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      Protection of Medical Staff during Tracheotomy: Lessons Learned from the COVID-19 Pandemic

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          Abstract

          Background

          During the ongoing pandemic of COVID-19, tracheotomy under emergency situation is considered a high-risk procedure that causes probable expose to aerosolized secretion.

          Summary

          We reviewed our case and previous reports, and summarized a detailed protocol that is needed to protect medical staffs who perform tracheotomy under the COVID-19 pandemic, considering the patient's condition, experience of medical staff members, and available facilities and equipment.

          Key Messages

          For efficient protection of medical staff who perform tracheotomy under the COVID-19 pandemic period, we suggest that the following needs to be considered: assessment of patient's condition (COVID-19 infection and the airway problem), route (safest route to the operating room), experienced surgical team, negative-pressure isolation facility and appliance (personal protective equipment) availability, and safe and appropriate post-tracheotomy care.

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Fei Zhou, Ting Yu, Ronghui Du … (2020)
          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic

            Babak Givi, Bradley Schiff, Steven B. Chinn … (2020)
            The rapidly expanding novel coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, has challenged the medical community to an unprecedented degree. Physicians and health care workers are at added risk of exposure and infection during the course of patient care. Because of the rapid spread of this disease through respiratory droplets, health care workers who come in close contact with the upper aerodigestive tract during diagnostic and therapeutic procedures, such as otolaryngologists-head and neck surgeons, are particularly at risk. A set of safety recommendations was created based on a review of the literature and communications with physicians with firsthand knowledge of safety procedures during the COVID-19 pandemic.
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              Surgical Considerations for Tracheostomy During the COVID-19 Pandemic: Lessons Learned From the Severe Acute Respiratory Syndrome Outbreak

              Joshua Tay, Mark Khoo, Woei Loh (2020)
              Article 0 comments Cited 124 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): ORL J Otorhinolaryngol Relat Spec
                Journal ID (iso-abbrev): ORL J Otorhinolaryngol Relat Spec
                Journal ID (publisher-id): ORL
                Title: ORL; journal for oto-rhino-laryngology and its related specialties
                Publisher: S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH-4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                ISSN (Print): 0301-1569
                ISSN (Electronic): 1423-0275
                Publication date (Electronic): 8 October 2020
                Pages: 1-6
                Affiliations
                Department of Otolaryngology-Head and Neck Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
                Author notes
                *Jun-Ook Park, Department of Otolaryngology-Head and Neck Surgery, Eunpyeong St. Mary's Hospital, 1021, Tongil-ro, Eunpyeong-gu, Seoul 03312 (Republic of Korea), junook2000@ 123456catholic.ac.kr
                Article
                Publisher ID: orl-0001
                DOI: 10.1159/000511012
                PMC ID: 7649695
                PubMed ID: 33032293
                SO-VID: 91aa3578-e891-45b0-894a-1f4714da7edf
                Copyright statement: Copyright © 2020 by S. Karger AG, Basel
                License:

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                Date received : 8 June 2020
                Date accepted : 16 August 2020
                Page count
                Figures: 2, Tables: 2, References: 9, Pages: 6
                Categories
                Subject: Review Article

                Keywords: covid-19,novel coronavirus,airway management,tracheotomy,medical staff protection
                Data availability:
                Keywords: covid-19, novel coronavirus, airway management, tracheotomy, medical staff protection

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