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Emergent tracheostomy during the pandemic of COVID-19: Slovenian National Recommendations

PURPOSE: Emergent tracheostomy under local anaesthesia is a reliable method of airway management when orotracheal intubation is not possible. COVID-19 is spread through aerosol making the emergent tracheostomy a high-risk procedure for surgeons. The surgical establishment of the air conduit in emerg...

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Autores principales: Šifrer, Robert, Urbančič, Jure, Piazza, Cesare, van Weert, Stijn, García-Purriños, Francisco, Benedik, Janez, Tancer, Ivana, Aničin, Aleksandar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473826/
https://www.ncbi.nlm.nih.gov/pubmed/32889621
http://dx.doi.org/10.1007/s00405-020-06318-8
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author Šifrer, Robert
Urbančič, Jure
Piazza, Cesare
van Weert, Stijn
García-Purriños, Francisco
Benedik, Janez
Tancer, Ivana
Aničin, Aleksandar
author_facet Šifrer, Robert
Urbančič, Jure
Piazza, Cesare
van Weert, Stijn
García-Purriños, Francisco
Benedik, Janez
Tancer, Ivana
Aničin, Aleksandar
author_sort Šifrer, Robert
collection PubMed
description PURPOSE: Emergent tracheostomy under local anaesthesia is a reliable method of airway management when orotracheal intubation is not possible. COVID-19 is spread through aerosol making the emergent tracheostomy a high-risk procedure for surgeons. The surgical establishment of the air conduit in emergency scenarios must be adjusted for safety reasons. METHODS: To establish the Slovenian National Guidelines for airway management in cannot intubate—cannot ventilate situations in COVID-19 positive patients. RESULTS: Good communication and coordination between surgeon and anaesthesiologist is absolutely necessary. Deep general anaesthesia, full muscle relaxation and adequate preoxygenation without intubation are initial steps. The surgical cricothyrotomy is performed quickly, the thin orotracheal tube is inserted, the cuff is inflated and ventilation begins. Following patient stabilisation, the conversion to the tracheostomy is undertaken with the following features: skin infiltration with vasoconstrictor, a vertical incision, avoidance of electrical devices in favour of classical manners of haemostasis, the advancement of the tube towards the carina, performing the tracheal window in complete apnoea following adequate oxygenation, the insertion of non-fenestrated canulla attached to a heat and moisture exchanger, the fixation of canulla with stitches and tapes, and the cricothyrotomy entrance closure. Appropriate safety equipment is equally important. CONCLUSION: The goal of the guidelines is to make the procedure safer for medical teams, without harming the patients. Further improvements of the guidelines will surely appear as COVID-19 is a new entity and there is not yet much experience in handling it.
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spelling pubmed-74738262020-09-08 Emergent tracheostomy during the pandemic of COVID-19: Slovenian National Recommendations Šifrer, Robert Urbančič, Jure Piazza, Cesare van Weert, Stijn García-Purriños, Francisco Benedik, Janez Tancer, Ivana Aničin, Aleksandar Eur Arch Otorhinolaryngol Review Article PURPOSE: Emergent tracheostomy under local anaesthesia is a reliable method of airway management when orotracheal intubation is not possible. COVID-19 is spread through aerosol making the emergent tracheostomy a high-risk procedure for surgeons. The surgical establishment of the air conduit in emergency scenarios must be adjusted for safety reasons. METHODS: To establish the Slovenian National Guidelines for airway management in cannot intubate—cannot ventilate situations in COVID-19 positive patients. RESULTS: Good communication and coordination between surgeon and anaesthesiologist is absolutely necessary. Deep general anaesthesia, full muscle relaxation and adequate preoxygenation without intubation are initial steps. The surgical cricothyrotomy is performed quickly, the thin orotracheal tube is inserted, the cuff is inflated and ventilation begins. Following patient stabilisation, the conversion to the tracheostomy is undertaken with the following features: skin infiltration with vasoconstrictor, a vertical incision, avoidance of electrical devices in favour of classical manners of haemostasis, the advancement of the tube towards the carina, performing the tracheal window in complete apnoea following adequate oxygenation, the insertion of non-fenestrated canulla attached to a heat and moisture exchanger, the fixation of canulla with stitches and tapes, and the cricothyrotomy entrance closure. Appropriate safety equipment is equally important. CONCLUSION: The goal of the guidelines is to make the procedure safer for medical teams, without harming the patients. Further improvements of the guidelines will surely appear as COVID-19 is a new entity and there is not yet much experience in handling it. Springer Berlin Heidelberg 2020-09-05 2021 /pmc/articles/PMC7473826/ /pubmed/32889621 http://dx.doi.org/10.1007/s00405-020-06318-8 Text en © Springer-Verlag GmbH Germany, part of Springer Nature 2020 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Review Article
Šifrer, Robert
Urbančič, Jure
Piazza, Cesare
van Weert, Stijn
García-Purriños, Francisco
Benedik, Janez
Tancer, Ivana
Aničin, Aleksandar
Emergent tracheostomy during the pandemic of COVID-19: Slovenian National Recommendations
title Emergent tracheostomy during the pandemic of COVID-19: Slovenian National Recommendations
title_full Emergent tracheostomy during the pandemic of COVID-19: Slovenian National Recommendations
title_fullStr Emergent tracheostomy during the pandemic of COVID-19: Slovenian National Recommendations
title_full_unstemmed Emergent tracheostomy during the pandemic of COVID-19: Slovenian National Recommendations
title_short Emergent tracheostomy during the pandemic of COVID-19: Slovenian National Recommendations
title_sort emergent tracheostomy during the pandemic of covid-19: slovenian national recommendations
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473826/
https://www.ncbi.nlm.nih.gov/pubmed/32889621
http://dx.doi.org/10.1007/s00405-020-06318-8
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