Early percutaneous tracheotomy in coronavirus disease 2019 (COVID-19) and infection in healthcare personnel: a cohort study

Rosanò, Antonio; Martinelli, Enrico; Fusina, Federica; Morandi, Alessandro; Bertelli, Michele; Malpetti, Elena; Ferretti, Pierluigi; Militano, Carmine Rocco; Marri, Marco; Natalini, Giuseppe

doi:10.1017/ice.2020.1399

Cited by 7 publications

(7 citation statements)

References 8 publications

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“…Because the studies do not comment on any known deviations from intended exposure, all studies were rated as “no information”. For bias due to missing data, most studies were low, with the exception of two studies that were moderate due to missing data for more than five percent of the sample [ 38 , 57 ]. Bias in the measurement of the outcome was rated as low for 25 studies because diagnostic testing for VRI was conducted on all HCWs, regardless of exposure.…”

Section: Resultsmentioning

confidence: 99%

“…Bias in the measurement of the outcome was rated as low for 25 studies because diagnostic testing for VRI was conducted on all HCWs, regardless of exposure. Serious and moderate studies were rated as such if testing for VRI was dependent on the presence of symptoms (n = 8) [ 32 , 38 , 41 , 48 , 56 , 57 , 63 , 64 ], or known exposure (n = 5) [ 36 , 40 , 43 , 55 , 59 ], respectively. On bias regarding selection of reported results, 18 studies reported results on all outcomes that were outlined in their data analysis plan and were rated as moderate.…”

Section: Resultsmentioning

confidence: 99%

“…Across all pathogens, 22 studies reported transmission of VRIs during a specific, individual AGMP. Of these, 20 studies conducted a statistical test of significance between individual AGMPs and the transmission of COVID-19 (n = 10) [12,28,29,32,34,36,38,44,45,48], SARS (n = 8) [55, [58][59][60][62][63][64][65], MERS (n = 1) [54], or multiple VRIs (n = 1) [51]. The remaining two studies reported event data only, with no statistical comparison reported [57,61].…”

Section: Summary Of Findingsmentioning

confidence: 99%

“…Nine studies reported tests of statistical significance for 12 specific AGMPs and the transmission of COVID-19 including: airway suctioning (n = 5) [12,28,32,45,48], broncho-alveolar lavage (n = 1) [36], bronchoscopy (n = 4) [12,32,34,48],CPR (n = 4) [12,29,32,45], extubation (n = 2) [12,32], extubation/intubation combined (n = 1) [45], intubation (n = 5) [28,29,32,36,48], manual ventilation (n = 3) [32,45,48], mechanical ventilation (n = 1) [29], nebulizer administration (n = 3) [32,45,48], oxygen administration (n = 1) [32], and tracheostomy (n = 3) [32,38,45] (Table 4). All reported, unadjusted associations were non-significant or had 95% CIs that crossed unity for broncho-alveolar lavage, bronchoscopy, CPR, extubation, extubation/intubation combined, mechanical ventilation, oxygen administration, and tracheostomy.…”

Section: Specific Agmpsmentioning

confidence: 99%

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Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review

Leal

Farkas

Mastikhina

et al. 2022

Antimicrob Resist Infect Control

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Background In many jurisdictions healthcare workers (HCWs) are using respirators for aerosol-generating medical procedures (AGMPs) performed on adult and pediatric populations with all suspect/confirmed viral respiratory infections (VRIs). This systematic review assessed the risk of VRIs to HCWs in the presence of AGMPs, the role respirators versus medical/surgical masks have on reducing that risk, and if the risk to HCWs during AGMPs differed when caring for adult or pediatric patient populations. Main text We searched MEDLINE, EMBASE, Cochrane Central, Cochrane SR, CINAHL, COVID-19 specific resources, and MedRxiv for English and French articles from database inception to September 9, 2021. Independent reviewers screened abstracts using pre-defined criteria, reviewed full-text articles, selected relevant studies, abstracted data, and conducted quality assessments of all studies using the ROBINS-I risk of bias tool. Disagreements were resolved by consensus. Thirty-eight studies were included; 23 studies on COVID-19, 10 on SARS, and 5 on MERS/ influenza/other respiratory viruses. Two of the 16 studies which assessed associations found that HCWs were 1.7 to 2.5 times more likely to contract COVID-19 after exposure to AGMPs vs. not exposed to AGMPs. Eight studies reported statistically significant associations for nine specific AGMPs and transmission of SARS to HCWS. Intubation was consistently associated with an increased risk of SARS. HCWs were more likely (OR 2.05, 95% CI 1.2–3.4) to contract human coronaviruses when exposed to an AGMP in one study. There were no reported associations between AGMP exposure and transmission of influenza or in a single study on MERS. There was limited evidence supporting the use of a respirator over a medical/surgical mask during an AGMP to reduce the risk of viral transmission. One study described outcomes of HCWs exposed to a pediatric patient during intubation. Conclusion Exposure to an AGMP may increase the risk of transmission of COVID-19, SARS, and human coronaviruses to HCWs, however the evidence base is heterogenous and prone to confounding, particularly related to COVID-19. There continues to be a significant research gap in the epidemiology of the risk of VRIs among HCWs during AGMPs, particularly for pediatric patients. Further evidence is needed regarding what constitutes an AGMP.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Summary Of Findingsmentioning

confidence: 99%

Section: Specific Agmpsmentioning

confidence: 99%

See 2 more Smart Citations

Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review

Leal

Farkas

Mastikhina

et al. 2022

Antimicrob Resist Infect Control

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“…In one study where 15 HCW infections occurred, discontinuing MV did not occur. This potentially highlights the importance of maintaining apnoea during the tracheostomy 42 . Modifications in the anaesthesia technique should therefore be considered in patients with COVID‐19.…”

Section: Discussionmentioning

confidence: 99%

SARS‐CoV‐2 transmission risk to healthcare workers performing tracheostomies: a systematic review

Subramaniam

Lim

Reddy

et al. 2022

ANZ Journal of Surgery

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Background: Tracheostomy is a commonly performed procedure in patients with coronavirus disease 2019 (COVID-19) receiving mechanical ventilation (MV). This review aims to investigate the occurrence of SARS-CoV-2 transmission from patients to healthcare workers (HCWs) when tracheostomies are performed. Methods: This systematic review used the preferred reporting items for systematic reviews and meta-analysis framework. Studies reporting SARS-CoV-2 infection in HCWs involved in tracheostomy procedures were included. Results: Sixty-nine studies (between 01/11/2019 and 16/01/2022) reporting 3117 tracheostomy events were included, 45.9% (1430/3117) were performed surgically. The mean time from MV initiation to tracheostomy was 16.7 AE 7.9 days. Location of tracheostomy, personal protective equipment used, and anaesthesia technique varied between studies. The mean procedure duration was 14.1 AE 7.5 minutes; was statistically longer for percutaneous tracheostomies compared with surgical tracheostomies (mean duration 17.5 AE 7.0 versus 15.5 AE 5.6 minutes, p = 0.02). Across 5 out of 69 studies that reported 311 tracheostomies, 34 HCWs tested positive for SARS-CoV-2 and 23/34 (67.6%) were associated with percutaneous tracheostomies. Conclusions: In this systematic review we found that SARS-CoV-2 transmission to HCWs performing or assisting with a tracheostomy procedure appeared to be low, with all reported transmissions occurring in 2020, prior to vaccinations and more recent strains of SARS-CoV-2. Transmissions may be higher with percutaneous tracheostomies. However, an accurate estimation of infection risk was not possible in the absence of the actual number of HCWs exposed to the risk during the procedure and the inability to control for multiple confounders related to variable timing, technique, and infection control practices.

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Aerosol-generating procedure; percutaneous versus surgical tracheostomy

Tüzemen

Kaya

2022

American Journal of Otolaryngology

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Early percutaneous tracheotomy in coronavirus disease 2019 (COVID-19) and infection in healthcare personnel: a cohort study

Cited by 7 publications

References 8 publications

Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review

Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review

SARS‐CoV‐2 transmission risk to healthcare workers performing tracheostomies: a systematic review

Aerosol-generating procedure; percutaneous versus surgical tracheostomy

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