scholarly journals A study on the Safety of Percutaneous Tracheostomy in Patients with Severe Acute Respiratory Syndrome Novel Corona Virus 2 (SARS-nCoV2) Infection: A Single-center Observational Cohort Study in a CoVID Intensive Care Unit.

2021 ◽  
Author(s):  
Krishna Kumar ◽  
Aditya Joshi ◽  
Ranjith Nair ◽  
Rangraj Setlur ◽  
Rajan Kapoor
Keyword(s):  
Mechanical Ventilation ◽  
Severe Acute Respiratory Syndrome ◽  
Prolonged Mechanical Ventilation ◽  
Percutaneous Tracheostomy ◽  
Invasive Mechanical Ventilation ◽  
Percutaneous Dilatational Tracheostomy ◽  
P Value ◽  
Clinical Criteria ◽  
Fraction Of Inspired Oxygen ◽  
Novel Coronavirus

Abstract Background: We studied the safety of percutaneous dilatational tracheostomy (PCDT) in severe acute respiratory syndrome novel coronavirus 2 (SARS-nCoV2). Patients & Methods: From 01 March 20 to 30 November 2020, 1635 required hospital admission of which 145 (9%) required intensive (ICU) care. The primary outcomes are mortality and secondary outcomes were duration of invasive mechanical ventilation (IMV), length of stay (LOS) in ICU and hospital, & days required for decannulation.Results: Out of the 145 (9%), 107 (73.7%) were males (mean 61.4 years, median body mass index (BMI) of 28.2 kg/m2 ), 38 (26.2%) were females (mean 58.10 years, median BMI of 31.2 kg/m2). In the cohort of 80 (55.17%) requiring IMV, 19 (23.7%) died within 72 hours and were not included in the study, 37 (group “NT”) and 24 (group “T”) had a median duration of ventilation of 9 d (IQR, 6-11) and 12 d (IQR, 11-17.25) respectively. Patients in group “T” underwent PCDT based on clinical criteria (fraction of inspired oxygen (FiO2 ) of ≤ 50% with positive end-expiratory pressure (PEEP) of ≤ 10 cms of H2O with stable hemodynamics), 16 (66.7%) had survived. The reverse transcription-polymerase chain reaction (RT-PCR) does not need to be negative, and none of the health care workers (HCW’s) were infected. The Cox-hazard ratio [HR] is 0.19, 95% Confidence interval [CI] (0.09, 0.41) with a P-value of <0.001, 83 (57.2%) were discharged with a mortality of 42.8%. Conclusions: PCDT is safe and effective in patients anticipated in need of prolonged mechanical ventilation.

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 Safety and outcomes of percutaneous tracheostomy in coronavirus disease 2019 pneumonitis patients requiring prolonged mechanical ventilation

2020 ◽  
pp. 1-10
Author(s):  
A Takhar ◽  
C Tornari ◽  
N Amin ◽  
D Wyncoll ◽  
S Tricklebank ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Multidisciplinary Approach ◽  
Prolonged Mechanical Ventilation ◽  
Percutaneous Tracheostomy ◽  
Univariate Analysis ◽  
Invasive Mechanical Ventilation ◽  
Interquartile Range ◽  
Resource Utilisation ◽  
Healthcare Resource Utilisation

Abstract Objectives Tracheostomy for coronavirus disease 2019 pneumonitis patients requiring prolonged invasive mechanical ventilation remains a matter of debate. This study analysed the timing and outcomes of percutaneous tracheostomy, and reports our experience of a dedicated ENT–anaesthetics department led tracheostomy team. Method A prospective single-centre observational study was conducted of patients undergoing tracheostomy, who had been diagnosed with coronavirus disease 2019 pneumonitis, between 21st March and 20th May 2020. Results Eighty-one patients underwent tracheostomy after a median (interquartile range) of 16 (13–20) days of invasive mechanical ventilation. Median follow-up duration was 32 (23–40) days. Of patients, 86.7 per cent were successfully liberated from invasive mechanical ventilation in a median (interquartile range) of 12 (7–16) days. Moreover, 68.7 per cent were subsequently discharged from hospital. On univariate analysis, there was no difference in outcomes between early (before day 14) and late (day 14 or later) tracheostomy. The mortality rate was 8.6 per cent and no deaths were tracheostomy related. Conclusion Outcomes appear favourable when patients are carefully selected. Percutaneous tracheostomy performed via a multidisciplinary approach, with appropriate training, was safe and optimised healthcare resource utilisation.

scholarly journals Sedation and analgesia in critically ill patients with COVID-19: a cohort retrospective study

2021 ◽  
Keyword(s):  
Mechanical Ventilation ◽  
Retrospective Study ◽  
Deep Sedation ◽  
Invasive Mechanical Ventilation ◽  
Global Pandemic ◽  
Non Invasive Ventilation ◽  
Fraction Of Inspired Oxygen ◽  
Light Sedation ◽  
Novel Coronavirus ◽  
Clinical Conditions

Introduction: The global pandemic of novel coronavirus disease 2019 (COVID-19) began in Wuhan, China in December 2019 and spread worldwide. This retrospective study summarizes clinical experience and analgo-sedation treatment used for this novel epidemic in an Italian ICU between February to May 2020. Methods: This is a retrospective trial of 72 patients with laboratory-confirmed SARS-CoV-2 infection (COVID-19) admitted to ICU between February15, 2020 and May 15, 2020. Main Outcomes are demographic, clinical data (age, sex, medical comorbidities, respiratory supports, positive end-expiratory pressure values (PEEP), fraction of inspired oxygen (FiO2), arterial partial pressure of oxygen (PaO2), sedatives and analgesic drugs, their dosage and way of administration, medical treatments and patients mortality), ventilation strategies, sedation management in ICUs and patient mortality. Results: The mean age of the 72 patients included in the study was 69 years (SD ±12), 77% were male. All patients required respiratory support and sedation management according to different techniques of ventilation: 100% received deep sedation (RASS -4) before intubation and invasive mechanical ventilation and 19% received light sedation (RASS -1) and noninvasive ventilation). Conclusions: Of the 72 patients admitted in ICUs, 92% died. A total of 608 patients admitted to the AORN dei Colli “Naples” with confirmed COVID-19. In this restrospective study we have analyzed 72 (out of 608) patients that were admitted to intensive care due to worsening clinical conditions. All patients required tracheal intubation and mechanical ventilation with deep sedation (RASS -4), while only 19%(patients required light sedation so RASS -1) were subsequentely swiched to light sedation because of the need of compliance with non-invasive ventilation. Sedation was obtained with propofol, remifentanil, midazolam and dexmedetomidine, according to hospital guidelines.

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 Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study

2013 ◽  
pp. 184-188 ◽  
Author(s):  
Alvaro Sanabria ◽  
Ximena Gomez ◽  
Valentin Vega ◽  
Luis Carlos Dominguez ◽  
Camilo Osorio
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Critically Ill ◽  
Medical Condition ◽  
Prolonged Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Adult Patients ◽  
Saps Ii Score

Introduction: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients. Methods: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. Results: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation. Conclusions: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation.

scholarly journals A Technique to Minimize Aerosolization During Percutaneous Tracheostomy in COVID-19 Patients

2020 ◽  
Vol 86 (8) ◽  
pp. 904-906
Author(s):  
Alejandro Betancourt-Ramirez ◽  
Jay A. Yelon ◽  
Paul Boland ◽  
Michael Amaturo
Keyword(s):  
Prolonged Mechanical Ventilation ◽  
Percutaneous Tracheostomy ◽  
Percutaneous Dilatational Tracheostomy ◽  
Case Series ◽  
Surgical Intensive Care Unit ◽  
Surgical Team ◽  
Surgical Intensive Care ◽  
Level Of Evidence ◽  
Dilatational Tracheostomy ◽  
And Performance

Background The SARS-CoV-2 pandemic has caused respiratory failure in many patients. With no effective treatment or vaccine, prolonged mechanical ventilation is common in survivors. Timing and performance of tracheostomy, for both patient and surgical team safety, remains a question. Here within, we report our experience with percutaneous dilatational tracheostomy with modification to minimize aerosolization. Methods A modified percutaneous dilatational tracheostomy technique is described. The technique was performed on 10 patients in the surgical intensive care unit. Results Ten patients underwent percutaneous dilatational tracheostomy. There were 7 males, and the average age for the group was 60.8 years. The average number of ventilator days before the operation was 26.3. All procedures were successful, and no patient had any procedure-related complications. Conclusions The procedure described was successful in our patient population. We believe that this approach is safe for patients with coronavirus disease 2019 and limits aerosolization during the operation. Level of evidence Level IV, case series.

scholarly journals Open Tracheostomy for Critically Ill Patients with COVID-19

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Estefanía Hernández-García ◽  
Mar Martínez-RuizCoello ◽  
Andrés Navarro Mediano ◽  
Nuria Pérez-Martín ◽  
Victoria García-Peces ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Admissions ◽  
Prolonged Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Epidemiological Data ◽  
Orotracheal Intubation ◽  
Safe Procedure ◽  
Before And After ◽  
A Prospective Study ◽  
Mean Time

Background. COVID-19 is a worldwide pandemic, with many patients requiring prolonged mechanical ventilation. Tracheostomy can shorten ICU length of stay and help weaning. Aims/Objectives. To describe the long-term evolution of the critically patient with COVID-19 and the need for invasive mechanical ventilation and orotracheal intubation (OTI), with or without tracheostomy. Material and Methods. A prospective study was performed including all patients admitted to the ICU due to COVID-19 from 10th March to 30th April 2020. Epidemiological data, performing a tracheostomy or not, mean time of invasive mechanical ventilation until tracheotomy, mean time from tracheotomy to weaning, and final outcome after one month of minimum follow-up were recorded. The Otolaryngology team was tested for COVID-19 before and after the procedures. Results. Out of a total of 1612 hospital admissions for COVID-19, only 5.8% (93 patients) required ICU admission and IOT. Twenty-seven patients (29%) underwent a tracheostomy. After three months, within the group of tracheotomized patients, 29.6% died and 48.15% were extubated in a mean time of 28.53 days. In the nontracheostomized patients, the mortality was 42.4%. Conclusions. Tracheostomy is a safe procedure for COVID-19 and helps weaning of prolonged OTI. Mortality after tracheostomy was less common than in nontracheostomized patients.

scholarly journals Post-COVID recovery: characteristics of chronically critically ill patients admitted to a long-term acute care hospital

F1000Research ◽  
2021 ◽  
Vol 9 ◽  
pp. 1241
Author(s):  
Meg Stearn Hassenpflug ◽  
Dale Jun ◽  
David R. Nelson ◽  
Tamas Dolinay
Keyword(s):  
Mechanical Ventilation ◽  
Acute Care ◽  
Prolonged Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Survival Rates ◽  
Acute Care Hospital ◽  
Infectious Complications ◽  
Care Hospital ◽  
Chronic Critical Illness

Background: Survivors of COVID-19 pneumonia often suffer from chronic critical illness (CCI) and require long-term hospitalization. Long-term acute care (LTAC) hospitals are vital in the care of CCI patients, but their role for patients post COVID-19 infection is not known. Barlow Respiratory Hospital (BRH) is a 105-bed, LTAC hospital network serving ventilator-dependent and medically-complex patients transferred from the ICUs of hospitals in southern California. We report patient characteristics of our first series of COVID-19 survivors admitted to the post-acute venue of an LTAC hospital. Methods: Single-center observational descriptive report of patients recovering from acute infectious complications of COVID-19 pneumonia requiring long-term respiratory support. Results: From 28 April to 7 September 2020, 41 patients were admitted to BRH for continued recovery from COVID-19 pneumonia. Median age: 68 [44-94] years, 25/41 (61%) male, 33/41 (80.5%) with tracheostomy, 21/41 (51.2%) on invasive mechanical ventilation, 9/41 (22%) receiving hemodialysis. All mechanical ventilation and hemodialysis interventions were initiated at the transferring hospital. Conclusions: To our knowledge, this is the first report to characterize CCI and medically complex COVID-19 patients transferred to the post-acute venue of an LTAC hospital. Patients on average spent over six weeks in the transferring hospital mostly in the ICU, are largely elderly, carry the known risk factors for COVID-19 infection, and experienced respiratory failure necessitating prolonged mechanical ventilation via tracheostomy. Our findings suggest that these patients will continue to require considerable medical interventions and treatments, including weaning from mechanical ventilation, owing to the numerous sequelae of the infection and the burden of acute-on-chronic diseases. As ICU survival rates improve, this research further emphasizes the important role of the LTAC hospital in responding to the COVID-19 crisis.

scholarly journals Effects of ABCDE Bundle Implementation on Reduction of Delirium among Mechanically Ventilated Patients at Damietta Hospital, Egypt

2021 ◽  
pp. 1-14
Author(s):  
Khalil NS ◽  
El-Kady EM ◽  
Abdel-kader FA ◽  
EL-shafey MM
Keyword(s):  
Mechanical Ventilation ◽  
Prolonged Mechanical Ventilation ◽  
Hospital Length Of Stay ◽  
P Value ◽  
Post Intervention ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Early Exercise ◽  
Abcde Bundle ◽  
Ventilated Patients

Background: One of the principal complications in intensive care unit particularly those connected to mechanical ventilation is delirium. Delirium. It is associated with increased mortality, prolonged mechanical ventilation, and prolonged hospital length of stay (LOS). The ABCDE is a bundle intervention that stands for awakening, breathing coordination, delirium monitoring/management, and early exercise/mobility bundle that has been proposed as a multi-component intervention to reduce the incidence of delirium. Aim of the study: This study aimed to evaluate the effect of implementing the ABCDE bundle on the reduction of delirium among mechanically ventilated patients at Damietta hospital. Material and Methods: A quasi-experimental pre/post-intervention design was used to conduct this study. A purposive sample of 65 adult male and female mechanically ventilated patients aged between 18 and 60 years was recruited. Sedation and Delirium instruments measures were utilized in data collection. Result: significant differences were found in delirium scores among the studied patients (x2= 52.52; p-value=0.001). So, the mechanically ventilated patients who exposed to the implementation of the ABCDE bundle were experienced fewer delirium signs than before the ABCDE bundle implementation. Conclusion: Based on the findings of the current study, it can be concluded ABCDE bundle implementation reduced the occurrence of delirium among mechanically ventilated patients. Recommendations: ABCDE bundle should be recommended on mechanically ventilated patients. Keywords: ABCDE bundle; Mechanically Ventilated Patients; Critically Ill Patients

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