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Use of Tracheostomy During the COVID-19 Pandemic: American College of Chest Physicians/American Association for Bronchology and Interventional Pulmonology/Association of Interventional Pulmonology Program Directors Expert Panel Report
BACKGROUND: The role of tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic remains unknown. The goal of this consensus statement is to examine the current evidence for performing tracheostomy in patients with respiratory failure from COVID-19 and offer guidance to physicians on the...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Published by Elsevier Inc under license from the American College of Chest Physicians.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274948/ https://www.ncbi.nlm.nih.gov/pubmed/32512006 http://dx.doi.org/10.1016/j.chest.2020.05.571 |
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author | Lamb, Carla R. Desai, Neeraj R. Angel, Luis Chaddha, Udit Sachdeva, Ashutosh Sethi, Sonali Bencheqroun, Hassan Mehta, Hiren Akulian, Jason Argento, A. Christine Diaz-Mendoza, Javier Musani, Ali Murgu, Septimiu |
author_facet | Lamb, Carla R. Desai, Neeraj R. Angel, Luis Chaddha, Udit Sachdeva, Ashutosh Sethi, Sonali Bencheqroun, Hassan Mehta, Hiren Akulian, Jason Argento, A. Christine Diaz-Mendoza, Javier Musani, Ali Murgu, Septimiu |
author_sort | Lamb, Carla R. |
collection | PubMed |
description | BACKGROUND: The role of tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic remains unknown. The goal of this consensus statement is to examine the current evidence for performing tracheostomy in patients with respiratory failure from COVID-19 and offer guidance to physicians on the preparation, timing, and technique while minimizing the risk of infection to health care workers (HCWs). METHODS: A panel including intensivists and interventional pulmonologists from three professional societies representing 13 institutions with experience in managing patients with COVID-19 across a spectrum of health-care environments developed key clinical questions addressing specific topics on tracheostomy in COVID-19. A systematic review of the literature and an established modified Delphi consensus methodology were applied to provide a reliable evidence-based consensus statement and expert panel report. RESULTS: Eight key questions, corresponding to 14 decision points, were rated by the panel. The results were aggregated, resulting in eight main recommendations and five additional remarks intended to guide health-care providers in the decision-making process pertinent to tracheostomy in patients with COVID-19-related respiratory failure. CONCLUSION: This panel suggests performing tracheostomy in patients expected to require prolonged mechanical ventilation. A specific timing of tracheostomy cannot be recommended. There is no evidence for routine repeat reverse transcription polymerase chain reaction testing in patients with confirmed COVID-19 evaluated for tracheostomy. To reduce the risk of infection in HCWs, we recommend performing the procedure using techniques that minimize aerosolization while wearing enhanced personal protective equipment. The recommendations presented in this statement may change as more experience is gained during this pandemic. |
format | Online Article Text |
id | pubmed-7274948 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Published by Elsevier Inc under license from the American College of Chest Physicians. |
record_format | MEDLINE/PubMed |
spelling | pubmed-72749482020-06-08 Use of Tracheostomy During the COVID-19 Pandemic: American College of Chest Physicians/American Association for Bronchology and Interventional Pulmonology/Association of Interventional Pulmonology Program Directors Expert Panel Report Lamb, Carla R. Desai, Neeraj R. Angel, Luis Chaddha, Udit Sachdeva, Ashutosh Sethi, Sonali Bencheqroun, Hassan Mehta, Hiren Akulian, Jason Argento, A. Christine Diaz-Mendoza, Javier Musani, Ali Murgu, Septimiu Chest Critical Care: Guidelines and Consensus Statement BACKGROUND: The role of tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic remains unknown. The goal of this consensus statement is to examine the current evidence for performing tracheostomy in patients with respiratory failure from COVID-19 and offer guidance to physicians on the preparation, timing, and technique while minimizing the risk of infection to health care workers (HCWs). METHODS: A panel including intensivists and interventional pulmonologists from three professional societies representing 13 institutions with experience in managing patients with COVID-19 across a spectrum of health-care environments developed key clinical questions addressing specific topics on tracheostomy in COVID-19. A systematic review of the literature and an established modified Delphi consensus methodology were applied to provide a reliable evidence-based consensus statement and expert panel report. RESULTS: Eight key questions, corresponding to 14 decision points, were rated by the panel. The results were aggregated, resulting in eight main recommendations and five additional remarks intended to guide health-care providers in the decision-making process pertinent to tracheostomy in patients with COVID-19-related respiratory failure. CONCLUSION: This panel suggests performing tracheostomy in patients expected to require prolonged mechanical ventilation. A specific timing of tracheostomy cannot be recommended. There is no evidence for routine repeat reverse transcription polymerase chain reaction testing in patients with confirmed COVID-19 evaluated for tracheostomy. To reduce the risk of infection in HCWs, we recommend performing the procedure using techniques that minimize aerosolization while wearing enhanced personal protective equipment. The recommendations presented in this statement may change as more experience is gained during this pandemic. Published by Elsevier Inc under license from the American College of Chest Physicians. 2020-10 2020-06-06 /pmc/articles/PMC7274948/ /pubmed/32512006 http://dx.doi.org/10.1016/j.chest.2020.05.571 Text en © 2020 Published by Elsevier Inc under license from the American College of Chest Physicians. 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 | Critical Care: Guidelines and Consensus Statement Lamb, Carla R. Desai, Neeraj R. Angel, Luis Chaddha, Udit Sachdeva, Ashutosh Sethi, Sonali Bencheqroun, Hassan Mehta, Hiren Akulian, Jason Argento, A. Christine Diaz-Mendoza, Javier Musani, Ali Murgu, Septimiu Use of Tracheostomy During the COVID-19 Pandemic: American College of Chest Physicians/American Association for Bronchology and Interventional Pulmonology/Association of Interventional Pulmonology Program Directors Expert Panel Report |
title | Use of Tracheostomy During the COVID-19 Pandemic: American College of Chest Physicians/American Association for Bronchology and Interventional Pulmonology/Association of Interventional Pulmonology Program Directors Expert Panel Report |
title_full | Use of Tracheostomy During the COVID-19 Pandemic: American College of Chest Physicians/American Association for Bronchology and Interventional Pulmonology/Association of Interventional Pulmonology Program Directors Expert Panel Report |
title_fullStr | Use of Tracheostomy During the COVID-19 Pandemic: American College of Chest Physicians/American Association for Bronchology and Interventional Pulmonology/Association of Interventional Pulmonology Program Directors Expert Panel Report |
title_full_unstemmed | Use of Tracheostomy During the COVID-19 Pandemic: American College of Chest Physicians/American Association for Bronchology and Interventional Pulmonology/Association of Interventional Pulmonology Program Directors Expert Panel Report |
title_short | Use of Tracheostomy During the COVID-19 Pandemic: American College of Chest Physicians/American Association for Bronchology and Interventional Pulmonology/Association of Interventional Pulmonology Program Directors Expert Panel Report |
title_sort | use of tracheostomy during the covid-19 pandemic: american college of chest physicians/american association for bronchology and interventional pulmonology/association of interventional pulmonology program directors expert panel report |
topic | Critical Care: Guidelines and Consensus Statement |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274948/ https://www.ncbi.nlm.nih.gov/pubmed/32512006 http://dx.doi.org/10.1016/j.chest.2020.05.571 |
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