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Modified percutaneous tracheostomy in COVID-19 critically ill patients.

ABSTRACT: BACKGROUND:Percutaneous tracheostomy (PT) in patients with coronavirus disease (COVID-19) included several critical steps associated with increased risk of aerosol generation. We reported a modified PT technique aiming to minimize the risk of aerosol generation and to increase the staff safety in COVID-19 patients. METHODS:PT was performed with a modified technique including the use of a smaller endotracheal tube (ETT) cuffed at the carina during the procedure. RESULTS:The modified technique we proposed was successfully performed in three critically ill patients with COVID-19. CONCLUSIONS:In COVID-19 critically ill patients, a modified PT technique, including the use of a smaller ETT cuffed at the carina and fiber-optic bronchoscope inserted between the tube and the inner surface of the trachea, may ensure a better airway management, respiratory function, patient comfort, and great safety for the staff.

SUBMITTER: Vargas M

PROVIDER: S-EPMC7280702 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Modified percutaneous tracheostomy in COVID-19 critically ill patients.

Vargas Maria M Russo Gennaro G Iacovazzo Carmine C Servillo Giuseppe G

Head & neck 20200521 7

<h4>Background</h4>Percutaneous tracheostomy (PT) in patients with coronavirus disease (COVID-19) included several critical steps associated with increased risk of aerosol generation. We reported a modified PT technique aiming to minimize the risk of aerosol generation and to increase the staff safety in COVID-19 patients.<h4>Methods</h4>PT was performed with a modified technique including the use of a smaller endotracheal tube (ETT) cuffed at the carina during the procedure.<h4>Results</h4>The ...[more]

PMID: 32437066

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Project description:INTRODUCTION: Tracheostomy is one of the more commonly performed procedures in critically ill patients yet the optimal method of performing tracheostomies in this population remains to be established. The aim of this study was to systematically review and quantitatively synthesize all randomized clinical trials (RCTs), comparing elective percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST) in adult critically ill patients with regards to major short and long term outcomes. METHODS: MEDLINE, EMBASE, CINAHL and the Cochrane Controlled Clinical Trials Register databases were searched to identify relevant studies. Additionally, bibliographies and selected conference proceedings were reviewed, and experts in the field and manufacturers of two PDT kits were contacted. Randomized clinical trials comparing any method of elective PDT to ST that included critically ill adults and reported at least one clinically relevant outcome were included. Data extracted included trial characteristics, measures of study validity, and clinically relevant outcomes. RESULTS: Seventeen RCTs involving 1,212 patients were included. Most PDTs used a multiple dilator technique and were performed in the intensive care unit (ICU). The pooled odds ratio (OR) for wound infection was 0.28 (95% confidence interval (CI), 0.16 to 0.49, p < 0.0005), indicating a significant reduction with PDT compared to ST. Overall, PDT was equivalent to ST for bleeding, major peri-procedural and long-term complications; however, subgroup analysis suggested PDT resulted in a lower incidence of bleeding (OR = 0.29 (95% CI 0.12 to 0.75, p = 0.01)) and death (OR = 0.71 (95% CI 0.50 to 1.0, p = 0.05)) when the STs were performed in the operating theatre. CONCLUSION: PDT reduces the overall incidence of wound infection and may further reduce clinical relevant bleeding and mortality when compared with ST performed in the operating theatre. PDT, performed in the ICU, should be considered the procedure of choice for performing elective tracheostomies in critically ill adult patients.

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Modified percutaneous tracheostomy in COVID-19 critically ill patients.

Publications

Modified percutaneous tracheostomy in COVID-19 critically ill patients.

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