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      Surgical Tracheostomy Outcomes in COVID-19–Positive Patients

      research-article
      , MSc, MRCS 1 , 2 , , MBBS 2 , 3 , , MB, ChB, FRCA 2 , , MD, FRCA, PhD 2 , 4 *
      OTO Open
      SAGE Publications
      surgical tracheostomy, COVID-19, outcomes

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          Abstract

          Objective

          The aim of this case series was to demonstrate that surgical tracheostomy can be undertaken safely in critically ill mechanically ventilated patients with coronavirus disease 2019 (COVID-19) and that it is an effective weaning tool.

          Study Design

          Retrospective case series.

          Setting

          Single academic teaching hospital in London.

          Methods

          All adult patients admitted to the adult intensive care unit (AICU), diagnosed with severe COVID-19 infection and requiring surgical tracheostomy between the March 10, 2020, and May 1, 2020, were included. Data collection focused upon patient demographics, AICU admission data, tracheostomy-specific data, and clinical outcomes.

          Results

          Twenty patients with COVID-19 underwent surgical tracheostomy. The main indication for tracheostomy was to assist in respiratory weaning. Patients had undergone mechanical ventilation for a median of 16.5 days prior to surgical tracheostomy. Tracheostomy remained in situ for a median of 12.5 days. Sixty percent of patients were decannulated at the end of the data collection period. There were no serious immediate or short-term complications. Surgical tracheostomy facilitated significant reduction in intravenous sedation at 48 hours after tracheostomy formation. There was no confirmed COVID-19 infection or reported sickness in the operating surgical or anesthetic teams.

          Conclusion

          Surgical tracheostomy has been demonstrated to be an effective weaning tool in patients with severe COVID-19 infection.

          Related collections

          Most cited references10

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          Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

          There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19).
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            Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State

            This case series describes the clinical presentation, characteristics, and outcomes of patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit at a public hospital in Washington State in February 2020, including initial reports of cardiomyopathy in one-third of the patients.
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              Tracheostomy: epidemiology, indications, timing, technique, and outcomes.

              Tracheostomy is a common procedure performed in critically ill patients requiring prolonged mechanical ventilation for acute respiratory failure and for airway issues. The ideal timing (early vs late) and techniques (percutaneous dilatational, other new percutaneous techniques, open surgical) for tracheostomy have been topics of considerable debate. In this review, we address general issues regarding tracheostomy (epidemiology, indications, and outcomes) and specifically review the literature regarding appropriate timing of tracheostomy tube placement. Based on evidence from 2 recent large randomized trials, it is reasonable to wait at least 10 d to be certain that a patient has an ongoing need for mechanical ventilation before consideration of tracheostomy. Percutaneous tracheostomy with flexible bronchoscopy guidance is recommended, and optimal percutaneous techniques, indications, and contraindications and results in high-risk patients (coagulopathy, thrombocytopenia, obesity) are reviewed. Additional issues related to tracheostomy diagnosis-related groups, charges, and procedural costs are reviewed. New advances regarding tracheostomy include the use of real-time ultrasound guidance for percutaneous tracheostomy in high-risk patients. New tracheostomy tubes (tapered with low-profile cuffs that fit better on the tapered dilators, longer percutaneous tracheostomy tubes) are discussed for optimal use with percutaneous dilatational tracheostomy. Two new percutaneous techniques, a balloon inflation technique (Dolphin) and the PercuTwist procedure, are reviewed. The efficacy of tracheostomy teams and tracheostomy hospital services with standardized protocols for tracheostomy insertion and care has been associated with improved outcomes. Finally, the UK National Tracheostomy Safety Project developed standardized resources for education of both health care providers and patients, including emergency algorithms for tracheostomy incidents, and serves as an excellent educational resource in this important area.
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                Author and article information

                Journal
                OTO Open
                OTO Open
                OPN
                spopn
                OTO Open
                SAGE Publications (Sage CA: Los Angeles, CA )
                2473-974X
                8 January 2021
                Jan-Mar 2021
                : 5
                : 1
                : 2473974X20984998
                Affiliations
                [1 ]Department of Surgery and Cancer, Imperial College London, London, UK
                [2 ]Chelsea and Westminster NHS Foundation Trust, London, UK
                [3 ]Life Sciences Department, Imperial College London, London, UK
                [4 ]Academic Department of Anaesthesia & Intensive Care Medicine, Chelsea and Westminster Campus, Imperial College London, London, UK
                Author notes
                [*]Alona Courtney, MSc, MRCS, Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Campus, 369 Fulham Road, London SW10 9NH, UK. Email: alona.courtney@ 123456imperial.ac.uk
                [*]

                List of names provided in the online version of the article.

                Article
                10.1177_2473974X20984998
                10.1177/2473974X20984998
                7797581
                a35ecb2a-d3f2-4eb2-9553-47b3aca899fa
                © The Author(s) 2020

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 3 November 2020
                : 9 December 2020
                Categories
                Original Research
                Custom metadata
                January-March 2021
                ts1

                surgical tracheostomy,covid-19,outcomes
                surgical tracheostomy, covid-19, outcomes

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