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Novel Percutaneous Tracheostomy for Critically Ill Patients With COVID-19

BACKGROUND: Coronavirus 2019 (COVID-19) is a worldwide pandemic, with many patients requiring prolonged mechanical ventilation. Tracheostomy is not recommended by current guidelines as it is considered a superspreading event owing to aerosolization that unduly risks health care workers. METHODS: Pat...

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Autores principales: Angel, Luis, Kon, Zachary N., Chang, Stephanie H., Rafeq, Samaan, Palasamudram Shekar, Saketh, Mitzman, Brian, Amoroso, Nancy, Goldenberg, Ronald, Sureau, Kimberly, Smith, Deane E., Cerfolio, Robert J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: by The Society of Thoracic Surgeons Published by Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182508/
https://www.ncbi.nlm.nih.gov/pubmed/32339508
http://dx.doi.org/10.1016/j.athoracsur.2020.04.010
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author Angel, Luis
Kon, Zachary N.
Chang, Stephanie H.
Rafeq, Samaan
Palasamudram Shekar, Saketh
Mitzman, Brian
Amoroso, Nancy
Goldenberg, Ronald
Sureau, Kimberly
Smith, Deane E.
Cerfolio, Robert J.
author_facet Angel, Luis
Kon, Zachary N.
Chang, Stephanie H.
Rafeq, Samaan
Palasamudram Shekar, Saketh
Mitzman, Brian
Amoroso, Nancy
Goldenberg, Ronald
Sureau, Kimberly
Smith, Deane E.
Cerfolio, Robert J.
author_sort Angel, Luis
collection PubMed
description BACKGROUND: Coronavirus 2019 (COVID-19) is a worldwide pandemic, with many patients requiring prolonged mechanical ventilation. Tracheostomy is not recommended by current guidelines as it is considered a superspreading event owing to aerosolization that unduly risks health care workers. METHODS: Patients with severe COVID-19 who were on mechanical ventilation for 5 days or longer were evaluated for percutaneous dilational tracheostomy. We developed a novel percutaneous tracheostomy technique that placed the bronchoscope alongside the endotracheal tube, not inside it. That improved visualization during the procedure and continued standard mechanical ventilation after positioning the inflated endotracheal tube cuff in the distal trachea. This technique offers a significant mitigation for the risk of virus aerosolization during the procedure. RESULTS: From March 10 to April 15, 2020, 270 patients with COVID-19 required invasive mechanical ventilation at New York University Langone Health Manhattan’s campus; of those, 98 patients underwent percutaneous dilational tracheostomy. The mean time from intubation to the procedure was 10.6 ± 5 days. Currently, 32 patients (33%) do not require mechanical ventilatory support, 19 (19%) have their tracheostomy tube downsized, and 8 (8%) were decannulated. Forty patients (41%) remain on full ventilator support, and 19 (19%) are weaning from mechanical ventilation. Seven patients (7%) died as a result of respiratory and multiorgan failure. Tracheostomy-related bleeding was the most common complication (5 patients). None of health care providers has had symptoms or tested positive for COVID-19. CONCLUSIONS: Our percutaneous tracheostomy technique appears to be safe and effective for COVID-19 patients and safe for health care workers.
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spelling pubmed-71825082020-04-27 Novel Percutaneous Tracheostomy for Critically Ill Patients With COVID-19 Angel, Luis Kon, Zachary N. Chang, Stephanie H. Rafeq, Samaan Palasamudram Shekar, Saketh Mitzman, Brian Amoroso, Nancy Goldenberg, Ronald Sureau, Kimberly Smith, Deane E. Cerfolio, Robert J. Ann Thorac Surg Original Article BACKGROUND: Coronavirus 2019 (COVID-19) is a worldwide pandemic, with many patients requiring prolonged mechanical ventilation. Tracheostomy is not recommended by current guidelines as it is considered a superspreading event owing to aerosolization that unduly risks health care workers. METHODS: Patients with severe COVID-19 who were on mechanical ventilation for 5 days or longer were evaluated for percutaneous dilational tracheostomy. We developed a novel percutaneous tracheostomy technique that placed the bronchoscope alongside the endotracheal tube, not inside it. That improved visualization during the procedure and continued standard mechanical ventilation after positioning the inflated endotracheal tube cuff in the distal trachea. This technique offers a significant mitigation for the risk of virus aerosolization during the procedure. RESULTS: From March 10 to April 15, 2020, 270 patients with COVID-19 required invasive mechanical ventilation at New York University Langone Health Manhattan’s campus; of those, 98 patients underwent percutaneous dilational tracheostomy. The mean time from intubation to the procedure was 10.6 ± 5 days. Currently, 32 patients (33%) do not require mechanical ventilatory support, 19 (19%) have their tracheostomy tube downsized, and 8 (8%) were decannulated. Forty patients (41%) remain on full ventilator support, and 19 (19%) are weaning from mechanical ventilation. Seven patients (7%) died as a result of respiratory and multiorgan failure. Tracheostomy-related bleeding was the most common complication (5 patients). None of health care providers has had symptoms or tested positive for COVID-19. CONCLUSIONS: Our percutaneous tracheostomy technique appears to be safe and effective for COVID-19 patients and safe for health care workers. by The Society of Thoracic Surgeons Published by Elsevier 2020-09 2020-04-25 /pmc/articles/PMC7182508/ /pubmed/32339508 http://dx.doi.org/10.1016/j.athoracsur.2020.04.010 Text en © 2020 by The Society of Thoracic Surgeons Published by Elsevier. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Original Article
Angel, Luis
Kon, Zachary N.
Chang, Stephanie H.
Rafeq, Samaan
Palasamudram Shekar, Saketh
Mitzman, Brian
Amoroso, Nancy
Goldenberg, Ronald
Sureau, Kimberly
Smith, Deane E.
Cerfolio, Robert J.
Novel Percutaneous Tracheostomy for Critically Ill Patients With COVID-19
title Novel Percutaneous Tracheostomy for Critically Ill Patients With COVID-19
title_full Novel Percutaneous Tracheostomy for Critically Ill Patients With COVID-19
title_fullStr Novel Percutaneous Tracheostomy for Critically Ill Patients With COVID-19
title_full_unstemmed Novel Percutaneous Tracheostomy for Critically Ill Patients With COVID-19
title_short Novel Percutaneous Tracheostomy for Critically Ill Patients With COVID-19
title_sort novel percutaneous tracheostomy for critically ill patients with covid-19
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182508/
https://www.ncbi.nlm.nih.gov/pubmed/32339508
http://dx.doi.org/10.1016/j.athoracsur.2020.04.010
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