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Syamal MN, Hanisak J, Macfarlan J, Ortega B, Sataloff RT, Benninger MS. To Tube, or Not to Tube: Comparing Ventilation Techniques in Microlaryngeal Surgery. Laryngoscope 2021; 131:2773-2781. [PMID: 34338303 DOI: 10.1002/lary.29750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/10/2021] [Accepted: 06/24/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objective of this study was to compare ventilation techniques utilized in microlaryngeal surgery. STUDY DESIGN Retrospective cohort study. METHODS Two-hundred surgeries performed from May 1, 2018 to March 1, 2020 and stratified as intubated, intermittently intubated (AAIV) or apneic. Patient demographics, comorbidities, anesthetic agents, intraoperative parameters/events, and complications were studied and compared across the three groups using inferential analyses. RESULTS Median body mass index in the AAIV group was significantly higher (33 vs. 29; P = .0117). Median oxygen nadirs were lower in AAIV cases (81% vs. 91-92%) while CO2 peak measurements were lower (33 mmHg vs. 48 mmHg) in the fully apneic cohort which were significantly shorter cases (P < .0001). CO2 peak measurements were comparable between AAIV and intubated cohorts (median 48.5 mmHg vs. 48.0 mmHg). Median apnea times were significantly prolonged by 2-5.5 minutes using nasal cannula and THRIVE/Optiflow in fully apneic cases when compared to no supplementary oxygenation (P = .0013). Systolic blood pressures following insertion of laryngoscope were higher (159.5 vs. 145 mmHg) and postoperative diastolic pressures were lower (68.5 vs. 76.5 mmHg) in fully apneic cases than intubated cases. No differences existed between frequencies of complications. CONCLUSIONS This study compares intubated, intermittently apneic, and fully apneic surgeries. No statistically significant differences were noted in comorbid conditions. While intraoperative hemodynamic fluctuations were more pronounced in the fully apneic cohort, and oxygenation distributions were lower in the AAIV cohort, no significant differences existed between events and complications. Apneic techniques are as safe and effective as traditional intubation. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Mausumi N Syamal
- Division of Otolaryngology-Head and Neck Surgery, Lehigh Valley Health Network, Allentown, Pennsylvania, U.S.A.,Department of Surgery, Division of Otolaryngology, University of South Florida, Morsani School of Medicine, Tampa, Florida, U.S.A
| | - Jill Hanisak
- Department of Anesthesia, Lehigh Valley Health Network, Allentown, Pennsylvania, U.S.A
| | - Jennifer Macfarlan
- Network Office of Research and Innovation, Lehigh Valley Health Network, Allentown, Pennsylvania, U.S.A
| | - Briana Ortega
- Department of Surgery, Division of Otolaryngology, University of South Florida, Morsani School of Medicine, Tampa, Florida, U.S.A
| | - Robert T Sataloff
- Department of Otolaryngology-Head and Neck Surgery and Lankenau Institute for Medical Research, Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A
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Herzog M, Beule AG, Lüers JC, Guntinas-Lichius O, Grafmans D, Deitmer T. [The first year of the SARS-CoV-2 pandemic-impact on otorhinolaryngology]. HNO 2021; 69:615-622. [PMID: 33620505 PMCID: PMC7900796 DOI: 10.1007/s00106-021-01015-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The first year of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has already affected our public health care system to an enormous extent and will continue to do so in the future. Otorhinolaryngologists (ORLs) are suspected to be at high risk of infection, due to the high viral load in the mucosa of the upper airways. The current review evaluates the impact of the pandemic on ORLs' activities and assesses the risk infection. METHODS A selective literature research was conducted using relevant English and German terms for ORL, SARS-CoV‑2, risk, and infection at PubMed, medRxiv, and bioRxiv, as well as in the Deutsches Ärzteblatt and on the websites of the Robert Koch Institute and the Johns Hopkins University. RESULTS Protection recommendations for ORL include general hygiene measures and wearing KN95 masks for routine professional activities. When in contact with coronavirus disease 2019 (COVID-19) patients, it is recommended to extend the personal protective equipment by eye protection, gloves, cap, and gown. International otorhinolaryngology societies have released guidelines for procedures (e.g., tracheostomy, sinus surgery), propagating personal protection for the surgical team and reduction of aerosols. Testing for SARS-CoV‑2 in patients and medical staff can contribute to reducing the risk of infection. Vaccination would provide some additional protection for ORLs and other health care professionals with increased exposure to aerosols. There is increasing evidence that ORLs are at a high risk of contracting SARS-CoV‑2. CONCLUSION Consequent personal protection, frequent testing of patients and health care professionals, and the promised SARS-CoV‑2 vaccinations may provide adequate protection for highly exposed persons.
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Affiliation(s)
- M Herzog
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Carl-Thiem-Klinikum, Thiemstraße 111, 03048, Cottbus, Deutschland.
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - A G Beule
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Münster, Münster, Deutschland
- Klinik und Poliklinik für Hals‑, Nasen‑, Ohrenkrankheiten, Kopf- und Halschirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - J-C Lüers
- Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Medizinische Fakultät, Uniklinik Köln, Köln, Deutschland
| | - O Guntinas-Lichius
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Jena, Jena, Deutschland
| | - D Grafmans
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Carl-Thiem-Klinikum, Thiemstraße 111, 03048, Cottbus, Deutschland
| | - T Deitmer
- Deutsche Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie e. V., Bonn, Deutschland
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Šifrer R, Urbančič J, Piazza C, van Weert S, García-Purriños F, Benedik J, Tancer I, Aničin A. Emergent tracheostomy during the pandemic of COVID-19: Slovenian National Recommendations. Eur Arch Otorhinolaryngol 2021; 278:2209-2217. [PMID: 32889621 PMCID: PMC7473826 DOI: 10.1007/s00405-020-06318-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/21/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Emergent tracheostomy under local anaesthesia is a reliable method of airway management when orotracheal intubation is not possible. COVID-19 is spread through aerosol making the emergent tracheostomy a high-risk procedure for surgeons. The surgical establishment of the air conduit in emergency scenarios must be adjusted for safety reasons. METHODS To establish the Slovenian National Guidelines for airway management in cannot intubate-cannot ventilate situations in COVID-19 positive patients. RESULTS Good communication and coordination between surgeon and anaesthesiologist is absolutely necessary. Deep general anaesthesia, full muscle relaxation and adequate preoxygenation without intubation are initial steps. The surgical cricothyrotomy is performed quickly, the thin orotracheal tube is inserted, the cuff is inflated and ventilation begins. Following patient stabilisation, the conversion to the tracheostomy is undertaken with the following features: skin infiltration with vasoconstrictor, a vertical incision, avoidance of electrical devices in favour of classical manners of haemostasis, the advancement of the tube towards the carina, performing the tracheal window in complete apnoea following adequate oxygenation, the insertion of non-fenestrated canulla attached to a heat and moisture exchanger, the fixation of canulla with stitches and tapes, and the cricothyrotomy entrance closure. Appropriate safety equipment is equally important. CONCLUSION The goal of the guidelines is to make the procedure safer for medical teams, without harming the patients. Further improvements of the guidelines will surely appear as COVID-19 is a new entity and there is not yet much experience in handling it.
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Affiliation(s)
- Robert Šifrer
- University Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1104, Ljubljana, Slovenia.
| | - Jure Urbančič
- University Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1104, Ljubljana, Slovenia
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, National Cancer Institute of Milan, Via Giacomo Venezian 1, Milan, Italy
- Department of Oncology and Oncohematology, University of Milan, Via Festa del Perdono 7, Milan, Italy
| | - Stijn van Weert
- Department of Otolaryngology - Head and Neck Surgery, Amsterdam UMC, Locatie VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Francisco García-Purriños
- Servicio de Otorrinolaringología, Hospital Universitario Los Arcos del Mar Menor, Paraje Torre Octavio 54, 30739, Pozo Aledo, Murcia, Spain
| | - Janez Benedik
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1104, Ljubljana, Slovenia
- Department of Anaesthesiology and Surgical Intensive Therapy, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia
| | - Ivana Tancer
- University Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia
| | - Aleksandar Aničin
- University Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloška 2, 1000, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1104, Ljubljana, Slovenia
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4
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Elective open "Shield Tracheostomy" in patients with COVID-19. Eur Arch Otorhinolaryngol 2021; 279:891-897. [PMID: 33881578 PMCID: PMC8059421 DOI: 10.1007/s00405-021-06820-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/09/2021] [Indexed: 01/08/2023]
Abstract
Purpose To prevent the consequences of long-term endotracheal intubation, patients undergo tracheostomies. However, as COVID-19 is highly contagious, its existence has made the tracheostomy a high-risk procedure. Tracheostomy procedures must, therefore, be adjusted for safety reasons. The aim is to present the adjustments that should be made to the surgical technique. Methods Both the medical charts and surgical reports of patients with COVID-19 who were subjected to elective open tracheostomies were reviewed. Results The retrospective study included 25 patients. Our adjustments include the timing of tracheostomies, ideally putting them at 21 days after the onset of COVID-19, the advancement of an endotracheal tube to 26–28 cm from the upper-alveolar ridge, surgery being carried out in the intensive care unit with appropriately modified positions of the patient and providers, tracheo-cutaneous sutures, and intentionally making the small tracheal flap and the tracheal window the same shape as a medieval shield. Conclusions A tracheostomy performed in this way is now referred to as the Shield Tracheostomy. Further improvements to the surgical technique are expected in the future.
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Çobanoğlu HB, Enver N, Akbulut S, Atmış EÖ, Birkent H, Büyükatalay Ç, Demirhan E, Denizoğlu İ, Haşimli R, Korkmaz MÖ, Özgürsoy SK, Öztürk K, Paltura C, Şirin S, Tatar EÇ, Tüzüner A, Yelken K, Coşkun HH, Oğuz H, Öz F. Laryngoscopic Examination During the COVID-19 Pandemic: Turkish Voice Speech and Swallowing Disorders Society and Turkish Professional Voice Society Recommendations. Turk Arch Otorhinolaryngol 2020; 58:274-278. [PMID: 33554203 PMCID: PMC7846307 DOI: 10.5152/tao.2020.5719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/15/2020] [Indexed: 01/07/2023] Open
Abstract
COVID-19 is highly transmissible and spreads rapidly in the population. This increases the occupational risk for health care workers. In otolaryngology clinic practice, patients with upper respiratory tract infection symptoms are common. Also, routine head and neck examinations such as oral cavity examination, nasal/nasopharyngeal examination, or video laryngostroboscopic evaluation are highly risky because of the aerosol formation. To emphasize this issue, two leading otolaryngology organizations in Turkey; 'Voice Speech and Swallowing Disorders Society', and 'Professional Voice Society' gathered a task force. This task force aimed to prepare a consensus report that would provide practical recommendations of the safety measurements during routine clinical care of laryngology patients. To fulfill this, universal aim, on the 2nd and 9th of May 2020, two web-based meetings were conducted by 20 expert physicians. This eighteen items list was prepared as an output.
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Affiliation(s)
- H. Bengü Çobanoğlu
- Department of Otolaryngology, Head and Neck Surgery, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Necati Enver
- Department of Otolaryngology, Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University, İstanbul, Turkey
| | - Sevtap Akbulut
- Department of Otolaryngology, Head and Neck Surgery, Yeditepe University School of Medicine, İstanbul, Turkey
| | - E. Özlem Atmış
- Department of Otolaryngology, Head and Neck Surgery, Fulya Acıbadem Hospital, İstanbul, Turkey
| | - Hakan Birkent
- Department of Otolaryngology, Head and Neck Surgery, İstanbul Cerrahi Hospital, İstanbul, Turkey
| | - Çiler Büyükatalay
- Department of Otorhinolaryngology, Head and Neck Surgery, İbni Sina Hospital, Ankara University School of Medicine, Ankara, Turkey
| | | | | | - Ramil Haşimli
- Department of Otorhinolaryngology, Head and Neck Surgery, Lor Hospital, Baku, Azerbaijan
| | - Müge Özçelik Korkmaz
- Department of Otorhinolaryngology, Head and Neck Surgery, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Selmin Karataylı Özgürsoy
- Department of Otorhinolaryngology, Head and Neck Surgery, Ufuk University School of Medicine, Ankara, Turkey
| | - Kayhan Öztürk
- Department of Otorhinolaryngology, Head and Neck Surgery, Medicana Hospital, Konya, Turkey
| | - Ceki Paltura
- Department of Otorhinolaryngology, Head and Neck Surgery, Gaziosmanpaşa Training and Research Hospital, İstanbul, Turkey
| | - Seher Şirin
- Department of Otolaryngology, Head and Neck Surgery, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Emel Çadallı Tatar
- Department of Otorhinolaryngology, Head and Neck Surgery, Dışkapı Training and Research Hospital, Ankara, Turkey
| | - Arzu Tüzüner
- Department of Otorhinolaryngology, Head and Neck Surgery, Başkent University School of Medicine, Ankara, Turkey
| | - Kürşat Yelken
- Department of Otorhinolaryngology, Head and Neck Surgery, Maltepe University School of Medicine, İstanbul, Turkey
| | - H. Hakan Coşkun
- Department of Otolaryngology, Head and Neck Surgery, Uludağ University School of Medicine, Bursa, Turkey
| | - Haldun Oğuz
- Department of Otorhinolaryngology, Head and Neck Surgery, Private Practice, Ankara, Turkey
| | - Ferhan Öz
- Department of Otolaryngology, Head and Neck Surgery, Bakırköy Acıbadem Hospital, İstanbul, Turkey
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6
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Jessop ZM, Dobbs TD, Ali SR, Combellack E, Clancy R, Ibrahim N, Jovic TH, Kaur AJ, Nijran A, O'Neill TB, Whitaker IS. Personal protective equipment for surgeons during COVID-19 pandemic: systematic review of availability, usage and rationing. Br J Surg 2020; 107:1262-1280. [PMID: 32395837 PMCID: PMC7273092 DOI: 10.1002/bjs.11750] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Surgeons need guidance regarding appropriate personal protective equipment (PPE) during the COVID-19 pandemic based on scientific evidence rather than availability. The aim of this article is to inform surgeons of appropriate PPE requirements, and to discuss usage, availability, rationing and future solutions. METHODS A systematic review was undertaken in accordance with PRISMA guidelines using MEDLINE, Embase and WHO COVID-19 databases. Newspaper and internet article sources were identified using Nexis. The search was complemented by bibliographic secondary linkage. The findings were analysed alongside guidelines from the WHO, Public Health England, the Royal College of Surgeons and specialty associations. RESULTS Of a total 1329 articles identified, 95 studies met the inclusion criteria. Recommendations made by the WHO regarding the use of PPE in the COVID-19 pandemic have evolved alongside emerging evidence. Medical resources including PPE have been rapidly overwhelmed. There has been a global effort to overcome this by combining the most effective use of existing PPE with innovative strategies to produce more. Practical advice on all aspects of PPE is detailed in this systematic review. CONCLUSION Although there is a need to balance limited supplies with staff and patient safety, this should not leave surgeons treating patients with inadequate PPE.
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Affiliation(s)
- Z M Jessop
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - T D Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - S R Ali
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - E Combellack
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - R Clancy
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - N Ibrahim
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - T H Jovic
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - A J Kaur
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - A Nijran
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - T B O'Neill
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - I S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University Medical School, Institute of Life Science, University of Swansea, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
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Miles A, Connor NP, Desai RV, Jadcherla S, Allen J, Brodsky M, Garand KL, Malandraki GA, McCulloch TM, Moss M, Murray J, Pulia M, Riquelme LF, Langmore SE. Dysphagia Care Across the Continuum: A Multidisciplinary Dysphagia Research Society Taskforce Report of Service-Delivery During the COVID-19 Global Pandemic. Dysphagia 2020; 36:170-182. [PMID: 32654059 PMCID: PMC7353832 DOI: 10.1007/s00455-020-10153-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/03/2020] [Indexed: 12/11/2022]
Abstract
At the time of writing this paper, there are over 11 million reported cases of COVID-19 worldwide. Health professionals involved in dysphagia care are impacted by the COVID-19 pandemic in their day-to-day practices. Otolaryngologists, gastroenterologists, rehabilitation specialists, and speech-language pathologists are subject to virus exposure due to their proximity to the aerodigestive tract and reliance on aerosol-generating procedures in swallow assessments and interventions. Across the globe, professional societies and specialty associations are issuing recommendations about which procedures to use, when to use them, and how to reduce the risk of COVID-19 transmission during their use. Balancing safety for self, patients, and the public while maintaining adequate evidence-based dysphagia practices has become a significant challenge. This paper provides current evidence on COVID-19 transmission during commonly used dysphagia practices and provides recommendations for protection while conducting these procedures. The paper summarizes current understanding of dysphagia in patients with COVID-19 and draws on evidence for dysphagia interventions that can be provided without in-person consults and close proximity procedures including dysphagia screening and telehealth.
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Affiliation(s)
- Anna Miles
- The University of Auckland, Auckland, New Zealand. .,Speech Science, School of Psychology, The University of Auckland, Grafton Campus, Private Bag 92019, Auckland, New Zealand.
| | - Nadine P Connor
- Communication Sciences & Disorders; Otolaryngology, Head and Neck Surgery, University of Wisconsin-Madison, Madison, USA
| | - Rinki Varindani Desai
- Department of Otolaryngology - Head and Neck Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sudarshan Jadcherla
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jacqui Allen
- The University of Auckland, Auckland, New Zealand
| | - Martin Brodsky
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
| | - Kendrea L Garand
- Department of Speech Pathology and Audiology, University of South Alabama, Mobile, AL, USA
| | - Georgia A Malandraki
- Speech, Language, and Hearing Sciences, and Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Timothy M McCulloch
- Otolaryngology, Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Marc Moss
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joseph Murray
- Audiology Speech Pathology Service, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Michael Pulia
- Emergency Care for Infectious Diseases (ECID) Research Program, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Luis F Riquelme
- New York Medical College, Valhalla, NY, USA.,Barrique Speech-Language Pathology, PC, Brooklyn, NY, USA
| | - Susan E Langmore
- Otolaryngology Head/Neck Surgery, Boston University School of Medicine, Boston, USA
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8
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Lagos AE, Ramos PH, Andrade T. Protection for Otolaryngologic Surgery in the COVID-19 Pandemic. OTO Open 2020; 4:2473974X20934734. [PMID: 32551408 PMCID: PMC7281886 DOI: 10.1177/2473974x20934734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/13/2022] Open
Abstract
Objective The coronavirus disease 2019 (COVID-19) has placed unprecedented challenges on the world and the medical community. It is transmitted through droplets, contact, the fecal-oral route, and airborne transmission under certain conditions that allow droplets to combine with air particles to form an aerosol. Viral loads are higher in the nasal area and similar in symptomatic and asymptomatic patients. Medical situations have been classified into high and low risk of generating aerosols. Most procedures and surgery in otolaryngology correspond to high-risk medical situations. This review aims to gather the vast amount of available information and generate recommendations for different surgical procedures according to aerosolization risk and COVID-19 status, with use of specific personal protective equipment in each case. Data Sources PubMed, MEDLINE, and Embase. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, and Food and Drug Administration. Review Methods We conducted a review on the literature on personal protective equipment for otolaryngologic surgery and surgical indication restrictions during the COVID-19 pandemic. Conclusions SARS-CoV-2 is an easily transmitted virus. Asymptomatic and symptomatic patients with COVID-19 present an upper airway high viral load, conferring otolaryngologic procedures a high risk of aerosolization. Surgical procedures must be categorized according to aerosolization risk and the possibility of COVID-19 diagnosis, according to use of personal protective equipment. Implications for Practice This review contributes to scientific knowledge regarding the detailed description of protective personal equipment and, most important, surgical recommendations to reduce the risk of infection in the otolaryngology community during the COVID-19 pandemic.
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Affiliation(s)
- Antonia E Lagos
- Otolaryngology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Phoebe H Ramos
- Otolaryngology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tomás Andrade
- Otolaryngology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
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