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      Traqueostomías quirúrgicas en pacientes ingresados en cuidados intensivos durante la pandemia de COVID 19 en el Hospital Central de la Defensa «GÓMEZ ULLA». Madrid. Spain Translated title: Surgical tracheostomy in patients admitted to intensive care during the COVID pandemic 19 at the Central Defense Hospital «GÓMEZ ULLA». Madrid. Spain

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          Abstract

          RESUMEN La traqueostomía quirúrgica tiene indicaciones muy establecidas en pacientes con intubación prolongada. En este artículo se presentan los casos de traqueostomías quirúrgicas realizadas en el Hospital Militar de Madrid en la primera fase de la pandemia por COVID-19, con 21 casos entre los meses de abril y junio de 2020. Se presenta la metodología con el material y los recursos que se han utilizado y adaptado a las necesidades de un espacio reducido, cuando se realizan los procedimientos en la unidad de cuidados intensivos, la presencia de poco personal y la dificultad añadida del equipo protector.

          Translated abstract

          SUMMARY Surgical tracheostomy has well established indications in patients with prolonged intubation. In this article, we present the cases of surgical tracheostomies performed at the Military Hospital of Madrid in the first phase of the COVID 19 pandemic, with 21 cases between the months of april and june 2020. We present our methodology with the material and resources that we use and have adapted to the needs of a reduced space, when performing procedures in the intensive care unit, the presence of few personnel and the added difficulty of using protective equipment.

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          Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy

          Many patients with coronavirus disease 2019 (COVID-19) are critically ill and require care in the intensive care unit (ICU).
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            Obesity and mortality of COVID-19. Meta-analysis

            Background Obesity is a global disease with at least 2.8 million people dying each year as a result of being overweight or obese according to the world health organization figures. This paper aims to explore the links between obesity and mortality in COVID-19. Methods Electronic search was made for the papers studying obesity as a risk factor for mortality following COVID-19 infection. Three authors independently selected the papers and agreed for final inclusion. The outcomes were the age, gender, body mass index, severe comorbidities, respiratory support and the critical illness related mortality in COVID-19. 572 publications were identified and 42 studies were selected including one unpublished study data. Only 14 studies were selected for quantitative analysis. Results All the primary points but the gender are significantly associated with COVID-19 mortality. The age >70, [odd ratio (OR): 0.17, CI; 95%, P-value: 25 kg/m2 [OR: 3.68, CI: 95%, P-value: <0.003], severe comorbidities [OR: 1.84, CI:95%, P-value: <0.00001], advanced respiratory support [OR: 6.98, CI: 95%, P-value: <0.00001], and critical illness [OR: 2.03, CI: 95%, P-value: <0.00001]. Conclusions Patients with obesity are at high risk of mortality from COVID-19 infection.
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              Recommendation of a practical guideline for safe tracheostomy during the COVID-19 pandemic

              Purpose The COVID-19 pandemic is placing unprecedented demand upon critical care services for invasive mechanical ventilation. There is current uncertainty regarding the role of tracheostomy for weaning ventilated patients with COVID-19 pneumonia. This is due to a number of factors including prognosis, optimal healthcare resource utilisation, and safety of healthcare workers when performing such a high-risk aerosol-generating procedure. Methods Literature review and proposed practical guideline based on the experience of a tertiary healthcare institution with 195 critical care admissions for COVID-19 up until 4th April 2020. Results A synthesis of the current international literature and reported experience is presented with respect to prognosis, viral load and staff safety, thus leading to a pragmatic recommendation that tracheostomy is not performed until at least 14 days after endotracheal intubation in COVID-19 patients. Practical steps to minimise aerosol generation in percutaneous tracheostomy are outlined and we describe the process and framework for setting up a dedicated tracheostomy team. Conclusion In selected COVID-19 patients, there is a role for tracheostomy to aid in weaning and optimise healthcare resource utilisation. Both percutaneous and open techniques can be performed safely with careful modifications to technique and appropriate enhanced personal protective equipment. ORL-HNS surgeons can play a valuable role in forming tracheostomy teams to support critical care teams during this global pandemic.
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                Author and article information

                Journal
                sm
                Sanidad Militar
                Sanid. Mil.
                Ministerio de Defensa (Madrid, Madrid, Spain )
                1887-8571
                December 2020
                : 76
                : 4
                : 254-258
                Affiliations
                [1] Madrid orgnameHospital Central de la Defensa
                [2] orgnameHospital de El Escorial
                Article
                S1887-85712020000400254 S1887-8571(20)07600400254
                10.4321/s1887-85712020000400008
                92d9cc38-e8d8-4514-97b0-3851a5c6db2d

                http://creativecommons.org/licenses/by/4.0/

                History
                : 02 December 2020
                : 22 October 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 11, Pages: 5
                Product

                SciELO Spain

                Categories
                Informe

                surgical,COVID 19,cirugía,intensive care unit,Traqueostomía,unidad de cuidados intensivos,Tracheostomy,COVID-19

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