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BackgroundPatients 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.MethodsThis 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.ResultsTwelve 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.ConclusionsA modified percutaneous tracheostomy is feasible and can be safely performed in patients infected with COVID-19.Level of evidenceLevel V, case series.

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Objective: Weaning parameters are well studied in patients undergoing first time extubation. Fewer data exists to guide re-extubation of patients who failed their first extubation attempt. It is reasonable to postulate that improved weaning parameters between the first and second extubation attempt would lead to improved rates of re-extubation success. To investigate, we studied a cohort of patients who failed their first extubation attempt and underwent a second attempt at extubation. We hypothesized that improvement in weaning parameters between the first and the second extubation attempt is associated with successful reextubation. Interventions: Rapid shallow breathing index (RSBI), maximum inspiratory pressure (MIP), vital capacity (VC), and the blood partial pressure of CO2 (PaCO2) were measured and recorded in the medical record prior to extubation along with demographic information. We examined the relationship between the change in extubation and re-extubation weaning parameters and re-extubation success. Measurements and Main results: A total of 1283 adult patients were included. All weaning parameters obtained prior to re-extubation differed between those who were successful and those who required a second reintubation. Those with reextubation success had slightly lower PaCO2 values (39.5 ± 7.4 mmHg vs. 41.6 ± 9.1 mmHg, p = 0.0045) and about 13% higher vital capacity volumes (1021 ± 410 mL vs. 907 ± 396 mL, p = 0.0093). Lower values for RSBI (53 ± 32 breaths/min/L vs. 69 ± 42 breaths/min/L, p < 0.001) and MIP (−41 ± 12 cmH2O vs. −38 ± 13 cm H2O), p = 0.0225) were seen in those with re-extubation success. Multivariable logistical regression demonstrates lack of independent associated between the change in parameters between the 2 attempts and re-extubation success. Conclusions: The relationship between the changes in extubation parameters through successive attempts is driven primarily by the value obtained immediately prior to re-extubation. These findings do not support waiting for an improvement in extubation parameters to extubate patients who failed a first attempt at extubation if extubation parameters are compatible with success.

El objetivo del estudio fue analizar la viabilidad de enseñar RCP en actividades deportivas con apoyo musical y evaluar si este nuevo enfoque iguala los resultados de un curso tradicional de reanimación cardiopulmonar (RCP). Participaron 84 estudiantes universitarias sin conocimientos de RCP distribuidas en dos grupos de forma aleatoria. El primero recibió formación de RCP sólo manos integradas en una clase de aeróbic y el otro recibió un curso de RCP de manera convencional. Los resultados en la clase coreografiada comparados con el curso tradicional fueron: Profundidad media de compresiones (41,64 vs 42,92; p= 0,446), re-expansión correcta (65,47% vs 72,47%; p=0,423), frecuencia de compresiones en un minuto (102,50 vs 138,53; p<0,001), compresiones totales (202,50 vs 277,95; p< 0,001). Los dos métodos formativos alcanzaron resultados similares por lo que la introducción de la enseñanza de RCP en actividades deportivas puede ser un nuevo método formativo.