-020-06068-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/18/2020] [Indexed: 12/23/2022]
Abstract
Background The indications and timing for tracheostomy in patients with SARS CoV2-related are controversial.
Purpose In a recent issue published in the European Archives of Otorhinolaryngology, Mattioli et al. published a short communication about tracheostomy timing in patients with COVID-19 (Coronavirus Disease 2019); they reported that the tracheostomy could allow early Intensive Care Units discharge and, in the context of prolonged Invasive Mechanical Ventilation, should be suggested within 7 and 14 days to avoid potential tracheal damages. In this Letter to the Editor we would like to present our experience with tracheostomy in a Hub Covid Hospital.
Methods 8 patients underwent open tracheostomy in case of intubation prolonged over 14 days, bronchopulmonary overlap infections, and patients undergoing weaning. They were followed up and the number and timing of death were recorded. Results
Two patients died after tracheostomy; the median time between tracheostomy and death was 3 days. A negative prognostic trend was observed for a shorter duration of intubation. Conclusion In our experience, tracheostomy does not seem to influence the clinical course and prognosis of the disease, in the face of possible risks of contagion for healthcare workers. The indication for tracheostomy in COVID-19 patients should be carefully evaluated and reserved for selected patients. Although it is not possible to define an optimal timing, it is our opinion that tracheostomy in a stable or clinically improved COVID-19 patient should not be proposed before the 20th day after orotracheal intubation.
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Delides A, Maragoudakis P, Nikolopoulos T. Timing of Tracheotomy in Intubated Patients With COVID-19. Otolaryngol Head Neck Surg 2020; 163:328-329. [PMID: 32427056 DOI: 10.1177/0194599820930668] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Timing of elective tracheotomy in the intensive care unit for intubated patients with COVID-19 is still unclear. Recent recommendations and guidelines describe the surgical steps to achieve maximum protection of the involved medical staff and propose a delay of the procedure, so the viral load is decreased. Most authors of these recommendations agree that tracheotomy should be performed after at least 14 days from intubation, but data on this subject are still lacking. We discuss the issue of timing for such a procedure in regard to viral load and propose that the decision should be predominately based on its calculation.
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Affiliation(s)
- Alexander Delides
- Second Otolaryngology Department, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Pavlos Maragoudakis
- Second Otolaryngology Department, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
| | - Thomas Nikolopoulos
- Second Otolaryngology Department, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University Hospital, Athens, Greece
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