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Per-cutaneous dilatation tracheostomy (PCTD) in COVID-19 patients and peri-tracheostomy care: A case series and guidelines

BACKGROUND & OBJECTIVE: COVID 19 patients with severe respiratory failure may require prolonged mechanical ventilation. Placement of a tracheostomy tube often becomes necessary for such patients. The steps of tracheostomy procedure and post tracheostomy care of these patients can be classified a...

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Autores principales: Khan, Ehtesham, Lal, Shankar, Hashmi, Junaid, Thomas, Jubil, Malik, Muhammad Anwar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Professional Medical Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674874/
https://www.ncbi.nlm.nih.gov/pubmed/33235603
http://dx.doi.org/10.12669/pjms.36.7.3518
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author Khan, Ehtesham
Lal, Shankar
Hashmi, Junaid
Thomas, Jubil
Malik, Muhammad Anwar
author_facet Khan, Ehtesham
Lal, Shankar
Hashmi, Junaid
Thomas, Jubil
Malik, Muhammad Anwar
author_sort Khan, Ehtesham
collection PubMed
description BACKGROUND & OBJECTIVE: COVID 19 patients with severe respiratory failure may require prolonged mechanical ventilation. Placement of a tracheostomy tube often becomes necessary for such patients. The steps of tracheostomy procedure and post tracheostomy care of these patients can be classified as aerosol generating. We wish to highlight our modified technique to address these issues. METHODOLOGY: We performed percutaneous dilation tracheostomy in three clinically challenging COVID-19 patients in our ICU and developed guidelines aiming to minimise aerosolisation during and after the tracheostomy procedure to safeguard healthcare workers. RESULTS: Percutaneous tracheostomy was performed by a team of three experienced anaesthetists and an ICU nurse. CONCLUSION: The decision of surgical or percutaneous tracheostomy should be dependent on the experience of the tracheostomy performer, health-care worker safety, resource availability, and patient-centred care. We believe our modified strategic approach of brief bronchoscopy, minimum PEEP and gas flows and step-wise planned approach for PCDT offers an extra level of safety to healthcare workers.
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spelling pubmed-76748742020-11-23 Per-cutaneous dilatation tracheostomy (PCTD) in COVID-19 patients and peri-tracheostomy care: A case series and guidelines Khan, Ehtesham Lal, Shankar Hashmi, Junaid Thomas, Jubil Malik, Muhammad Anwar Pak J Med Sci Clinical Case Series BACKGROUND & OBJECTIVE: COVID 19 patients with severe respiratory failure may require prolonged mechanical ventilation. Placement of a tracheostomy tube often becomes necessary for such patients. The steps of tracheostomy procedure and post tracheostomy care of these patients can be classified as aerosol generating. We wish to highlight our modified technique to address these issues. METHODOLOGY: We performed percutaneous dilation tracheostomy in three clinically challenging COVID-19 patients in our ICU and developed guidelines aiming to minimise aerosolisation during and after the tracheostomy procedure to safeguard healthcare workers. RESULTS: Percutaneous tracheostomy was performed by a team of three experienced anaesthetists and an ICU nurse. CONCLUSION: The decision of surgical or percutaneous tracheostomy should be dependent on the experience of the tracheostomy performer, health-care worker safety, resource availability, and patient-centred care. We believe our modified strategic approach of brief bronchoscopy, minimum PEEP and gas flows and step-wise planned approach for PCDT offers an extra level of safety to healthcare workers. Professional Medical Publications 2020 /pmc/articles/PMC7674874/ /pubmed/33235603 http://dx.doi.org/10.12669/pjms.36.7.3518 Text en Copyright: © Pakistan Journal of Medical Sciences http://creativecommons.org/licenses/by/3.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Case Series
Khan, Ehtesham
Lal, Shankar
Hashmi, Junaid
Thomas, Jubil
Malik, Muhammad Anwar
Per-cutaneous dilatation tracheostomy (PCTD) in COVID-19 patients and peri-tracheostomy care: A case series and guidelines
title Per-cutaneous dilatation tracheostomy (PCTD) in COVID-19 patients and peri-tracheostomy care: A case series and guidelines
title_full Per-cutaneous dilatation tracheostomy (PCTD) in COVID-19 patients and peri-tracheostomy care: A case series and guidelines
title_fullStr Per-cutaneous dilatation tracheostomy (PCTD) in COVID-19 patients and peri-tracheostomy care: A case series and guidelines
title_full_unstemmed Per-cutaneous dilatation tracheostomy (PCTD) in COVID-19 patients and peri-tracheostomy care: A case series and guidelines
title_short Per-cutaneous dilatation tracheostomy (PCTD) in COVID-19 patients and peri-tracheostomy care: A case series and guidelines
title_sort per-cutaneous dilatation tracheostomy (pctd) in covid-19 patients and peri-tracheostomy care: a case series and guidelines
topic Clinical Case Series
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7674874/
https://www.ncbi.nlm.nih.gov/pubmed/33235603
http://dx.doi.org/10.12669/pjms.36.7.3518
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