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Elander L, Abdirashid A, Andersson H, Idh J, Johansson H, Chew MS. Frequency and outcomes of critically ill COVID-19 patients with tracheostomy, a retrospective two-center cohort study. Acta Anaesthesiol Scand 2025; 69:e70011. [PMID: 40103328 DOI: 10.1111/aas.70011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 02/11/2025] [Accepted: 02/12/2025] [Indexed: 03/20/2025]
Abstract
BACKGROUND The optimal use of tracheostomy in COVID-19 patients is debated, and considerable uncertainties on the frequency, timing, and outcomes of tracheostomy remain. The objective was to study the frequency and timing of tracheostomy in a real-world population of critically ill COVID-19 patients. The secondary aim was to study whether early tracheostomy was associated with days alive and out of intensive care unit (ICU), days free of invasive mechanical ventilation (IMV), 60-day mortality, ventilator weaning rate, and ICU discharge rate compared to late tracheostomy. METHODS The study is a retrospective two-center cohort study. All COVID-19 patients admitted to critical care in the Region Östergötland County Council, Sweden, between March 2020 and September 2021 were included. Early (≤10 days from tracheal intubation) and late (>10 days) tracheostomy were compared. Through the Swedish intensive care registry, 249 mechanically ventilated COVID-19-positive patients ≥18 years old with respiratory failure were included. The pre-defined primary outcomes were the frequency and timing of tracheostomy. Secondary outcomes were days free of mechanical ventilation and intensive care, ICU discharge rate, ventilator weaning rate, and 60-day mortality. RESULTS Of 319 identified patients (70% men), 249 (78%) underwent endotracheal intubation. Of these, 145 (58%) underwent tracheostomy and 99 (68%) were performed early. Tracheostomy patients (vs. non-tracheostomy) had fewer IMV-free days and ICU-free days (27 [0-43] vs. 52 [43-55], p < .001, and 24 [0-40] vs. 49 [41-52], p < .001). Late (vs. early) tracheostomy patients had fewer IMV- and ICU-free days (16 [0-31] vs. 36 [0-47], p < .001 and 8 [0-28] vs. 32 [0-44], p < .001). Early tracheostomy (vs. late) was associated with a significantly higher ICU discharge rate (adjusted HR = 0.59, 95% CI [0.40-0.86], p = .006), but not with the weaning rate (adjusted HR = 0.64, 95% CI [0.12-3.32], p = .5) or 60-day mortality (adjusted HR = 1.27, 95% CI [0.61-2.67], p = .5). CONCLUSIONS Tracheostomy is common in critically ill COVID-19 patients. In patients predicted to need a tracheostomy at some point, early, rather than late, tracheostomy might be a means to reduce the time spent in ICU. However, we do not have sufficient evidence to suggest that early tracheostomy reduces mortality or weaning rates, compared with late tracheostomy.
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Affiliation(s)
- Louise Elander
- Department of Anaesthesiology and Intensive Care in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Anaesthesiology and Intensive Care, Centre for Clinical Research, Sörmland, Nyköping Hospital, Nyköping, Sweden
- Department of Anaesthesiology and Intensive Care in Norrköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anzal Abdirashid
- Department of Anaesthesiology and Intensive Care in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Henrik Andersson
- Department of Anaesthesiology and Intensive Care in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Jonna Idh
- Department of Anaesthesia and Intensive Care, Västervik Hospital, Västervik, Sweden
| | | | - Michelle S Chew
- Department of Anaesthesiology and Intensive Care in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Lais G, Piquilloud L. Tracheostomy: update on why, when and how. Curr Opin Crit Care 2025; 31:101-107. [PMID: 39588741 DOI: 10.1097/mcc.0000000000001224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2024]
Abstract
PURPOSE OF REVIEW The aim of this review is to summarize available data, including the most recent ones, to help develop the best possible strategy regarding the use of tracheostomy in ICU patients requiring prolonged mechanical ventilation or who experience loss of airway-protecting mechanisms. RECENT FINDINGS Tracheostomy facilitates the weaning process by reducing the patient's work of breathing and increasing comfort. It thus allows for a reduction in sedation levels. It also helps with secretions clearance, facilitates disconnection from the ventilator, and enables earlier phonation, oral intake, and mobilization. Despite these advantages, tracheostomy does not reduce mortality and is associated with both early and late complications, particularly tracheal stenosis. The timing of tracheostomy remains a subject of debate, and only a personalized approach that considers each patient's specific characteristics can help find the best possible compromise between avoiding unnecessary delays and minimizing the risks of performing a needless invasive procedure. In the absence of contraindications, the percutaneous single dilator technique under fibroscopic guidance should be the first choice, but only if the team is properly trained. SUMMARY A step-by-step individualized approach based on the available evidence allows identifying the best strategy regarding the use of tracheostomy in ICU patients.
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Affiliation(s)
- Giulia Lais
- Adult Intensive Care Unit, University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, and Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lise Piquilloud
- Adult Intensive Care Unit, University Hospital and University of Lausanne, Lausanne, Switzerland
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Ferrer G, Alas-Pineda C, Manara V, Tesch M, Gaitán-Zambrano K, Pavón-Varela DJ. The Value of Tracheal Visualization in Tracheostomized Patients in Skilled and Long-Term Care Homes. Cureus 2025; 17:e76748. [PMID: 39758865 PMCID: PMC11698548 DOI: 10.7759/cureus.76748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2025] [Indexed: 01/07/2025] Open
Abstract
Objective This study aims to assess the impact of tracheal visualization on weaning success among tracheostomized patients in skilled and long-term care facilities, highlighting its role in reducing complications and enhancing clinical outcomes. Methods A retrospective observational study was conducted on tracheostomized patients residing in skilled nursing homes in Florida between 2018 and 2023. The study included individuals aged 18 years or older with established tracheostomies. Routine tracheal visualization techniques were used to confirm tube placement, evaluate tracheal health, and detect complications such as infections, inflammation, or obstructions. Results Among the 21 patients analyzed, a weaning success rate of 23.8% was observed. Patients who successfully weaned had fewer comorbidities and higher tracheal health scores compared to those who did not. Routine tracheal visualization reduced complications related to tube malposition and facilitated timely interventions, such as correcting tube displacement or managing airway obstructions. Conclusions This study underscores the significance of incorporating tracheal visualization into care protocols for tracheostomized patients, especially in skilled nursing and long-term care settings. Future research should focus on developing standardized protocols to improve care quality and ensure patient safety, particularly in resource-constrained environments.
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Affiliation(s)
- Gustavo Ferrer
- Department of Pulmonary and Critical Care Medicine, Aventura Hospital and Medical Center, Aventura, USA
| | - César Alas-Pineda
- Department of Analytics, Ferrer Pulmonary Institute, Hallandale Beach, USA
| | - Viviane Manara
- Department of Pulmonary and Critical Care Medicine, Ferrer Pulmonary Institute, Hallandale Beach, USA
| | - Mari Tesch
- Department of Research and Development, Dr. Ferrer BioPharma, Hallandale Beach, USA
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Patel D, Devivo A, Leibner E, Shittu A, Govindarajulu U, Tandon P, Lee D, Owen R, Fernandez-Ranvier G, Hiensch R, Marin M, Kohli-Seth R, Bassily-Marcus A. The COVID-19 Tracheostomy Experience at a Large Academic Medical Center in New York during the First Year. J Clin Med 2024; 13:2130. [PMID: 38610895 PMCID: PMC11012500 DOI: 10.3390/jcm13072130] [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: 02/21/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Background: New York City was the epicenter of the initial surge of the COVID-19 pandemic in the United States. Tracheostomy is a critical procedure in the care of patients with COVID-19. We hypothesized that early tracheostomy would decrease the length of time on sedation, time on mechanical ventilation, intensive care unit length of stay, and mortality. Methods: A retrospective analysis of outcomes for all patients with COVID-19 who underwent tracheostomy during the first year of the COVID-19 pandemic at the Mount Sinai Hospital in New York City, New York. All adult intensive care units at the Mount Sinai Hospital, New York. Patients/subjects: 888 patients admitted to intensive care with COVID-19. Results: All patients admitted to the intensive care unit with COVID-19 (888) from 1 March 2020 to 1 March 2021 were analyzed and separated further into those intubated (544) and those requiring tracheostomy (177). Of those receiving tracheostomy, outcomes were analyzed for early (≤12 days) or late (>12 days) tracheostomy. Demographics, medical history, laboratory values, type of oxygen and ventilatory support, and clinical outcomes were recorded and analyzed. Conclusions: Early tracheostomy resulted in reduced duration of mechanical ventilation, reduced hospital length of stay, and reduced intensive care unit length of stay in patients admitted to the intensive care unit with COVID-19. There was no effect on overall mortality.
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Affiliation(s)
- Dhruv Patel
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.P.); (A.D.); (A.B.-M.)
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Anthony Devivo
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.P.); (A.D.); (A.B.-M.)
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Evan Leibner
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.P.); (A.D.); (A.B.-M.)
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Atinuke Shittu
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.P.); (A.D.); (A.B.-M.)
| | - Usha Govindarajulu
- Center for Biostatistics, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Pranai Tandon
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - David Lee
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Randall Owen
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | - Robert Hiensch
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Michael Marin
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Roopa Kohli-Seth
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.P.); (A.D.); (A.B.-M.)
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Adel Bassily-Marcus
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.P.); (A.D.); (A.B.-M.)
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Lee JJ, Rooney AS, Krzyzaniak A, Badiee J, Parra KT, Calvo RY, Lichter J, Sise CB, Sise MJ, Bansal V, Martin MJ. Lessons for the next pandemic: analysis of the timing and outcomes including post-discharge decannulation rates for tracheostomy in severe COVID-19 respiratory failure. Eur J Trauma Emerg Surg 2024; 50:581-590. [PMID: 38349397 DOI: 10.1007/s00068-024-02444-8] [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: 09/09/2023] [Accepted: 12/31/2023] [Indexed: 04/23/2024]
Abstract
PURPOSE COVID-19 patients with respiratory failure frequently require prolonged ventilatory support that would typically warrant early tracheostomy. There has been significant debate on timing, outcomes, and safety of these procedures. The purpose of this study was to determine the epidemiological, hospital, and post-discharge outcomes of this cohort, based on early (ET) versus late (LT) tracheostomy. METHODS Retrospective review (March 2020-January 2021) in a 5-hospital system of ventilated patients who underwent tracheostomy. Demographics, hospital/ICU length of stay (LOS), procedural characteristics, APACHE II scores at ICU admission, stabilization markers, and discharge outcomes were analyzed. Long-term decannulation rates were obtained from long-term acute care facility (LTAC) data. RESULTS A total of 97 patients underwent tracheostomy (mean 61 years, 62% male, 64% Hispanic). Despite ET being frequently performed during active COVID infection (85% vs. 64%), there were no differences in complication types or rates versus LT. APACHE II scores at ICU admission were comparable for both groups; however, > 50% of LT patients met PEEP stability at tracheostomy. ET was associated with significantly shorter ICU and hospital LOS, ventilator days, and higher decannulation rates. Of the cohort discharged to an LTAC, 59% were ultimately decannulated, 36% were discharged home, and 41% were discharged to a skilled nursing facility. CONCLUSIONS We report the first comprehensive analysis of ET and LT that includes LTAC outcomes and stabilization markers in relation to the tracheostomy. ET was associated with improved clinical outcomes and a short LOS, specifically on days of pre-tracheostomy ventilation and in-hospital decannulation rates.
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Affiliation(s)
- Joseph J Lee
- Department of Trauma & Acute Care Surgery, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, MER-62, San Diego, CA, 92103, USA
| | - Alexandra S Rooney
- Department of Trauma & Acute Care Surgery, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, MER-62, San Diego, CA, 92103, USA
| | - Andrea Krzyzaniak
- Department of Trauma & Acute Care Surgery, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, MER-62, San Diego, CA, 92103, USA.
| | - Jayraan Badiee
- Department of Trauma & Acute Care Surgery, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, MER-62, San Diego, CA, 92103, USA
| | - Kristine T Parra
- Department of Trauma & Acute Care Surgery, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, MER-62, San Diego, CA, 92103, USA
| | - Richard Y Calvo
- Department of Trauma & Acute Care Surgery, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, MER-62, San Diego, CA, 92103, USA
| | - Julian Lichter
- Department of Pulmonary Medicine, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, San Diego, CA, 92103, USA
| | - C Beth Sise
- Department of Trauma & Acute Care Surgery, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, MER-62, San Diego, CA, 92103, USA
| | - Michael J Sise
- Department of Trauma & Acute Care Surgery, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, MER-62, San Diego, CA, 92103, USA
| | - Vishal Bansal
- Department of Trauma & Acute Care Surgery, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, MER-62, San Diego, CA, 92103, USA
| | - Matthew J Martin
- Department of Trauma & Acute Care Surgery, LA+USC Medical Center, University of Southern California, 2051 Marengo St, Los Angeles, CA, 90033, USA
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Albayrak T, Yanal H, Sengul D, Sengul I, Albayrak M, Eyüpoğlu S, Muhtaroğlu A, Cinar E. First management of percutaneous dilatational tracheostomy in severe acute respiratory syndrome coronavirus 2 akin to the vital head and neck region and thyroid gland bed: trust, but be careful whom (you trust)? REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230832. [PMID: 37792870 PMCID: PMC10547483 DOI: 10.1590/1806-9282.20230832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE The objective of this study was to compare the clinical outcomes of percutaneous dilatational tracheostomy in COVID-19 and non-COVID-19 patients. METHODS A total of 48 patients who underwent percutaneous dilatational tracheostomy, with 24 COVID-19 patients (Group C) and 24 non-COVID-19 patients (Group N), were included in the study. Patients' demographic features including age and gender, time to intubation, duration of intubation, Acute Physiology and Chronic Health Evaluation scores, comorbidities, duration of opening tracheostomy, complications, duration of mechanical ventilation, length of stay in the intensive care units, and mortality were recorded and compared between the groups. RESULTS There was no statistically significant difference between the groups regarding age and gender (p=0.558 and p=0.110, respectively). Time to intubation was significantly more prolonged, and intubation follow-up duration was significantly shorter in Group C compared to Group N (p=0.034 and p=0.002, respectively). The Acute Physiology and Chronic Health Evaluation score was statistically significantly higher in Group N compared with Group C (p=0.012). The most common comorbidity was hypertension in 29 (60.4%) patients, followed by cerebrovascular disease in 19 (39.6%) patients. There was no statistically significant difference between the groups regarding mortality (p=0.212). CONCLUSION This study suggests that percutaneous dilatational tracheostomy can be performed safely in COVID-19 and non-COVID-19 patients. However, COVID-19 patients may have a longer time to intubation and shorter intubation follow-up duration than non-COVID-19 patients. The study also found a higher incidence of complications in COVID-19 patients undergoing percutaneous dilatational tracheostomy. These results emphasize the importance of careful patient selection, meticulous technique, and close postoperative monitoring in patients undergoing percutaneous dilatational tracheostomy, particularly in those with COVID-19.
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Affiliation(s)
- Tuna Albayrak
- Giresun University, Faculty of Medicine, Department of Anesthesiology and Reanimation – Giresun, Turkey
| | - Hülya Yanal
- Giresun Prof. Dr. A. Ilhan Ozdemir State Hospital, Department of Anesthesiology and Reanimation – Giresun, Turkey
| | - Demet Sengul
- Giresun University, Faculty of Medicine, Department of Pathology – Giresun, Turkey
| | - Ilker Sengul
- Giresun University, Faculty of Medicine, Division of Endocrine Surgery – Giresun, Turkey
- Giresun University, Faculty of Medicine, Department of General Surgery – Giresun, Turkey
| | - Mehmet Albayrak
- Karadeniz Technical University, Faculty of Medicine, Division of Perinatology – Giresun, Turkey
- Karadeniz Technical University, Faculty of Medicine, Department of Obstetrics and Gynecology – Giresun, Turkey
| | - Selin Eyüpoğlu
- Giresun University, Ministry of Health Education and Research Hospital, Division of Intensive Care Unit – Giresun, Turkey
- Giresun University, Ministry of Health Education and Research Hospital, Department of Anesthesiology and Reanimation – Giresun, Turkey
| | - Ali Muhtaroğlu
- Giresun University, Faculty of Medicine, Department of General Surgery – Giresun, Turkey
| | - Esma Cinar
- Giresun University, Faculty of Medicine, Department of Pathology – Giresun, Turkey
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Carboni Bisso I, Ruiz V, Huespe IA, Rosciani F, Cantos J, Lockhart C, Fernández Ceballos I, Las Heras M. Bronchoscopy-guided percutaneous tracheostomy during the COVID-19 pandemic. Surgery 2023; 173:944-949. [PMID: 36621447 PMCID: PMC9771743 DOI: 10.1016/j.surg.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/17/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Assessment of the efficacy and complications associated with performing bronchoscopy-guided percutaneous tracheostomy in COVID-19 and non-COVID-19 patients. METHODS Prospective observational study conducted between March of 2020 and February of 2022. All adult patients who underwent elective bronchoscopy-guided percutaneous tracheostomy were included. The efficacy of the procedure was evaluated based either on the success rate in the execution or on the need for conversion to open technique. Percutaneous tracheostomy-related complications were registered during the procedure. We performed 6-month follow-up for identifying late complications. RESULTS During the study period, 312 bronchoscopy-guided percutaneous tracheostomies were analyzed. One hundred and eighty-three were performed in COVID-19 patients and 129 among non-COVID-19 patients. Overall, 64.1% (200) of patients were male, with a median age of 66 (interquartile range 54-74), and 65% (205) presented at least 1 comorbidity. Overall, oxygen desaturation was the main complication observed (20.8% [65]), being more frequent in the COVID-19 group occurring in 27.3% (50) with a statistically significant difference versus the non-COVID-19 patients' group (11.6% [15]); P < .01). Major complications such as hypotension, arrhythmias, and pneumothorax were more frequently observed among COVID-19 patients as well but with no significant differences. Percutaneous tracheostomy could be executed quickly and satisfactorily in all the patients with no need for conversion to the open technique. Likewise, no suspension of the procedure was required in any case. During 6-month follow-up, we found an incidence of 0.96% (n = 3) late complications, 2 tracheal granulomas, and 1 ostomal infection. CONCLUSION Bronchoscopy-guided percutaneous tracheostomy can be considered an effective and safe procedure in COVID-19 patients. Nevertheless, it is highly remarkable that in the series under study, a great number of COVID-19 patients presented oxygen desaturation during the procedure.
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Affiliation(s)
| | - Victoria Ruiz
- Intensive Care Unit, Hospital Italiano de Buenos Aires, Argentina
| | | | - Foda Rosciani
- Intensive Care Unit, Hospital Italiano de Buenos Aires, Argentina
| | - Joaquín Cantos
- Intensive Care Unit, Hospital Italiano de Buenos Aires, Argentina
| | | | | | - Marcos Las Heras
- Intensive Care Unit, Hospital Italiano de Buenos Aires, Argentina
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Madsen HJ, Lambert-Kerzner A, Mucharsky E, Phillips JD, David EA, Odell DD, Dyas AR, Meguid RA. Lessons learned by thoracic surgeons during the COVID-19 pandemic. J Thorac Dis 2023; 15:507-515. [PMID: 36910104 PMCID: PMC9992568 DOI: 10.21037/jtd-22-920] [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: 07/03/2022] [Accepted: 01/06/2023] [Indexed: 02/12/2023]
Abstract
Background The scale of the coronavirus disease 2019 (COVID-19) pandemic has necessitated healthcare systems to adapt and evolve, altering physician roles and expectations. Thoracic surgeons have seen practice changes from new COVID-19 consults to necessary delay and triage of elective care. The goal of this study was to understand the impact of COVID-19 on thoracic surgeon experiences in order to anticipate roles and changes in practice in future such circumstances. Methods Semi-structured, qualitative individual telephone interviews were conducted with thoracic surgeons. Interviews were structured to understand how surgeons were impacted by the COVID-19 pandemic and to record lessons learned. Interviews were conducted until thematic saturation was achieved. Data were analyzed using matrix analysis. Results Eleven board-certified general thoracic surgeons from nine institutions were interviewed. Thoracic surgeon roles in COVID-19 care included critical care delivery, performing tracheostomies and establishing related protocols, and interventions for long-term airway complications. Attention was called to the impact of the pandemic on thoracic cancer: patients avoided hospitals because of concern over COVID-19, delaying care. Conclusions Thoracic surgeons played a critical role in the COVID-19 pandemic response in both technical patient care and administrative capacities. Primary care responsibilities included the development, administration and delivery of tracheostomy protocols, and the care of down-stream airway complications. Thoracic surgeons were critical in triage decisions to minimize the impact of COVID-19 on thoracic cancer care. Lessons learned during the COVID-19 pandemic may provide insight into opportunities to promote collaboration in thoracic surgery and facilitate improved care delivery in future settings of resource limitation.
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Affiliation(s)
- Helen J Madsen
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anne Lambert-Kerzner
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.,Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ellison Mucharsky
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joseph D Phillips
- Section of Thoracic Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Thoracic Surgery Outcomes Research Network (ThORN), Inc., Lebanon, NH, USA
| | - Elizabeth A David
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.,Thoracic Surgery Outcomes Research Network (ThORN), Inc., Lebanon, NH, USA
| | - David D Odell
- Thoracic Surgery Outcomes Research Network (ThORN), Inc., Lebanon, NH, USA.,Division of Thoracic Surgery, Canning Thoracic Institute Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Adam R Dyas
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert A Meguid
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.,Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA.,Thoracic Surgery Outcomes Research Network (ThORN), Inc., Lebanon, NH, USA
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Mikhaylichenko MI, Mudrov VA, Zverochkina YN, Porushnichak EB, Pudov MV. [Pudov Surgical care in a multi-field hospital during the new coronavirus infection pandemic (SARS-COVID-19): a 5-year experience]. Khirurgiia (Mosk) 2023:53-58. [PMID: 37707332 DOI: 10.17116/hirurgia202309153] [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] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To analyze the 5-year experience of surgical care in a multi-field hospital during the coronavirus pandemic and before infection. MATERIAL AND METHODS We assessed «non-traumatic» surgery and the main indicators in a multi-field hospital during the coronavirus pandemic and surgical work in the «pre-COVID» period. RESULTS The number of discharged patients was the same between 2018 and 2021. In 2020-2021, mortality increased by 2.8 times, the number of deceased patients - by 2.5 times, hospitalizations for emergency surgical indications - by 2.1 times. Elective care decreased by 2.5 times. The number of adverse vascular events increased by 3 times. CONCLUSION Acute increase in emergency surgery and decrease in elective care create the prerequisites for growth of «neglect» with subsequent postoperative complications. We observed significant increase in mortality. It is advisable to create a backup emergency surgical service in infectious disease hospitals to provide care in obviously infected patients.
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Affiliation(s)
| | - V A Mudrov
- Chita State Medical Academy, Chita, Russia
| | | | | | - M V Pudov
- Regional Main Clinical Hospital, Chita, Russia
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10
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What Have We Learned About Transmission of COVID-19: Implications for PFT and Pulmonary Procedures. Clin Chest Med 2022; 44:215-226. [PMID: 37085215 PMCID: PMC9678821 DOI: 10.1016/j.ccm.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Because of the potential for high aerosol transmission during pulmonary function testing and pulmonary procedures, performing these tests and procedures must be considered carefully during the coronavirus disease-2019 (COVID-19) pandemic. Much has been learned about the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by aerosols and the potential for such transmission through pulmonary function tests and pulmonary procedures, and subsequently preventative practices have been enhanced and developed to reduce the risk of transmission of virus to patients and personnel. This article reviews what is known about the potential for transmission of SARS-CoV-2 during pulmonary function testing and pulmonary procedures and the recommended mitigation steps to prevent the spread of COVID-19.
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Nazario LC, Magajewski FRL, Pizzol ND, Saloti MHDAS, Medeiros LK. Temporal trend of tracheostomy in patients hospitalized in the Brazilian National Unified Health System from 2011 to 2020. Rev Col Bras Cir 2022; 49:e20223373. [PMID: 36074394 PMCID: PMC10578828 DOI: 10.1590/0100-6991e-20223373-en] [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: 05/19/2022] [Accepted: 06/05/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the temporal trend in the tracheostomy use in patients hospitalized by the Sistema Único de Saúde in Brazil from 2011 to 2020. METHODS ecological observational study with a quantitative approach and including the Brazilian population aged 20 or over that were admitted by Sistema único de Saúde and had a record of performing the tracheostomy procedure at any time during hospitalization. RESULTS 113.569.570 Hospitalizations studied were identified 172.456 tracheostomies realized in Brazil (0,15%). The average tax of this procedure showed a downward trend during the study procedure. The highest tracheostomy rate was found in the southern region, and the most affected age group was 80 years old or more. The average rate of tracheostomy in males was 1.8 times higher than in females. The average mortality and lethality rates of admissions with tracheostomy were 3.36 and 28.57% in the period but showed a tendency to decrease in the period studied. The main causes associated with the performance of tracheostomy were respiratory, oncological, and external causes. Respiratory causes contributed to 73% of the total procedures performed in the analyzed period. CONCLUSION the average mortality and lethality rates of hospitalizations with tracheostomy in Brazil were 3.36 and 28.57%, but showed a downward trend in the period.
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Affiliation(s)
| | | | - Natalia Dal Pizzol
- - Universidade do Sul de Santa Catarina, Medicina - Tubarão - SC - Brasil
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12
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Hansson A, Sunnergren O, Hammarskjöld A, Alkemark C, Taxbro K. Characteristics, complications, and a comparison between early and late tracheostomy: A retrospective observational study on tracheostomy in patients with COVID‐19‐related acute respiratory distress syndrome. Health Sci Rep 2022; 5:e595. [PMID: 35509382 PMCID: PMC9059198 DOI: 10.1002/hsr2.595] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/08/2023] Open
Abstract
Background and Aims As the coronavirus disease 2019 (COVID-19) pandemic spread worldwide in 2020, the number of patients requiring intensive care and invasive mechanical ventilation (IMV) has increased rapidly. During the pandemic, early recommendations suggested that tracheostomy should be postponed, as the potential benefits were not certain to exceed the risk of viral transmission to healthcare workers. The aim of this study was to assess the utility of tracheostomy in patients with COVID-19-related acute respiratory distress syndrome, in terms of patient and clinical characteristics, outcomes, and complications, by comparing between early and late tracheostomy. Methods A multicenter, retrospective observational study was conducted in Jönköping County, Sweden. Between 14 March 2020 and 13 March 2021, 117 patients were included. All patients ≥18 years of age with confirmed COVID-19, who underwent tracheostomy were divided into two groups based on the timing of the procedure (≤/>7 days). Outcomes including the time on IMV, intensive care unit (ICU) length of stay, and mortality 30 days after ICU admission, as well as complications due to tracheostomy were compared between the groups. Results Early tracheostomy (<7 days, n = 56) was associated with a shorter median duration of mechanical ventilation (7 [12], p = 0.001) as well as a shorter median ICU stay (8 [14], p = 0.001). The most frequent complication of tracheostomy was minor bleeding. With the exception of a higher rate of obesity in the group receiving late tracheostomy, the patient characteristics were similar between the groups. Conclusion This study showed that early tracheostomy was safe and associated with a shorter time on IMV as well as a shorter ICU length of stay, implicating possible clinical benefits in critically ill COVID-19 patients. However, it is necessary to verify these findings in a randomized controlled trial.
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Affiliation(s)
- Anna Hansson
- Department of Anaesthesiology and Intensive Care Medicine Ryhov County Hospital Jönköping Sweden
- Faculty of Medicine and Health Sciences, School of Medicine Linköping University Linköping Sweden
| | - Ola Sunnergren
- Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
- Department of Otorhinolaryngology Region Jönköping County Jönköping Sweden
| | - Anneli Hammarskjöld
- Department of Anaesthesiology and Intensive Care Medicine Ryhov County Hospital Jönköping Sweden
| | - Catarina Alkemark
- Department of Anaesthesiology and Intensive Care Medicine Ryhov County Hospital Jönköping Sweden
| | - Knut Taxbro
- Department of Anaesthesiology and Intensive Care Medicine Ryhov County Hospital Jönköping Sweden
- Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
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NAZARIO LUIZACASCAES, MAGAJEWSKI FLÁVIORICARDOLIBERALI, PIZZOL NATALIADAL, SALOTI MATHEUSHENRIQUEDASILVA, MEDEIROS LEONARDOKFOURI. Tendência temporal da utilização da traqueostomia em pacientes hospitalizados pelo Sistema Único de Saúde no Brasil no período de 2011 a 2020. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: analisar a tendência temporal da utilização da traqueostomia em pacientes hospitalizados pelo Sistema Único de Saúde no Brasil no período de 2011 a 2020. Método: estudo observacional de tipo ecológico, com abordagem quantitativa, e incluiu a população brasileira com 20 anos ou mais que, internadas pelo Sistema Único de Saúde, tiveram registro de realização do procedimento de traqueostomia em qualquer momento da hospitalização. Resultados: das 113.569.570 hospitalizações estudadas, foram identificadas 172.456 traqueostomias realizadas no Brasil (0,15%). A taxa média de realização deste procedimento apresentou tendência de queda no período estudado. A maior taxa média de traqueostomia foi encontrada na Região Sul, e a faixa etária mais afetada foi a dos 80 anos ou mais. A taxa média de traqueostomia no sexo masculino foi de 1,8 vezes maior do que no sexo feminino. As principais causas associadas à realização de traqueostomia foram as patologias respiratórias, oncológicas e decorrentes de causas externas, sendo que as causas respiratórias contribuíram com 73% do total de procedimentos estudados. Conclusões: as taxas médias de mortalidade e letalidade das internações com traqueostomia no Brasil foram de 3,36 e 28,57%, mas apresentaram tendência de redução no período.
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14
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Amadi N, Trivedi R, Ahmed N. Timing of tracheostomy in mechanically ventilated COVID-19 patients. World J Crit Care Med 2021; 10:345-354. [PMID: 34888160 PMCID: PMC8613720 DOI: 10.5492/wjccm.v10.i6.345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/09/2021] [Accepted: 10/27/2021] [Indexed: 02/06/2023] Open
Abstract
According to the World Health Organization as of September 16, 2021, there have been over 226 million documented cases of coronavirus disease 2019 (COVID-19), which has resulted in more than 4.6 million deaths and approximately 14% develop a more severe disease that requires respiratory assistance such as intubation. Early tracheostomy is recommended for patients that are expected to be on prolonged mechanical ventilation; however, supporting data has not yet been provided for early tracheostomies in COVID-19 patients. The aim of this study was to explore established guidelines for performing tracheostomies in patients diagnosed with COVID-19. Factors considered were patient outcomes such as mortality, ventilator-associated pneumonia, intensive care unit length of stay, complications associated with procedures, and risks to healthcare providers that performed tracheostomies. Various observational studies, meta-analyses, and systematic reviews were collected through a PubMed Database search. Additional sources were found through Google. The search was refined to publications in English and between the years of 2003 and 2021. The keywords used were “Coronavirus” and/or “guidelines'' and/or “tracheostomy” and/or “intensive care”. Twenty-three studies were retained. Due to the complex presentation of the respiratory virus COVID-19, previously established guidelines for tracheostomies had to be reevaluated to determine if these guidelines were still applicable to these critically ill ventilated patients. More specifically, medical guidelines state benefits to early tracheostomies in critically ill ventilated non-COVID-19 patients. However, after having conducted this review, the assumptions about the benefits of early tracheostomies in critically ill ventilated patients may not be appropriate for COVID-19 patients.
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Affiliation(s)
- Nwonukwuru Amadi
- Division of Trauma, Jersey Shore University Medical Center, Neptune, NJ 07754, United States
| | - Radhika Trivedi
- Division of Trauma, Jersey Shore University Medical Center, Neptune, NJ 07754, United States
| | - Nasim Ahmed
- Division of Trauma and Surgical Critical Care, Jersey Shore University Medical Center, Nepune, NJ 07754, United States
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15
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Prats-Uribe A, Tobed M, Villacampa JM, Agüero A, García-Bastida C, Tato JI, Rodrigáñez L, Holguera VD, Hernández-García E, Poletti D, Simonetti G, Villarraga V, Meler-Claramonte C, Sánchez Barrueco Á, Chiesa-Estomba C, Casasayas M, Parente-Arias P, Mata-Castro N, Rello J, Castro P, Prieto-Alhambra D, Vilaseca I, Avilés-Jurado FX. Timing of elective tracheotomy and duration of mechanical ventilation among patients admitted to intensive care with severe COVID-19: A multicenter prospective cohort study. Head Neck 2021; 43:3743-3756. [PMID: 34524714 PMCID: PMC8652734 DOI: 10.1002/hed.26863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 01/08/2023] Open
Abstract
Background Optimal timing for tracheotomy for critically ill COVID‐19 patients requiring invasive mechanical ventilation (IMV) is not established. Methods Multicenter prospective cohort including all COVID‐19 patients admitted to intensive care units (ICUs) in 36 hospitals who required tracheotomy during first pandemic wave. With a target emulation trial framework, we studied the causal effects of early (7–10 days) versus late (>10 days) tracheotomy (LT) on time from tracheotomy to weaning, postoperative mortality, and tracheotomy complications. Results Of 696 patients, 20.4% received early tracheotomy (ET). ET was associated with faster weaning (hazard ratio [HR] [95% confidence interval, CI]: 1.25 [1.00–1.56]) without differences in mortality (HR [95% CI]: 0.85 [0.60–1.21]) or complications (adjusted rate ratio [95% CI]: 0.56 [0.23–1.33]). Conclusions ET had a similar or lower post‐tracheotomy weaning time than LT, potentially shortening IMV and ICU stays, without changing complication or mortality rates in COVID‐19 patients.
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Affiliation(s)
- Albert Prats-Uribe
- Pharmaco and Device Epidemiology, Centre for Statistics in Medicine - Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, UK
| | - Marc Tobed
- Otorhinolaryngology Department, Hospital Josep Trueta, Girona, Spain
| | | | - Adriana Agüero
- Otorhinolaryngology Department, Hospital General de Catalunya, Sant Cugat, Spain
| | | | - José Ignacio Tato
- Otorhinolaryngology Department, Hospital Príncipe de Asturias, Alcalá de Henares, Spain
| | - Laura Rodrigáñez
- Otorhinolaryngology Department, Hospital Universitario de La Paz, Madrid, Spain
| | | | | | - Daniel Poletti
- Otorhinolaryngology Department, Hospital Gregorio Marañón, Madrid, Spain
| | | | | | | | | | | | - Maria Casasayas
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pablo Parente-Arias
- Otorhinolaryngology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
| | | | - Jordi Rello
- Clin Research/epidemiol In Pneumonia & Sepsis (CRIPS)- Vall d'Hebrón Institute of Research (VHIR), Barcelona, Spain
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clínic de Barcelona, UB, IDIBAPS, Barcelona, Spain
| | - Daniel Prieto-Alhambra
- Pharmaco and Device Epidemiology, Centre for Statistics in Medicine - Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, UK
| | - Isabel Vilaseca
- Otorhinolaryngology Department, Hospital Clínic de Barcelona, UB, IDIBAPS, Barcelona, Spain.,Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca AGAUR, 2017-SGR-01581, Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Respiratorias (CIBERes), Bunyola, Spain
| | - Francesc Xavier Avilés-Jurado
- Otorhinolaryngology Department, Hospital Clínic de Barcelona, UB, IDIBAPS, Barcelona, Spain.,Head Neck Clínic, Agència de Gestió d'Ajuts Universitaris i de Recerca AGAUR, 2017-SGR-01581, Barcelona, Spain
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16
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Mahmood K, Cheng GZ, Van Nostrand K, Shojaee S, Wayne MT, Abbott M, Nettlow D, Parish A, Green CL, Safi J, Brenner MJ, De Cardenas J. Tracheostomy for COVID-19 Respiratory Failure: Multidisciplinary, Multicenter Data on Timing, Technique, and Outcomes. Ann Surg 2021; 274:234-239. [PMID: 34029231 PMCID: PMC8265239 DOI: 10.1097/sla.0000000000004955] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of this study was to assess the outcomes of tracheostomy in patients with COVID-19 respiratory failure. SUMMARY BACKGROUND DATA Tracheostomy has an essential role in managing COVID-19 patients with respiratory failure who require prolonged mechanical ventilation. However, limited data are available on how tracheostomy affects COVID-19 outcomes, and uncertainty surrounding risk of infectious transmission has led to divergent recommendations and practices. METHODS It is a multicenter, retrospective study; data were collected on all tracheostomies performed in COVID-19 patients at 7 hospitals in 5 tertiary academic medical systems from February 1, 2020 to September 4, 2020. RESULT Tracheotomy was performed in 118 patients with median time from intubation to tracheostomy of 22 days (Q1-Q3: 18-25). All tracheostomies were performed employing measures to minimize aerosol generation, 78.0% by percutaneous technique, and 95.8% at bedside in negative pressure rooms. Seventy-eight (66.1%) patients were weaned from the ventilator and 18 (15.3%) patients died from causes unrelated to tracheostomy. No major procedural complications occurred. Early tracheostomy (≤14 days) was associated with decreased ventilator days; median ventilator days (Q1-Q3) among patients weaned from the ventilator in the early, middle and late groups were 21 (21-31), 34 (26.5-42), and 37 (32-41) days, respectively with P = 0.030. Compared to surgical tracheostomy, percutaneous technique was associated with faster weaning for patients weaned off the ventilator [median (Q1-Q3): 34 (29-39) vs 39 (34-51) days, P = 0.038]; decreased ventilator-associated pneumonia (58.7% vs 80.8%, P = 0.039); and among patients who were discharged, shorter intensive care unit duration [median (Q1-Q3): 33 (27-42) vs 47 (33-64) days, P = 0.009]; and shorter hospital length of stay [median (Q1-Q3): 46 (33-59) vs 59.5 (48-80) days, P = 0.001]. CONCLUSION Early, percutaneous tracheostomy was associated with improved outcomes compared to surgical tracheostomy in a multi-institutional series of ventilated patients with COVID-19.
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Affiliation(s)
- Kamran Mahmood
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University, Durham, NC
| | - George Z Cheng
- Department of Medicine, Division of Pulmonary and Critical Care, University of California, San Diego, CA
| | - Keriann Van Nostrand
- Department of Medicine, Division of Pulmonary and Critical Care, Emory University, Atlanta, GA
| | - Samira Shojaee
- Department of Medicine, Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, VA
| | - Max T Wayne
- Department of Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI
| | - Matthew Abbott
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University, Durham, NC
| | - Darrell Nettlow
- Department of Medicine, Division of Pulmonary and Critical Care, University of California, San Diego, CA
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Javeryah Safi
- Department of Medicine, Division of Pulmonary and Critical Care, Virginia Commonwealth University, Richmond, VA
| | - Michael J Brenner
- Department of Otolaryngology- Head and Neck Surgery, University of Michigan, Ann Arbor, MI
- Global Tracheostomy Collaborative, Raleigh, NC
| | - Jose De Cardenas
- Department of Medicine, Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI
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17
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Lobanov LS, Cheptsov FR, Shilina IN, Lobanov YS, Shapovalov KG, Lobanov SL. [Surgical procedures at the city hospital for patients with Covid-19. A 9-month experience]. Khirurgiia (Mosk) 2021:45-48. [PMID: 34270193 DOI: 10.17116/hirurgia202107145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report our experience in surgical treatment of patients with COVID-19. MATERIAL AND METHODS There were 7815 patients with COVID-19 for the period from April 1, 2020 to December 31, 2020. During this period, 172 operations were performed in this group. RESULTS The most common procedures were tracheostomy (n=86, 50.0%), pleural puncture and drainage (n=20, 11.6%), caesarean section (n=22, 12.7%). There were 24 (14.0%) abdominal surgeries including 11 laparoscopies, 5 appendectomies, 3 bowel resections and others. Six lower limb amputations were carried out. We should emphasize common soft tissue hematomas and effusions. This complication is associated with anticoagulation recommended for patients with COVID-19. CONCLUSION Surgical interventions using personal protective equipment is a significant challenge. According to our experience, round-the-clock surgical care in a specialized hospital is required.
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Affiliation(s)
- L S Lobanov
- City City Clinical Hospital No. 1, Chita, Russia
| | - F R Cheptsov
- City City Clinical Hospital No. 1, Chita, Russia
| | - I N Shilina
- City City Clinical Hospital No. 1, Chita, Russia
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18
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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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Boisen ML, Fernando RJ, Kolarczyk L, Teeter E, Schisler T, La Colla L, Melnyk V, Robles C, Rao VK, Gelzinis TA. The Year in Thoracic Anesthesia: Selected Highlights From 2020. J Cardiothorac Vasc Anesth 2021; 35:2855-2868. [PMID: 34053812 DOI: 10.1053/j.jvca.2021.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/10/2021] [Indexed: 12/20/2022]
Abstract
Selected highlights in thoracic anesthesia in 2020 include updates in the preoperative assessment and prehabilitation of patients undergoing thoracic surgery; updates in one-lung ventilation (OLV) pertaining to the devices used for OLV; the use of dexmedetomidine for lung protection during OLV and protective ventilation, recommendations for the care of thoracic surgical patients with coronavirus disease 2019; a review of recent meta-analyses comparing truncal blocks with paravertebral and thoracic epidural blocks; and a review of outcomes after initiating the enhanced recovery after surgery guidelines for lung and esophageal surgery.
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Affiliation(s)
- Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC
| | - Lavinia Kolarczyk
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Emily Teeter
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC
| | - Travis Schisler
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Luca La Colla
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Vladyslav Melnyk
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto General Hospital, Toronto, Ontario, Canada
| | - Constantin Robles
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Vidya K Rao
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA
| | - Theresa A Gelzinis
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA.
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20
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Ahn D, Lee GJ, Choi YS, Park JW, Kim JK, Kim EJ, Lee YH. Timing and clinical outcomes of tracheostomy in patients with COVID-19. Br J Surg 2021; 108:e27-e28. [PMID: 33640938 PMCID: PMC7799185 DOI: 10.1093/bjs/znaa064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 01/06/2023]
Abstract
In this retrospective multicentre cohort study that included 27 COVID-19 patients who underwent tracheostomy, the mean time between intubation and tracheostomy was 15.8 days and the negative conversion time of COVID-19 was 43.1 days. Eleven patients (40.7%) died of COVID-19 and the use of percutaneous dilatation tracheostomy was significantly associated with in-hospital death. Timely tracheostomy could be performed in COVID-19 patients, regardless of duration of intubation or positivity of COVID-19 test, with an open surgical tracheostomy as a preferable technique.
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Affiliation(s)
- D Ahn
- Department of Otolaryngology-Head and Neck Surgery, Kyungpook National University, Daegu, Korea
| | - G J Lee
- Department of Otolaryngology-Head and Neck Surgery, Kyungpook National University, Daegu, Korea
| | - Y S Choi
- Department of Otolaryngology-Head and Neck Surgery, Yeungnam University, Daegu, Korea
| | - J W Park
- Department of Otolaryngology-Head and Neck Surgery, Keimyung University, Daegu, Korea
| | - J K Kim
- Department of Otolaryngology-Head and Neck Surgery, Catholic University of Daegu, Daegu, Korea
| | - E J Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Catholic University of Daegu, Daegu, Korea
| | - Y H Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyungpook National University, Daegu, Korea
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21
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West TE, Schultz MJ, Ahmed HY, Shrestha GS, Papali A. Pragmatic Recommendations for Tracheostomy, Discharge, and Rehabilitation Measures in Hospitalized Patients Recovering From Severe COVID-19 in Low- and Middle-Income Countries. Am J Trop Med Hyg 2021; 104:110-119. [PMID: 33534772 PMCID: PMC7957235 DOI: 10.4269/ajtmh.20-1173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/04/2021] [Indexed: 12/14/2022] Open
Abstract
New studies of COVID-19 are constantly updating best practices in clinical care. However, research mainly originates in resource-rich settings in high-income countries. Often, it is impractical to apply recommendations based on these investigations to resource-constrained settings in low- and middle-income countries (LMICs). We report on a set of pragmatic recommendations for tracheostomy, discharge, and rehabilitation measures in hospitalized patients recovering from severe COVID-19 in LMICs. We recommend that tracheostomy be performed in a negative pressure room or negative pressure operating room, if possible, and otherwise in a single room with a closed door. We recommend using the technique that is most familiar to the institution and that can be conducted most safely. We recommend using fit-tested enhanced personal protection equipment, with the fewest people required, and incorporating strategies to minimize aerosolization of the virus. For recovering patients, we suggest following local, regional, or national hospital discharge guidelines. If these are lacking, we suggest deisolation and hospital discharge using symptom-based criteria, rather than with testing. We likewise suggest taking into consideration the capability of primary caregivers to provide the necessary care to meet the psychological, physical, and neurocognitive needs of the patient.
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Affiliation(s)
- T. Eoin West
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - Marcus J. Schultz
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Department of Intensive Care, Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Hanan Y. Ahmed
- Division of Pulmonary and Critical Care Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gentle S. Shrestha
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Alfred Papali
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
| | - for the COVID-LMIC Task Force and the Mahidol-Oxford Research Unit (MORU)
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Department of Intensive Care, Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
- Division of Pulmonary and Critical Care Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
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Korolkov AY, Teplov VM, Zaitsev DA, Tcebrovskaya EA, Nikitina TO. Urgent surgical department in multidisciplinary hospital repurposed as infectious hospital for new coronavirus infection (COVID-19). ACTA ACUST UNITED AC 2021. [DOI: 10.24884/0042-4625-2020-179-5-11-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objective. In this paper, we show the work of the emergency surgical department on the example of a large repurposed multidisciplinary hospital, also its necessity even for infectious hospitals not accepting patients with acute surgical pathology.Methods and Materials. The work of surgical department of Pavlov First Saint Petersburg State Medical University repurposed for COVID-19 patients was analyzed. About 1500 COVID-19 patients were hospitalized during 4-month period.Results. All patients undergoing surgery were in severe condition (at intensive care unit). Most common surgery in abdomen was diagnostic laparoscopy. Spontaneous bleedings of different localization occurred in these patients, what required endovascular and endoscopic treatment. We observed only Clavien – Dindo 1-degree postoperative complications. Mortality rate was high and amounted to 75 %.Conclusion. The work of surgical department in an infectious hospital for the treatment of a new coronavirus infection is extremely difficult. An infectious hospital should have a 24-hour diagnostic service (US, CT, MRI). Patients severity and the working conditions necessitate the availability of the trained surgical personnel. Given the high risks of bleedings in patients with COVID-19, it is necessary to have a 24-hour endoscopy and endovascular surgery departments with the ability to perform diagnostic and therapeutic interventions.
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23
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Sun BJ, Wolff CJ, Bechtold HM, Free D, Lorenzo J, Minot PR, Maggio PG, Spain DA, Weiser TG, Forrester JD. Modified percutaneous tracheostomy in patients with COVID-19. Trauma Surg Acute Care Open 2020; 5:e000625. [PMID: 34192161 PMCID: PMC7736959 DOI: 10.1136/tsaco-2020-000625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/16/2020] [Indexed: 01/12/2023] Open
Abstract
Background Patients hospitalized with COVID-19 are at risk of developing hypoxic respiratory failure and often require prolonged mechanical ventilation. Indication and timing to perform tracheostomy is controversial in patients with COVID-19. Methods This was a single-institution retrospective review of tracheostomies performed on patients admitted for COVID-19 between April 8, 2020 and August 1, 2020 using a modified percutaneous tracheostomy technique to minimize hypoxia and aerosolization. Results Twelve tracheostomies were performed for COVID-related respiratory failure. Median patient age was 54 years (range: 36–76) and 9 (75%) were male. Median time to tracheostomy was 17 days (range: 10–27), and 5 (42%) patients had failed attempts at extubation prior to tracheostomy. There were no intraprocedural complications, including hypoxia. Post-tracheostomy bleeding was noted in two patients. Eight (67%) patients have been discharged at the time of this study, and there were four patient deaths unrelated to tracheostomy placement. No healthcare worker transmissions resulted from participating in the tracheostomy procedure. Conclusions A modified percutaneous tracheostomy is feasible and can be safely performed in patients infected with COVID-19. Level of evidence Level V, case series.
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Affiliation(s)
- Beatrice J Sun
- Department of Surgery, Stanford University, Stanford, California, USA
| | | | | | - Dwayne Free
- Bronchoscopy and Respiratory Care Services, Stanford University, Stanford, California, USA
| | - Javier Lorenzo
- Anesthesiology, Stanford University, Stanford, California, USA
| | - Patrick R Minot
- Anesthesiology, Stanford University, Stanford, California, USA
| | - Paul G Maggio
- Department of Surgery, Stanford University, Stanford, California, USA
| | - David A Spain
- Department of Surgery, Stanford University, Stanford, California, USA
| | - Thomas G Weiser
- Department of Surgery, Stanford University, Stanford, California, USA
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24
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Weiss KD, Coppolino A, Wiener DC, McNamee C, Riviello R, Ng JM, Jaklitsch MT, Marshall MB, Rochefort MM. Controlled apneic tracheostomy in patients with coronavirus disease 2019 (COVID-19). JTCVS Tech 2020; 6:172-177. [PMID: 33319213 PMCID: PMC7720733 DOI: 10.1016/j.xjtc.2020.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/18/2020] [Indexed: 12/14/2022] Open
Abstract
Objective To develop a team-based institutional infrastructure for navigating management of a novel disease, to determine a safe and effective approach for performing tracheostomies in patients with COVID-19 respiratory failure, and to review outcomes of patients and health care personnel following implementation of this approach. Methods An interdisciplinary Task Force was constructed to develop innovative strategies for management of a novel disease. A single-institution, prospective, nonrandomized cohort study was then conducted on patients with coronavirus disease 2019 (COVID-19) respiratory failure who underwent tracheostomy using an induced bedside apneic technique at a tertiary care academic institution between April 27, 2020, and June 30, 2020. Results In total, 28 patients underwent tracheostomy with induced apnea. The median lowest procedural oxygen saturation was 95%. The median number of ventilated days following tracheostomy was 11. There were 3 mortalities (11%) due to sepsis and multiorgan failure; of 25 surviving patients, 100% were successfully discharged from the hospital and 76% are decannulated, with a median time of 26 days from tracheostomy to decannulation (range 12-57). There was no symptomatic disease transmission to health care personnel on the COVID-19 Tracheostomy Team. Conclusions Patients with respiratory failure from COVID-19 disease may benefit from tracheostomy. This can be completed effectively and safely without viral transmission to health care personnel. Performing tracheostomies earlier in the course of disease may expedite patient recovery and improve intensive care unit resource use. The creation of a collaborative Task Force is an effective strategic approach for management of novel disease.
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Affiliation(s)
- Kathleen D Weiss
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Antonio Coppolino
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Daniel C Wiener
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Ciaran McNamee
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Robert Riviello
- Division of Trauma, Burn, Surgical and Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Ju-Mei Ng
- Department of Anesthesiology, Brigham and Women's Hospital, Boston, Mass
| | - Michael T Jaklitsch
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Margaret B Marshall
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Matthew M Rochefort
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Mass
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25
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An uncomplicated and safe technique for preventing endotracheal tube cuff damage during tracheostomy using pressure-controlled ventilation: the PCV method. Can J Anaesth 2020; 67:1879-1880. [PMID: 32779003 PMCID: PMC7417109 DOI: 10.1007/s12630-020-01783-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 12/15/2022] Open
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26
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Vechorko VI, Anosov VD, Silaev BV. Diagnosis and treatment of acute surgical diseases in patients with COVID-19. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2020. [DOI: 10.24075/brsmu.2020.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Emergency surgery in the infectious diseases hospital is an urgent problem during the COVID-19 pandemic. Municipal Clinical Hospital No.15 named after O. M. Filatov has been providing emergency surgical care after conversion, from March 27, 2020 until now. The hospital’s medical staff has built up extensive experience: 194 surgical procedures were carried out in April, and 289 surgical procedures were carried out in May 2020. The paper reports the experience of emergency surgery at the stage of conversion to an infectious diseases hospital. Among all hospitalized patients, 482 (5.29%) people had acute surgical pathology requiring emergency surgery. Among patients who underwent urgent surgery, 472 (98%) people had the caused by COVID-19 community-acquired pneumonia of various degrees of severity. The paper discusses some features of acute surgical pathology and complications identified in patients with COVID-19. The surgical care features in the hospital after conversion are proper epidemiological regime implementation, minimization of the number of staff in the operating room, possible minimization of the number and reduction of the duration of surgical procedures. The most important challenge during the COVID-19 pandemic is medical staff safety.
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Affiliation(s)
- VI Vechorko
- Filatov City Clinical Hospital № 15, Moscow, Russia
| | - VD Anosov
- Filatov City Clinical Hospital № 15, Moscow, Russia
| | - BV Silaev
- Filatov City Clinical Hospital № 15, Moscow, Russia
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