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Development of an institutional protocol for percutaneous dilatational tracheostomy in critically ill COVID-19 patients: Initial experience

BACKGROUND AND AIMS: Percutaneous dilatational tracheostomy (PDT) may improve the outcome in critically ill COVID-19 patients on mechanical ventilation. However, the timing of performing tracheostomy may be controversial, and it is an aerosol-generating procedure with a potential risk of viral expos...

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Autores principales: Damarla, Haritha, Pangasa, Neha, Hirolli, Divya, Jha, Parthadeep, Garg, Heena, Khan, Tazeen, Soni, Lipika, Maitra, Souvik, Anand, Rahul K., Ray, Bikash R., Baidya, Dalim K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9438811/
https://www.ncbi.nlm.nih.gov/pubmed/36060193
http://dx.doi.org/10.4103/joacp.joacp_495_21
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author Damarla, Haritha
Pangasa, Neha
Hirolli, Divya
Jha, Parthadeep
Garg, Heena
Khan, Tazeen
Soni, Lipika
Maitra, Souvik
Anand, Rahul K.
Ray, Bikash R.
Baidya, Dalim K.
author_facet Damarla, Haritha
Pangasa, Neha
Hirolli, Divya
Jha, Parthadeep
Garg, Heena
Khan, Tazeen
Soni, Lipika
Maitra, Souvik
Anand, Rahul K.
Ray, Bikash R.
Baidya, Dalim K.
author_sort Damarla, Haritha
collection PubMed
description BACKGROUND AND AIMS: Percutaneous dilatational tracheostomy (PDT) may improve the outcome in critically ill COVID-19 patients on mechanical ventilation. However, the timing of performing tracheostomy may be controversial, and it is an aerosol-generating procedure with a potential risk of viral exposure to healthcare workers. MATERIAL AND METHODS: An operational protocol for performing PDT was made and subsequently followed in a designated COVID-19 ICU. Critically ill adult patients on mechanical ventilators who underwent PDT were included in this retrospective cohort study. Case files were retrospectively reviewed and patient characteristics, clinical outcome, and procedure-related details were noted. RESULTS: Forty-one patients were included in the analysis. The median age was 49 (39–67) years, and 41.5% of patients were females. The median duration of mechanical ventilation before tracheostomy was 10 (8–16) days, and the median (IQR) PaO(2)/FiO(2) ratio on the day of PDT was 155 (125–180) mm Hg. Further, 48.8% of patients had transient desaturation to SpO2 <90%, and 41.5% survived to ICU discharge. None of the health care providers involved in PDT developed any symptoms of COVID 19. CONCLUSION: This descriptive study demonstrates the feasibility, implementation, and apparent safety of the PDT protocol developed at our institution.
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spelling pubmed-94388112022-09-03 Development of an institutional protocol for percutaneous dilatational tracheostomy in critically ill COVID-19 patients: Initial experience Damarla, Haritha Pangasa, Neha Hirolli, Divya Jha, Parthadeep Garg, Heena Khan, Tazeen Soni, Lipika Maitra, Souvik Anand, Rahul K. Ray, Bikash R. Baidya, Dalim K. J Anaesthesiol Clin Pharmacol Original Article BACKGROUND AND AIMS: Percutaneous dilatational tracheostomy (PDT) may improve the outcome in critically ill COVID-19 patients on mechanical ventilation. However, the timing of performing tracheostomy may be controversial, and it is an aerosol-generating procedure with a potential risk of viral exposure to healthcare workers. MATERIAL AND METHODS: An operational protocol for performing PDT was made and subsequently followed in a designated COVID-19 ICU. Critically ill adult patients on mechanical ventilators who underwent PDT were included in this retrospective cohort study. Case files were retrospectively reviewed and patient characteristics, clinical outcome, and procedure-related details were noted. RESULTS: Forty-one patients were included in the analysis. The median age was 49 (39–67) years, and 41.5% of patients were females. The median duration of mechanical ventilation before tracheostomy was 10 (8–16) days, and the median (IQR) PaO(2)/FiO(2) ratio on the day of PDT was 155 (125–180) mm Hg. Further, 48.8% of patients had transient desaturation to SpO2 <90%, and 41.5% survived to ICU discharge. None of the health care providers involved in PDT developed any symptoms of COVID 19. CONCLUSION: This descriptive study demonstrates the feasibility, implementation, and apparent safety of the PDT protocol developed at our institution. Wolters Kluwer - Medknow 2022-07 2022-06-15 /pmc/articles/PMC9438811/ /pubmed/36060193 http://dx.doi.org/10.4103/joacp.joacp_495_21 Text en Copyright: © 2022 Journal of Anaesthesiology Clinical Pharmacology https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Damarla, Haritha
Pangasa, Neha
Hirolli, Divya
Jha, Parthadeep
Garg, Heena
Khan, Tazeen
Soni, Lipika
Maitra, Souvik
Anand, Rahul K.
Ray, Bikash R.
Baidya, Dalim K.
Development of an institutional protocol for percutaneous dilatational tracheostomy in critically ill COVID-19 patients: Initial experience
title Development of an institutional protocol for percutaneous dilatational tracheostomy in critically ill COVID-19 patients: Initial experience
title_full Development of an institutional protocol for percutaneous dilatational tracheostomy in critically ill COVID-19 patients: Initial experience
title_fullStr Development of an institutional protocol for percutaneous dilatational tracheostomy in critically ill COVID-19 patients: Initial experience
title_full_unstemmed Development of an institutional protocol for percutaneous dilatational tracheostomy in critically ill COVID-19 patients: Initial experience
title_short Development of an institutional protocol for percutaneous dilatational tracheostomy in critically ill COVID-19 patients: Initial experience
title_sort development of an institutional protocol for percutaneous dilatational tracheostomy in critically ill covid-19 patients: initial experience
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9438811/
https://www.ncbi.nlm.nih.gov/pubmed/36060193
http://dx.doi.org/10.4103/joacp.joacp_495_21
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