Performing tracheostomy during the Covid-19 pandemic: guidance and recommendations from the Critical Care and Acute Care Surgery Committees of the American Association for the Surgery of Trauma

Michetti, Christopher P.; Burlew, Clay Cothren; Bulger, Eileen M.; Davis, Kimberly A.; Spain, David A.

doi:10.1136/tsaco-2020-000482

Cited by 105 publications

(155 citation statements)

References 12 publications

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“…12,13 The surge in intensive care unit admissions and need for prolonged mechanical ventilation has, in turn, led to an increase in the requirement for tracheostomies. 14 Traditionally, a tracheostomy is performed to aid weaning from ventilatory support, facilitate clearance of secretions, and prevent complications of prolonged intubation such as subglottic stenosis and hospital-acquired pneumonia. [14][15][16] However, the role and safety of tracheostomies in patients with Covid-19 has been the source of great debate recently, with very limited experiential information available in the literature.…”

Section: Introductionmentioning

confidence: 99%

“…14 Traditionally, a tracheostomy is performed to aid weaning from ventilatory support, facilitate clearance of secretions, and prevent complications of prolonged intubation such as subglottic stenosis and hospital-acquired pneumonia. [14][15][16] However, the role and safety of tracheostomies in patients with Covid-19 has been the source of great debate recently, with very limited experiential information available in the literature. The number of challenges associated with performing tracheostomies in patients with Covid-19 has led to the recent publication of numerous guidelines and recommendations worldwide.…”

Section: Introductionmentioning

confidence: 99%

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Tracheostomy in the coronavirus disease 2019 patient: evaluating feasibility, challenges and early outcomes of the 14-day guidance

et al. 2020

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Objectives To report feasibility, early outcomes and challenges of implementing a 14-day threshold for undertaking surgical tracheostomy in the critically ill coronavirus disease 2019 patient. Methods Twenty-eight coronavirus disease 2019 patients underwent tracheostomy. Demographics, risk factors, ventilatory assistance, organ support and logistics were assessed. Results The mean time from intubation to tracheostomy formation was 17.0 days (standard deviation = 4.4, range 8–26 days). Mean time to decannulation was 15.8 days (standard deviation = 9.4) and mean time to intensive care unit stepdown to a ward was 19.2 days (standard deviation = 6.8). The time from intubation to tracheostomy was strongly positively correlated with: duration of mechanical ventilation (r(23) = 0.66; p < 0.001), time from intubation to decannulation (r(23) = 0.66; p < 0.001) and time from intubation to intensive care unit discharge (r(23) = 0.71; p < 0.001). Conclusion Performing a tracheostomy in coronavirus disease 2019 positive patients at 8–14 days following intubation is compatible with favourable outcomes. Multidisciplinary team input is crucial to patient selection.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tracheostomy in the coronavirus disease 2019 patient: evaluating feasibility, challenges and early outcomes of the 14-day guidance

et al. 2020

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“…The FOB use for PCT helps to visualize the incision site and ensures little more safety but FOB is not recommended universally for PCT. 8 , 9 In our protocol, we chose two basic principles, the appropriate timing of tracheostomy with patient's clinical stability as confirmed by pre-procedure apnea test and least invasive modification of the technique without using FOB, in order to minimalize the production of aerosols and hence transmission risk.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Tracheostomy in COVID-19 Patients: A Four-step Safe Protocol

Nasa¹,

Singh²,

Ali

et al. 2020

Indian Journal of Critical Care Medicine

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A bstract Background Coronavirus disease-2019 (COVID-19) pandemic has inundated healthcare systems globally especially resources in intensive care units (ICUs). Tracheostomy may be required in critically ill COVID-19 patients to facilitate weaning and to optimize resources like ventilator and ICU beds. Percutaneous tracheostomy (PCT) has become the standard of care globally in ICUs; however, it is considered a high-risk procedure in COVID-19 patients because of the inherent risk of aerosol generation. Materials and methods Patients with severe COVID-19 who were on mechanical ventilation because of respiratory failure for ≥10 days were evaluated for PCT. We developed a four-step approach from patient selection and timing, preparation, performance, and postprocedure for PCT in these patients. Results We evaluated our four-step protocol in four patients. One of them was non-COVID patient and rest three were COVID patients. The procedure was uneventful in all of the patients with median time of procedure and apnea is 10 minutes 30 seconds and 2 minutes 20 seconds, respectively. The tracheostomy was decannulated in two of these patients and one patient is still on ventilator. Conclusion We believe our four-step protocol for PCT in critically ill COVID-19 patient is simple, safe, and easily adapted in any setting with limited training and available resources. We recommend further studies to evaluate this approach in selected critically ill COVID-19 patients who need tracheostomy. How to cite this article Nasa P, Singh A, Ali A, Patidar S, Georgian A. Percutaneous Tracheostomy in COVID-19 Patients: A Four-step Safe Protocol. Indian J Crit Care Med 2020;24(9):832–834.

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“…Aunque el uso de fibrobroncoscopia podría reducir los riesgos relacionados con la TP 19 , estaría desaconsejado para pacientes con COVID-19, pues se incrementa el número de intervinientes y es un procedimiento de alto riesgo en la generación de aerosoles. En caso de que se considere practicarla, se recomienda utilizar piezas que produzcan un sellado a la entrada de este y valorar el uso de fibroscopios desechables 20,21 .…”

Section: Traqueotomía Quirúrgica Frente a Traqueotomía Percutáneaunclassified

Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica, y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19

Vadell¹,

Delgado²,

Avilés‐Jurado

et al. 2020

Revista Española de Anestesiología y Reanimación

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Performing tracheostomy during the Covid-19 pandemic: guidance and recommendations from the Critical Care and Acute Care Surgery Committees of the American Association for the Surgery of Trauma

Cited by 105 publications

References 12 publications

Tracheostomy in the coronavirus disease 2019 patient: evaluating feasibility, challenges and early outcomes of the 14-day guidance

Tracheostomy in the coronavirus disease 2019 patient: evaluating feasibility, challenges and early outcomes of the 14-day guidance

Percutaneous Tracheostomy in COVID-19 Patients: A Four-step Safe Protocol

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