1
|
Kearney A, Norris K, Bertelsen C, Samad I, Cambridge M, Croft G, Peavler S, Groen C, Doyle PC, Damrose EJ. Adoption and Utilization of Heat and Moisture Exchangers (HMEs) in the Tracheostomy Patient. Otolaryngol Head Neck Surg 2023; 169:1374-1381. [PMID: 37161949 DOI: 10.1002/ohn.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Management of tracheostomized patients typically involves a conventional external humidification system (CEHS). CEHS are noisy, negatively impact patient mobility, and increases costs. Additionally, they prevent phonation and the ability to cough. Alternatively, heat and moisture exchange (HME) devices have been used in laryngectomized patients. We present an institutional quality improvement project exploring the use and efficacy of an HME device following tracheostomy. METHODS Health care professionals and stakeholders from multiple disciplines were identified: otolaryngology, nursing, administration, case management, and speech-language pathology. The focus was on an otolaryngology acute care nursing unit. Protocols for product acquisition, nursing education, care flowcharts, and discharge planning were established. Efficacy was assessed by tracking patient pulmonary status, nursing notes, and questionnaires. RESULTS Seventy-one tracheostomized patients were enrolled. Two patients (2.8%) were unable to tolerate the HME. There were no complications from mucous plugging or respiratory distress. Eighty-nine percent of nursing staff surveyed preferred the use of an HME device over CEHS, particularly for ease of patient mobility. Additional favorable findings were patient satisfaction, cost savings, reduced noise, communication, and ease of discharge education and planning. DISCUSSION Replacing CEHS with HMEs provides distinct advantages, with a positive impact on patients, family members, and health care personnel. Resistance to changing from the traditional standard of care was alleviated with education, focused training, and positive outcomes. IMPLICATIONS FOR PRACTICE These data indicate that an HME device is safe and offers advantages to both patients and nurses over traditional CEHS.
Collapse
Affiliation(s)
- Ann Kearney
- Department of Otolaryngology-Head and Neck Surgery, Division of Laryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Kristi Norris
- Department of Patient Care Service and Nursing, Stanford Health Care, Stanford, California, USA
| | - Carol Bertelsen
- Department of Patient Care Service and Nursing, Stanford Health Care, Stanford, California, USA
| | - Idris Samad
- Department of Otolaryngology-Head and Neck Surgery, Division of Laryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Maribeth Cambridge
- Department of Patient Care Service and Nursing, Stanford Health Care, Stanford, California, USA
| | - Glenn Croft
- Department of Patient Care Service and Nursing, Stanford Health Care, Stanford, California, USA
| | - Staci Peavler
- Department of Social Work and Case Management, Stanford Health Care, Stanford, California, USA
| | - Christa Groen
- Department of Social Work and Case Management, Stanford Health Care, Stanford, California, USA
| | - Philip C Doyle
- Department of Otolaryngology-Head and Neck Surgery, Division of Laryngology, Stanford University School of Medicine, Stanford, California, USA
| | - Edward J Damrose
- Department of Otolaryngology-Head and Neck Surgery, Division of Laryngology, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
2
|
Ramírez-Torres CA, Rivera-Sanz F, Sufrate-Sorzano T, Pedraz-Marcos A, Santolalla-Arnedo I. Closed Endotracheal Suction Systems for COVID-19: Rapid Review. Interact J Med Res 2023; 12:e42549. [PMID: 36548950 PMCID: PMC9874988 DOI: 10.2196/42549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The increase in admissions to intensive care units (ICUs) in 2020 and the morbidity and mortality associated with SARS-CoV-2 infection pose a challenge to the analysis of evidence of health interventions carried out in ICUs. One of the most common interventions in patients infected with the virus and admitted to ICUs is endotracheal aspiration. Endotracheal suctioning has also been considered one of the most contaminating interventions. OBJECTIVE This review aims to analyze the benefits and risks of endotracheal suctioning using closed suction systems (CSS) in COVID-19 patients. METHODS A rapid review was carried out using the following databases: PubMed, MEDLINE, CINAHL, LILACS, the Cochrane Library, and IBECS. The data search included articles in English and Spanish, published between 2010 and 2020, concerning adult patients, and using the key words "endotracheal," "suction," and "closed system." RESULTS A total of 15 articles were included. The benefits and risks were divided into 3 categories: patient, care, and organization. Relating to the patient, we found differences in cardiorespiratory variables and changes in the ventilator, for example, improvement in patients with elevated positive and end-expiratory pressure due to maladaptation and alveolar collapse. Relating to care, we found a shorter suctioning time, by up to 1 minute. Relating to organization, we found fewer microorganisms on staff gloves. Other conflicting results between studies were related to ventilator-associated pneumonia, bacterial colonization, or mortality. CONCLUSIONS Aside from the need for quality research comparing open suction systems and CSS as used to treat COVID-19 patients, closed endotracheal suctioning has benefits in terms of shorter stay in the ICU and reduced environmental contamination, preventing ventilator disconnection from the patient, reducing the suctioning time-though it does produce the greatest number of mucosal occlusions-and preventing interpatient and patient-staff environmental contamination. New evidence in the context of the SARS-CoV-2 virus is required in order to compare results and establish new guidelines.
Collapse
Affiliation(s)
- Carmen Amaia Ramírez-Torres
- Health and Care Research Group, University of La Rioja, Logroño, Spain
- Research Unit on Health System Sustainability, Biomedical Center of La Rioja, Logroño, Spain
| | | | - Teresa Sufrate-Sorzano
- Health and Care Research Group, University of La Rioja, Logroño, Spain
- Research Unit on Health System Sustainability, Biomedical Center of La Rioja, Logroño, Spain
| | | | - Ivan Santolalla-Arnedo
- Health and Care Research Group, University of La Rioja, Logroño, Spain
- Research Unit on Health System Sustainability, Biomedical Center of La Rioja, Logroño, Spain
| |
Collapse
|
3
|
Dai Y, Zhang R, Jiang Y, Jin H, Zhao J, Guo A, Chen X, Fan D, Yang L. Infection control management strategy for operating room during COVID-19 pandemic. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1252. [PMID: 36544658 PMCID: PMC9761131 DOI: 10.21037/atm-22-4850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/08/2022] [Indexed: 11/30/2022]
Abstract
Coronavirus disease 2019 (COVID-19) outbreaks have occurred in many countries around the world. The numbers of confirmed cases and deaths continue to increase. It is increasingly likely that COVID-19 patients will require emergency surgeries in the operating room (OR). As COVID-19 can easily be transmitted to healthcare workers and other patients during surgery, it is important to establish a set of infection prevent and control management strategy to prevent COVID-19 from spreading in the OR. Based on our experience in COVID-19 prevention and control in the OR, we introduce this COVID-19 prevention and control management strategy for preventing COVID-19 from spreading in the OR. This management strategy includes a number of COVID-19 prevention and control procedures including (I) conduct COVID-19 knowledge training at the early stage of outbreak, (II) formulate the surgery arrangement procedures and suspend the elective surgery if the patient confirmed to COVID-19, (III) divide an isolated OR area for COVID-19 surgery, (IV) preoperative preparation procedures, (V) procedures for wearing and removing personal protective equipment, (VI) anesthesia management, intraoperative management, (VII) post-operative disposable waste management and disinfection. This management strategy has worked very effectively since the outbreak of COVID-19 in Wuhan at the end of 2019. We have performed emergency surgeries on several COVID-19 confirmed patient and dozens of COVID-19 suspected patients under this COVID-19 prevention and control management strategy, and have achieved an excellent result of zero COVID-19 infection in the OR.
Collapse
|
4
|
Jain A, Chaurasia R, Sengar NS, Deep A. Bain H: Innovative Modification of Bain Circuit for the Resuscitation and Transportation of Patients With Coronavirus Disease 2019. A A Pract 2021; 15:e01530. [PMID: 34673656 PMCID: PMC8555949 DOI: 10.1213/xaa.0000000000001530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 11/05/2022]
Abstract
Bain H circuit is an innovatively modified breathing circuit designed for the transportation and resuscitation of patients with coronavirus disease (COVID-19). For this circuit, the Heidbrink valve was replaced with a 15F inlet and 15M/22F outlet adjustable pressure-limiting (APL) valve, and a high-efficiency particulate air filter was placed over the APL outlet valve. The circuit is designed to filter the novel coronavirus without any increase in dead space or resistance. All benefits of the conventional Bain circuit were retained. Besides its use in dedicated COVID-19 areas, this circuit can be used in other emergency units of the hospital.
Collapse
|
5
|
Meister KD, Pandian V, Hillel AT, Walsh BK, Brodsky MB, Balakrishnan K, Best SR, Chinn SB, Cramer JD, Graboyes EM, McGrath BA, Rassekh CH, Bedwell JR, Brenner MJ. Multidisciplinary Safety Recommendations After Tracheostomy During COVID-19 Pandemic: State of the Art Review. Otolaryngol Head Neck Surg 2021; 164:984-1000. [PMID: 32960148 PMCID: PMC8198753 DOI: 10.1177/0194599820961990] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/06/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE In the chronic phase of the COVID-19 pandemic, questions have arisen regarding the care of patients with a tracheostomy and downstream management. This review addresses gaps in the literature regarding posttracheostomy care, emphasizing safety of multidisciplinary teams, coordinating complex care needs, and identifying and managing late complications of prolonged intubation and tracheostomy. DATA SOURCES PubMed, Cochrane Library, Scopus, Google Scholar, institutional guidance documents. REVIEW METHODS Literature through June 2020 on the care of patients with a tracheostomy was reviewed, including consensus statements, clinical practice guidelines, institutional guidance, and scientific literature on COVID-19 and SARS-CoV-2 virology and immunology. Where data were lacking, expert opinions were aggregated and adjudicated to arrive at consensus recommendations. CONCLUSIONS Best practices in caring for patients after a tracheostomy during the COVID-19 pandemic are multifaceted, encompassing precautions during aerosol-generating procedures; minimizing exposure risks to health care workers, caregivers, and patients; ensuring safe, timely tracheostomy care; and identifying and managing laryngotracheal injury, such as vocal fold injury, posterior glottic stenosis, and subglottic stenosis that may affect speech, swallowing, and airway protection. We present recommended approaches to tracheostomy care, outlining modifications to conventional algorithms, raising vigilance for heightened risks of bleeding or other complications, and offering recommendations for personal protective equipment, equipment, care protocols, and personnel. IMPLICATIONS FOR PRACTICE Treatment of patients with a tracheostomy in the COVID-19 pandemic requires foresight and may rival procedural considerations in tracheostomy in their complexity. By considering patient-specific factors, mitigating transmission risks, optimizing the clinical environment, and detecting late manifestations of severe COVID-19, clinicians can ensure due vigilance and quality care.
Collapse
Affiliation(s)
- Kara D. Meister
- Clinical Assistant Professor, Aerodigestive and Airway Reconstruction Center, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
- Clinical Assistant Professor, Center for Pediatric Voice and Swallowing Disorders, Department of Otolaryngology – Head & Neck Surgery, Division of Pediatric Otolaryngology, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
| | - Vinciya Pandian
- Associate Professor, Department of Nursing Faculty, Johns Hopkins University, Baltimore, Maryland, United States
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, United States
| | - Alexander T. Hillel
- Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Brian K. Walsh
- Professor, Department of Health Sciences, Liberty University, Lynchburg, United States
| | - Martin B. Brodsky
- Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland, United States
- Associate Professor, Department of Physical and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, United States
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Karthik Balakrishnan
- Clinical Assistant Professor, Aerodigestive and Airway Reconstruction Center, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
- Clinical Assistant Professor, Center for Pediatric Voice and Swallowing Disorders, Department of Otolaryngology – Head & Neck Surgery, Division of Pediatric Otolaryngology, Lucile Packard Children’s Hospital, Stanford Children’s Health, Stanford, Palo Alto, California, United States
| | - Simon R. Best
- Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, United States
| | - Steven B. Chinn
- Assistant Professor, Department of Otolaryngology – Head and Neck Surgery, University of Michigan, Michigan, United States
| | - John D. Cramer
- Assistant Professor, Department of Otolaryngology – Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Evan M. Graboyes
- Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, United States
- Hollings Cancer Center, Charleston, South Carolina, United States
| | - Brendan A. McGrath
- Anesthesiology Consultant, University of Manchester, NHS Foundation Trust, National Tracheostomy Safety Project, Manchester, United Kingdom
| | - Christopher H. Rassekh
- Professor, Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Joshua R. Bedwell
- Associate Professor, Baylor College of Medicine, Houston, Texas, United States
- Associate Professor, Division of Pediatric Otolaryngology-Head and Neck Surgery, Texas Children’s Hospital, Houston, Texas, United States
| | - Michael J. Brenner
- Associate Professor, Department of Otolaryngology – Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, United States, and President-elect, Global Tracheostomy Collaborative, Raleigh, North Carolina, United States
| |
Collapse
|
6
|
Pandian V, Morris LL, Brodsky MB, Lynch J, Walsh B, Rushton C, Phillips J, Rahman A, DeRose T, Lambe L, Lami L, Wu SPM, Garza FP, Maiani S, Zavalis A, Okusanya KA, Palmieri PA, McGrath BA, Pelosi P, Sole ML, Davidson P, Brenner MJ. Critical Care Guidance for Tracheostomy Care During the COVID-19 Pandemic: A Global, Multidisciplinary Approach. Am J Crit Care 2020; 29:e116-e127. [PMID: 32929453 DOI: 10.4037/ajcc2020561] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Critical care nurses caring for patients with a tracheostomy are at high risk because of the predilection of SARS-CoV-2 for respiratory and mucosal surfaces. This review identifies patient-centered practices that ensure safety and reduce risk of infection transmission to health care workers during the coronavirus disease 2019 (COVID-19) pandemic. METHODS Consensus statements, guidelines, institutional recommendations, and scientific literature on COVID-19 and previous outbreaks were reviewed. A global interdisciplinary team analyzed and prioritized findings via electronic communications and video conferences to develop consensus recommendations. RESULTS Aerosol-generating procedures are commonly performed by nurses and other health care workers, most notably during suctioning, tracheostomy tube changes, and stoma care. Patient repositioning, readjusting circuits, administering nebulized medications, and patient transport also present risks. Standard personal protective equipment includes an N95/FFP3 mask with or without surgical masks, gloves, goggles, and gown when performing aerosol-generating procedures for patients with known or suspected COVID-19. Viral testing of bronchial aspirate via tracheostomy may inform care providers when determining the protective equipment required. The need for protocols to reduce risk of transmission of infection to nurses and other health care workers is evident. CONCLUSION Critical care nurses and multidisciplinary teams often care for patients with a tracheostomy who are known or suspected to have COVID-19. Appropriate care of these patients relies on safeguarding the health care team. The practices described in this review may greatly reduce risk of infectious transmission.
Collapse
Affiliation(s)
- Vinciya Pandian
- Vinciya Pandian is associate professor, Department of Nursing Faculty, and Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland
| | - Linda L Morris
- Linda L. Morris is associate professor, Northwestern University Feinberg School of Medicine; Shirley Ryan AbilityLab, Chicago, Illinois
| | - Martin B Brodsky
- Martin B. Brodsky is associate professor, Department of Physical and Rehabilitation, Division of Critical Care and Pulmonary and OACIS Research Group, Johns Hopkins University
| | - James Lynch
- James Lynch is advanced critical care practitioner, Acute Intensive Care Unit, Manchester University National Health Services Foundation Trust, and National Tracheostomy Safety Project, Manchester, United Kingdom
| | - Brian Walsh
- Brian Walsh is professor, Department of Health Sciences, Liberty University, Lynchburg, Virginia
| | - Cynda Rushton
- Cynda Rushton is professor, Johns Hopkins University Anne and George L. Bunting Berman Institute of Bioethics, Department of Nursing Faculty, Johns Hopkins School of Nursing, and Department of Pediatrics, Johns Hopkins School of Medicine; and adjunct professor, University of Technology of Sydney, Sydney, New South Wales, Australia
| | - Jane Phillips
- Jane Phillips is professor of Palliative Nursing, and director IMPACCT, University of Technology Sydney
| | - Alphonsa Rahman
- Alphonsa Rahman is critical care clinical nurse specialist, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Troy DeRose
- Troy DeRose is nurse practitioner, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Leah Lambe
- Leah Lambe is nursing clinical coordinator, Rapid Response Team, Hospital of the University of Pennsylvania, Phila-delphia, Pennsylvania
| | - Lionel Lami
- Lionel Lami, University of Hospital of Toulouse, and University Cancer Institute of Toulouse Oncopole, Toulouse, France
| | - Sarah Pui Man Wu
- Sarah Pui Man Wu, advance practice nurse, Department of Otolaryngology, Head and Neck Surgery, Chinese University of Hong Kong, Hong Kong
| | - Francisco Paredes Garza
- Francisco Paredes Garza is critical care nurse, Hospital Universitario La Paz, Madrid, Spain
| | - Simona Maiani
- Simona Maiani is head nurse, Anesthesiology and Intensive Care, San Martino Policlinico Hospital, and IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Andrea Zavalis
- Andrea Zavalis is critical care nurse, Enfermeira Intensivista, Manaus, Brazil
| | - Kafilat Ajoke Okusanya
- Kafilat Ajoke Okusanya is critical care nurse, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Patrick A Palmieri
- Patrick A. Palmieri is vice chancellor for research, Universidad Norbert Wiener; and director of Centro de Salud Basada en Evidencia de Sudamérica: A Joanna Briggs Affiliated Group, Lima, Perú
| | - Brendan A McGrath
- Brendan A. McGrath is anesthesiology consultant, University of Manchester, National Health Service Foundation Trust, National Tracheostomy Safety Project, Manchester, United Kingdom
| | - Paolo Pelosi
- Paolo Pelosi is with Anesthesiology and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, University of Genoa, Genoa, Italy
| | - Mary Lou Sole
- Mary Lou Sole is dean of College of Nursing, Orlando Health Endowed Chair in Nursing, and University of Central Florida Pegasus Professor, University of Central Florida, Orlando, Florida
| | - Patricia Davidson
- Patricia Davidson is professor and dean, Department of Nursing Faculty, Johns Hopkins University
| | - Michael J Brenner
- Michael J. Brenner is associate professor, Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan; president, Global Tracheostomy Collaborative, Raleigh, North Carolina
| |
Collapse
|
7
|
Kaur R, Weiss TT, Perez A, Fink JB, Chen R, Luo F, Liang Z, Mirza S, Li J. Practical strategies to reduce nosocomial transmission to healthcare professionals providing respiratory care to patients with COVID-19. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:571. [PMID: 32967700 PMCID: PMC7509502 DOI: 10.1186/s13054-020-03231-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023]
Abstract
Coronavirus disease (COVID-19) is an emerging viral infection that is rapidly spreading across the globe. SARS-CoV-2 belongs to the same coronavirus class that caused respiratory illnesses such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). During the SARS and MERS outbreaks, many frontline healthcare workers were infected when performing high-risk aerosol-generating medical procedures as well as when providing basic patient care. Similarly, COVID-19 disease has been reported to infect healthcare workers at a rate of ~ 3% of cases treated in the USA. In this review, we conducted an extensive literature search to develop practical strategies that can be implemented when providing respiratory treatments to COVID-19 patients, with the aim to help prevent nosocomial transmission to the frontline workers.
Collapse
Affiliation(s)
- Ramandeep Kaur
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 1620 W Harrison St, Tower LL1202, Chicago, IL, 60612, USA
| | - Tyler T Weiss
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 1620 W Harrison St, Tower LL1202, Chicago, IL, 60612, USA
| | - Andrew Perez
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 1620 W Harrison St, Tower LL1202, Chicago, IL, 60612, USA
| | - James B Fink
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 1620 W Harrison St, Tower LL1202, Chicago, IL, 60612, USA
| | - Rongchang Chen
- Shenzhen Institute of Respiratory Disease, Shenzhen People's Hospital (First Affiliated Hospital of South University of Science and Technology of China), Shenzhen, China
| | - Fengming Luo
- Department of Respiratory and Critical Care Medicine, West China Medical Center of Sichuan University, Chengdu, China
| | - Zongan Liang
- Department of Respiratory and Critical Care Medicine, West China Medical Center of Sichuan University, Chengdu, China
| | - Sara Mirza
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 1620 W Harrison St, Tower LL1202, Chicago, IL, 60612, USA
| | - Jie Li
- Division of Respiratory Care, Department of Cardiopulmonary Sciences, Rush University Medical Center, 1620 W Harrison St, Tower LL1202, Chicago, IL, 60612, USA.
| |
Collapse
|
8
|
De Seta D, Marrosu V, Russo FY, Carta F, Puxeddu R. Closed Total Laryngectomy During the COVID-19 Pandemic Disease. Laryngoscope 2020; 130:2622-2624. [PMID: 32570286 PMCID: PMC7361463 DOI: 10.1002/lary.28919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/20/2020] [Accepted: 06/08/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Daniele De Seta
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Valeria Marrosu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Francesca Y Russo
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Filippo Carta
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Roberto Puxeddu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| |
Collapse
|
9
|
Varghese BT. Tracheostomy care during COVID 19 pandemic in a head and neck oncology unit. Oral Oncol 2020; 107:104810. [PMID: 32475647 PMCID: PMC7236717 DOI: 10.1016/j.oraloncology.2020.104810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/17/2020] [Indexed: 12/01/2022]
Abstract
Aerosol Generating Procedures (AGP) and interventions are challenging during COVID-19. During Emergencies AGP poses a major threat to health care workers and other patients. Minimisation of aerosolisation is best achieved by techniques such as closed suctioning and enhanced use of HME.
Collapse
Affiliation(s)
- Bipin T Varghese
- Head and Neck Surgery Unit, Surgical Services, Regional Cancer Centre, Trivandrum, Kerala 695011, India
| |
Collapse
|
10
|
Bresler SE, Vasil'eva NN, Kazbekov EN. [Mechanism of action of D-amino acid oxidase. II. Evidence for the free radical mechanism of the reaction catalysed by the monomer form of the enzyme]. Interact J Med Res 1976; 10:501-6. [PMID: 36548 PMCID: PMC9874988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
D-Amino acid oxidase was shown to dissociate into subunits in 2 M urea retaining the catalytic activity. This makes possible the direct observation of ESR spectra of the intermediate radical state of the enzyme when interacting with the substrate. We have shown that these radicals are really observable. Using the reversibility of the reaction and an equilibrium shift the amount of radicals can be increased up to 10% of all flavin groups present. The dependence of the radicals concentration on the amount of substrate and product can be predicted. The theory is confirmed by experimental data.
Collapse
|