scholarly journals Outcomes of Percutaneous Tracheostomy for Patients with SARS-CoV-2 Respiratory Failure

2021 ◽  
Author(s):  
Jason Arnold ◽  
Catherine A. Gao ◽  
Elizabeth Malsin ◽  
Kristy Todd ◽  
A. Christine Argento ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Median Time ◽  
Prolonged Mechanical Ventilation ◽  
Percutaneous Tracheostomy ◽  
Tertiary Care ◽  
Severe Respiratory Failure ◽  
Spearman Correlation ◽  
Early Tracheostomy ◽  
Lengths Of Stay

ABSTRACTBackgroundSARS-CoV-2 can cause severe respiratory failure leading to prolonged mechanical ventilation. Data are just emerging about the practice and outcomes of tracheostomy in these patients. We reviewed our experience with tracheostomies for SARS-CoV-2 at our tertiary-care, urban teaching hospital.MethodsWe reviewed the demographics, comorbidities, timing of mechanical ventilation, tracheostomy, and ICU and hospital lengths-of-stay (LOS) in SARS-CoV-2 patients who received tracheostomies. Early tracheostomy was considered <14 days of ventilation. Medians with interquartile ranges (IQR) were calculated and compared with Wilcoxon rank sum, Spearman correlation, Kruskal-Wallis, and regression modeling.ResultsFrom March 2020 to January 2021, our center had 370 patients intubated for SARS-CoV-2, and 59 (16%) had percutaneous bedside tracheostomy. Median time from intubation to tracheostomy was 19 (IQR 17 – 24) days. Demographics and comorbidities were similar between early and late tracheostomy, but early tracheostomy was associated with shorter ICU LOS and a trend towards shorter ventilation. To date, 34 (58%) of patients have been decannulated, 17 (29%) before hospital discharge; median time to decannulation was 24 (IQR 19-38) days. Decannulated patients were younger (56 vs 69 years), and in regression analysis, pneumothorax was associated was associated with lower decannulation rates (OR 0.05, 95CI 0.01 – 0.37). No providers developed symptoms or tested positive for SARS-CoV-2.ConclusionsTracheostomy is a safe and reasonable procedure for patients with prolonged SARS-CoV-2 respiratory failure. We feel that tracheostomy enhances care for SARS-CoV-2 since early tracheostomy appears associated with shorter duration of critical care, and decannulation rates appear high for survivors.

scholarly journals Surgical tracheostomy in a cohort of COVID-19 patients

HNO ◽  
2021 ◽  
Author(s):  
Patrick J. Schuler ◽  
Jens Greve ◽  
Thomas K. Hoffmann ◽  
Janina Hahn ◽  
Felix Boehm ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Prolonged Mechanical Ventilation ◽  
Tertiary Care ◽  
Lung Compliance ◽  
Hypoxemic Respiratory Failure ◽  
Surgical Tracheostomy ◽  
Increased Risk ◽  
Open Surgical Tracheostomy ◽  
Sedative Drugs

Abstract Background One of the main symptoms of severe infection with the new coronavirus‑2 (SARS-CoV-2) is hypoxemic respiratory failure because of viral pneumonia with the need for mechanical ventilation. Prolonged mechanical ventilation may require a tracheostomy, but the increased risk for contamination is a matter of considerable debate. Objective Evaluation of safety and effects of surgical tracheostomy on ventilation parameters and outcome in patients with COVID-19. Study design Retrospective observational study between March 27 and May 18, 2020, in a single-center coronavirus disease-designated ICU at a tertiary care German hospital. Patients Patients with COVID-19 were treated with open surgical tracheostomy due to severe hypoxemic respiratory failure requiring mechanical ventilation. Measurements Clinical and ventilation data were obtained from medical records in a retrospective manner. Results A total of 18 patients with confirmed SARS-CoV‑2 infection and surgical tracheostomy were analyzed. The age range was 42–87 years. All patients received open tracheostomy between 2–16 days after admission. Ventilation after tracheostomy was less invasive (reduction in PEAK and positive end-expiratory pressure [PEEP]) and lung compliance increased over time after tracheostomy. Also, sedative drugs could be reduced, and patients had a reduced need of norepinephrine to maintain hemodynamic stability. Six of 18 patients died. All surgical staff were equipped with N99-masks and facial shields or with powered air-purifying respirators (PAPR). Conclusion Our data suggest that open surgical tracheostomy can be performed without severe complications in patients with COVID-19. Tracheostomy may reduce invasiveness of mechanical ventilation and the need for sedative drugs and norepinehprine. Recommendations for personal protective equipment (PPE) for surgical staff should be followed when PPE is available to avoid contamination of the personnel.

Impact of early tracheotomy for successful prognosis of patients

2020 ◽  
Vol 7 (4) ◽  
pp. 261-266
Author(s):  
Mateusz Lech ◽  
Paulina Bakier ◽  
Sylwia Jabłońska ◽  
Rafał Milewski ◽  
Emilia Duchnowska ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Prolonged Mechanical Ventilation ◽  
Intensive Therapy ◽  
University Hospital ◽  
Individual Treatment ◽  
Clinical Issue ◽  
Early Tracheostomy ◽  
Risk Of Death

Introduction: Complications associated with intra-hospital infections are an important clinical issue determining the further condition of hospitalized patients. One of the most invasive and of high risk of complications in ICU conditions is the otolaryngological procedure of opening the anterior wall of the trachea, aimed at introducing the tube into the lumen of the respiratory tract, enabling subsequent ventilation. Epidemiological data indicate that in Poland the percentage of patients admitted to the ICU annually, due to respiratory failure, who require the implementation of mechanical ventilation reaches 74%, where 41% is qualified for prolonged ventilation and requires a tracheostomy. The aim: The epidemiological analysis of patients under the care of the Department of Anaesthesiology and Intensive Care of University Hospital in Bialystok. Particular attention was paid to patients who underwent tracheostomy. Material and methods: The study material was collected based on the analysis of the patient’s individual treatment process cards, the results of microbiological tests functioning in the Department of Anaesthesiology and Intensive Therapy of the University Hospital in Bialystok. 115 patients were qualified for the study, including 48 women and 67 men. Results: Retrospective studies were based on medical records of 115 patients treated in the Intensive Care Unit of the Department of Anaesthesiology and Intensive Care, University Hospital in Bialystok in 2017-2018. The analysis involved patients after tracheostomy tube implementation, 48 were women and 67 men. Among the analyzed cases, 53 deaths (46.1%) occurred, and 62 subjects were discharged from the ICU (53.9%). Conclusions: Early tracheostomy significantly improved patients’ prognosis and reduced the risk of death. Cardio-respiratory failure with respiratory arrest may often be associated with the need for prolonged mechanical ventilation applied in patients with the aforementioned disease. Therefore, prevention in the form of early tracheostomy is important.

scholarly journals Combined Percutaneous Tracheostomy and Endoscopic Gastrostomy Tubes in COVID-19: A Prospective Series of Patient Outcomes

2021 ◽  
Vol 36 (11) ◽  
pp. 1340-1346
Author(s):  
Catherine L. Oberg ◽  
Colleen Keyes ◽  
Tanmay S. Panchabhai ◽  
Muhammed Sajawal Ali ◽  
Scott S. Oh ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Critically Ill ◽  
Prolonged Mechanical Ventilation ◽  
Percutaneous Tracheostomy ◽  
Healthcare Providers ◽  
Tube Placement ◽  
Time To Event ◽  
Endoscopic Gastrostomy ◽  
Gastrostomy Tube Placement

Background: A significant number of patients with severe respiratory failure related to COVID-19 require prolonged mechanical ventilation. Minimal data exists regarding the timing, safety, and efficacy of combined bedside percutaneous tracheostomy and endoscopy gastrostomy tube placement in these patients. The safety for healthcare providers is also in question. This study's objective was to evaluate the effectiveness and safety of combined bedside tracheostomy and gastrostomy tube placement in COVID-19 patients. Design and Methods: This is a single arm, prospective cohort study in patients with COVID-19 and acute respiratory failure requiring prolonged mechanical ventilation who underwent bedside tracheostomy and percutaneous endoscopic gastrostomy placement. Detailed clinical and procedural data were collected. Descriptive statistics were employed and time to event curves were estimated and plotted using the Kaplan Meier method for clinically relevant prespecified endpoints. Results: Among 58 patients, the median total intensive care unit (ICU) length of stay was 29 days (24.7-33.3) with a median of 10 days (6.3-13.7) postprocedure. Nearly 88% of patients were weaned from mechanical ventilation postprocedure at a median of 9 days (6-12); 94% of these were decannulated. Sixty-day mortality was 10.3%. Almost 90% of patients were discharged alive from the hospital. All procedures were done at bedside with no patient transfer required out of the ICU. A median of 3.0 healthcare personnel total were present in the room per procedure. Conclusion: This study shows that survival of critically ill COVID-19 patients after tracheostomy and gastrostomy was nearly 90%. The time-to-event curves are encouraging regarding time to weaning, downsizing, decannulation, and discharge. A combined procedure minimizes the risk of virus transmission to healthcare providers in addition to decreasing the number of anesthetic episodes, transfusions, and transfers patients must undergo. This approach should be considered in critically ill COVID-19 patients requiring prolonged mechanical ventilation.

scholarly journals Incidence of ventilator associated pneumonia in tracheostomised and non tracheostomised patients

2018 ◽  
Vol 6 (8) ◽  
pp. 2754
Author(s):  
David D. M. Rosario ◽  
Anitha Sequeira
Keyword(s):  
Mechanical Ventilation ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Ventilator Associated Pneumonia ◽  
Care Hospital ◽  
Early Tracheostomy ◽  
Hospital Acquired Infection ◽  
Total Incidence ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Background: Pneumonia is the most common hospital acquired infection in the intensive care unit. One of the causes for hospital acquired pneumonia is ventilator associated pneumonia. Tracheostomy is known to prevent occurrence of ventilator associated pneumonia as it decreases the respiratory dead space, assists in better clearance of secretions and prevents chances of aspiration. Generally, tracheostomy is done after 2 weeks of endotracheal intubation to prevent tracheal complications. The aim of this study is to identify the incidence of ventilator associated pneumonia in tracheostomised and non tracheostomised patients and to see if early tracheostomy can prevent development of ventilator associated pneumonia.Methods: The study was conducted at a tertiary care hospital during a period of four years. 100 patients who were on mechanical ventilation for more than 7 days where taken up for the study. APACHE 4 scoring system was used. The incidence of Ventilator associated pneumonia in tracheostomised and non tracheostomised patients was studied.Results: In our study the total incidence of VAP was 44 %. In our study out of the 42 patients who had undergone tracheostomy 13 (30.95%) patients had ventilator associated pneumonia. Among the non-tracheostomised patients 31 (53.44%) out of 58 patients developed ventilator associated pneumonia. In our study the incidence of ventilator associated pneumonia was much lesser (12%) in patients who underwent tracheostomy in the period 7 to 10 days after mechanical ventilation, whereas in those who underwent tracheostomy after 11 days incidence of ventilator associated pneumonia was much higher.Conclusions: Our study showed that the incidence of ventilator associated pneumonia was much higher among non tracheostomised patients compared to patients who underwent tracheostomy. Hence patients undergoing earlier tracheostomy had a clear advantage than those undergoing tracheostomy late or non tracheostomised patients in preventing ventilator associated pneumonia.

scholarly journals Prone Position after Liberation from Prolonged Mechanical Ventilation in COVID-19 Respiratory Failure

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Andrei Karpov ◽  
Anish R. Mitra ◽  
Sarah Crowe ◽  
Gregory Haljan
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Respiratory Rate ◽  
Prolonged Mechanical Ventilation ◽  
Case Series ◽  
Prone Positioning ◽  
Retrospective Case ◽  
Number Of Patients

Objective and Rationale. Prone positioning of nonintubated patients has prevented intubation and mechanical ventilation in patients with respiratory failure from coronavirus disease 2019 (COVID-19). A number of patients in a recently published cohort have undergone postextubation prone positioning (PEPP) following liberation from prolonged mechanical ventilation in attempt to prevent reintubation. The objective of this study is to systematically search the literature for reports of PEPP as well as describe the feasibility and outcomes of PEPP in patients with COVID-19 respiratory failure. Design. This is a retrospective case series describing the feasibility and tolerability of postextubation prone positioning (PEPP) and its impact on physiologic parameters in a tertiary intensive care unit during the COVID-19 pandemic. Setting and Patients. This study was conducted on patients with COVID-19 respiratory failure hospitalized in a tertiary Intensive Care Unit at Surrey Memorial Hospital during the COVID-19 pandemic. Measurements and Results. We did not find prior reports of PEPP following prolonged intubation in the literature. Four patients underwent a total of 13 PEPP sessions following liberation from prolonged mechanical ventilation. Each patient underwent a median of 3 prone sessions (IQR: 2, 4.25) lasting a median of 1.5 hours (IQR: 1.2, 2.1). PEPP sessions were associated with a reduction in median oxygen requirements, patient respiratory rate, and reintubation rate. The sessions were well tolerated by patients, nursing, and the allied health team. Conclusions. The novel practice of PEPP after liberation from prolonged mechanical ventilation in patients with COVID-19 respiratory failure is feasible and well tolerated, and may be associated with favourable clinical outcomes including improvement in oxygenation and respiratory rate and a low rate of reintubation. Larger prospective studies of PEPP are warranted.

scholarly journals The percutaneous dilatational tracheostomy in the intensive care unit - our experience

2018 ◽  
Vol 71 (suppl. 1) ◽  
pp. 77-82
Author(s):  
Vladimir Dolinaj ◽  
Sanja Milosev ◽  
Gordana Jovanovic ◽  
Ana Andrijevic ◽  
Nensi Lalic ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Prothrombin Time ◽  
Prolonged Mechanical Ventilation ◽  
Percutaneous Tracheostomy ◽  
Percutaneous Dilatational Tracheostomy ◽  
Seldinger Technique ◽  
Dilatational Tracheostomy ◽  
Tracheal Cannula

Percutaneous tracheostomy is a commonly carried out procedure in patients in the Intensive Care Unit. Percutaneous dilatational tracheostomy consists of the introduction of a tracheal cannula from the front of the neck, through blunt dissection of the pretracheal tissues, using a guide by Seldinger technique. When percutaneous dilatational tracheostomy procedure was introduced in routine clinical practice in the Clinical Center of Vojvodina, procedural protocol was established. This Protocol includes: 1. indications, contraindications and timing for percutaneous dilatational tracheostomy, 2. assessment of the patient, 3. preparation of the patient and equipment, 4. procedure description, 5. potential complications and complication management. At our institution percutaneous dilatational tracheostomy is performed on an individual patient basis assessment within 5-7 days following translaryngeal intubation. Routinely the platelet count, activated prothrombin time and prothrombin time are checked. The patient?s neck is assessed clinicaly and by the use of fiberoptic bronchoscope and ultrasound. At our institution we use the modified Ciaglia technique of the percutaneous dilatational tracheostomy-Ciaglia Single Dilatator method with the TRACOE? experc Set vario which includes spiral rein?forced tracheal cannula. At the end of procedure fiberoptic evaluation of the tracheobroinchial tree is made and chest X-ray is done. Percutaneous dilatational tracheostomy is a simple, safe, and effective procedure performed in the Intensive Care Unit. It is the preferred technique of airway management in the Intensive Care Units in the patients requiring prolonged mechanical ventilation, tracheobronchial hygiene and weaning from mechanical ventilation.

scholarly journals Postoperative Phrenic Nerve Palsy, A Cause Of Prolonged Mechanical Ventilation In Trans-Sternal Thymectomy

2015 ◽  
Vol 3 (3) ◽  
pp. 122-125
Author(s):  
Mona Sharma
Keyword(s):  
Mechanical Ventilation ◽  
Respiratory Failure ◽  
Myasthenia Gravis ◽  
Phrenic Nerve ◽  
Nerve Palsy ◽  
Prolonged Mechanical Ventilation ◽  
Myasthenic Crisis ◽  
Phrenic Nerve Palsy ◽  
Thoracic Epidural ◽  
Grade Iii

Post trans-sternal thymectomy, the patient may develop respiratory failure, usually due to myasthenic crisis or cholinergic crisis. These crises may prolong mechanical ventilation and impede on-table extubation. We report a case of respiratory failure due to unilateral phrenic nerve palsy in a case of myasthenia gravis. A 35 year old female, known case of myasthenia gravis was posted for trans-sternal thymectomy. Anaesthesia was induced with Propofol, Fentanyl and low dose of Atracurium. Thymoma was incasing right subclavian vein and was adherent with the pericardium, Masaoka Grade III. Blood loss was approximately 200ml. Immediate post operative period showed low tidal volume, tachypnea and tachycardia in spite of train of four ratio >0.9. Patient was kept intubated with suspicion of myasthenic crisis and the dose of Pyridostigmine was increased, but this lead to increased cholinergic symptoms. Pain was addressed with thoracic epidural analgesia. Chest radiograph done later in the evening showed elevated right hemi diaphragm, thereby, confirming the diagnosis of phrenic nerve palsy.   Difficult dissection in this case has resulted in right phrenic nerve palsy. Phrenic nerve palsy has to be considered as a cause of respiratory failure post sternotomy thymectomy, especially in case of Masaoka grade III and IV.DOI: http://dx.doi.org/10.3126/jkmc.v3i3.12249Journal of Kathmandu Medical CollegeVol. 3, No. 3, Issue 9, Jul.-Sep., 2014, Page: 122-125

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