Early percutaneous tracheostomy in COVID19 patients with failed intubation: A case series.
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ABSTRACT: Introduction
COVID19 and pulmonary dysfunction leading to acute respiratory distress syndrome (ARDS).Case study presentation
Herein we presented the cases of failed intubation that was replaced by early percutaneous dilational tracheostomy. The procedure is safe for the patients, doctors and clinical staff.Conclusion
Additionally, we report mucormycosis after COVID19 treatment that was potentially due to immunosuppressive drugs.
SUBMITTER: Marzban-Rad S
PROVIDER: S-EPMC8576056 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectivesTracheostomy usually is performed to aid weaning from mechanical ventilation and facilitate rehabilitation and secretion clearance. Little is known about the safety of percutaneous tracheostomy in patients with severe COVID-19 supported on venovenous extracorporeal membrane oxygenation (VV-ECMO). This study aimed to investigate the bleeding risk of bedside percutaneous tracheostomy in patients with COVID-19 infection supported with VV-ECMO.DesignA Retrospective review of electronic data for routine care of patients on ECMO.SettingTertiary, university-affiliated national ECMO center.ParticipantsPatients with COVID-19 who underwent percutaneous tracheostomy while on VV-ECMO support.InterventionsNo intervention was conducted during this study.Measurements and main resultsElectronic medical records of 16 confirmed patients with COVID-19 who underwent percutaneous tracheostomy while on VV-ECMO support, including patient demographics, severity of illness, clinical variables, procedural complications, and outcomes, were compared with 16 non-COVID-19 patients. The SPSS statistical software was used for statistical analysis. The demographic data were compared using the chi-square test, and normality assumption was tested using the Shapiro-Wilk test. The indications for tracheostomy in all the patients were prolonged mechanical ventilation and sedation management. None of the patients suffered a life-threatening procedural complication within 48 hours. Moderate-to-severe bleeding was similar in both groups. There was no difference in 30- and 90-days mortality between both groups. As per routine screening results, none of the staff involved contracted COVID-19 infection.ConclusionsIn this case series, percutaneous tracheostomy during VV-ECMO in patients with COVID-19 appeared to be safe and did not pose additional risks to patients or healthcare workers.
| S-EPMC9487148 | biostudies-literature
Project description:BackgroundPercutaneous dilatational tracheostomy (PDT) is increasingly popular within intensive care units for patients who need prolonged ventilatory support. Significant complications are rare.Case presentationOur patient suffered tracheal ring fracture and early tracheomalacia following this procedure. These complications are demonstrated in our accompanying video.ConclusionContrary to common beliefs, tracheal rings are commonly fractured during the PDT procedure. The consequent granulation can lead to tracheal stenosis and tracheomalacia.
| S-EPMC1242107 | biostudies-literature
Project description:IntroductionWith the outbreak of coronavirus, the number of patients who referred to the pain clinic for follow-up was much higher than before, which coincided with the onset of the coronavirus pandemic. However, due to incomplete knowledge regarding the virus and its effects, patients did not follow up to the pain.MethodsWe present case of 8 patients who were treated previously for chronic pain (complete remission).ResultsDuring the pandemic, these patients were presented to our center presenting identical pain, that did not respond to the conservative therapy. Owing to the symptoms, these patients were screened and tested positive for COVID19. Two of the patients died whereas, symptoms were improved in other patients.ConclusionPatients with the history of chronic pain may present relapse as a result of the infection or infection can trigger previous chronic pain among patients with risk factors.
| S-EPMC7774008 | biostudies-literature
Project description:The purpose of this study was to evaluate the feasibility of ultrasound (US)-guided percutaneous tracheostomy (PCT) and the incidence of complications in critically ill, obese patients.Fifty consecutive patients were included in a prospective study in two surgical and critical care medicine departments. Obesity was defined as a body mass index (BMI) of at least 30 kg/m². The feasibility of PCT and the incidence of complications were compared in obese patients (n = 26) and non-obese patients (n = 24). Results are expressed as the median (25th-75th percentile) or number (percentage).The median BMIs were 34 kg/m² (32-38) in the obese patient group and 25 kg/m² (24-28) in the non-obese group (p < 0.001). The median times for tracheostomy were 10 min (8-14) in non-obese patients and 9 min (5-10) in obese-patients (p = 0.1). The overall complication rate was similar in obese and non-obese patient groups (35% vs. 33%, p = 0.92). Most complications were minor (hypotension, desaturation, tracheal cuff puncture and minor bleeding), with no differences between obese and non-obese groups. Bronchoscopic inspection revealed two cases of granuloma (8%) in obese patients. One non-obese patient developed a peristomal skin infection, which was treated with intravenous antibiotics. Ultrasound-guided PCT was possible in all enrolled patients and there were no surgical conversions or deaths.This study demonstrated that US-guided PCT is feasible in obese patients with a low complication rate. Obesity may not constitute a contra-indication for US-guided PCT. A US examination provides information on cervical anatomy and hence modifies and guides choice of the PCT puncture site.ClinicalTrials.gov: NCT01502657.
| S-EPMC3681363 | biostudies-literature
Project description:BackgroundPercutaneous 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.MethodsPT was performed with a modified technique including the use of a smaller endotracheal tube (ETT) cuffed at the carina during the procedure.ResultsThe modified technique we proposed was successfully performed in three critically ill patients with COVID-19.ConclusionsIn 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.
| S-EPMC7280702 | biostudies-literature
Project description: Not available
| S-EPMC8212164 | biostudies-literature
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.
| S-EPMC1550905 | biostudies-other
Project description:Post intubation laryngeal injuries are seen relatively commonly in the Intensive Care Unit (ICU) setting. The most common intubation associated laryngeal injuries are characterised by vocal cord oedema, mucosal ulceration, laryngeal granulomas and vocal cord paralysis. Laryngeal stenosis is seen much less commonly and generally presents with posterior adhesions from prolonged intubation or anterior webbing from instrumentation. The finding of adhesions between the vocal cords at the middle third of the glottis without anterior or posterior adhesions and in the absence of previous laryngeal surgery is rare. The authors present a case of a patient with Covid-19 (SARS-CoV-2) who was discovered to have this finding following admission to the Intensive Care Unit for ventilation, tracheostomy for weaning and subsequent failure to decannulate. The patient underwent a microlaryngoscopy and frank adhesions between the middle third of the vocal cords were noted. The authors feel that the mucosal inflammatory component associated with Covid-19 was a significant contributing factor in this clinical finding. Following successful divisions of the adhesions, the patient made a full recovery.
| S-EPMC7834573 | biostudies-literature
Project description: Not available
| S-EPMC1065029 | biostudies-literature
Project description:BackgroundCoronavirus 2019 (COVID-19) is a worldwide pandemic, with many patients requiring prolonged mechanical ventilation. Tracheostomy is not recommended by current guidelines as it is considered a superspreading event owing to aerosolization that unduly risks health care workers.MethodsPatients with severe COVID-19 who were on mechanical ventilation for 5 days or longer were evaluated for percutaneous dilational tracheostomy. We developed a novel percutaneous tracheostomy technique that placed the bronchoscope alongside the endotracheal tube, not inside it. That improved visualization during the procedure and continued standard mechanical ventilation after positioning the inflated endotracheal tube cuff in the distal trachea. This technique offers a significant mitigation for the risk of virus aerosolization during the procedure.ResultsFrom March 10 to April 15, 2020, 270 patients with COVID-19 required invasive mechanical ventilation at New York University Langone Health Manhattan's campus; of those, 98 patients underwent percutaneous dilational tracheostomy. The mean time from intubation to the procedure was 10.6 ± 5 days. Currently, 32 patients (33%) do not require mechanical ventilatory support, 19 (19%) have their tracheostomy tube downsized, and 8 (8%) were decannulated. Forty patients (41%) remain on full ventilator support, and 19 (19%) are weaning from mechanical ventilation. Seven patients (7%) died as a result of respiratory and multiorgan failure. Tracheostomy-related bleeding was the most common complication (5 patients). None of health care providers has had symptoms or tested positive for COVID-19.ConclusionsOur percutaneous tracheostomy technique appears to be safe and effective for COVID-19 patients and safe for health care workers.
| S-EPMC7182508 | biostudies-literature