TRACHEOSTOMY AND TRACHEOSTOMY CARE DURING THE COVID-19 PANDEMIC

Year 2020, Volume: 8 Issue: 3, 551 - 556, 20.12.2020

Tolga Ersözlü , Erdoğan Gültekin

https://doi.org/10.37696/nkmj.746867

Abstract

Covid-19 pandemic is a global health problem that affects the whole world and can progress with asymptomatic or viral symptoms of pneumonia or cause severe acute respiratory failure. SARS-CoV-2 has spread much more widely and quickly than other viruses and has caused a significant number of life losses globally. Tracheostomy is a surgical procedure that is frequently performed by ENT and head & neck surgeons with various indications, and its implementation can facilitate weaning patients from mechanical ventilation, thereby potentially increasing the availability of beds in the intensive care unit (ICU). Since tracheostomy causes a large amount of aerosol formation, it is a serious risk process for the spread of covid-19 infection even if personal protective equipment (PPE) is used both during surgery and postoperative care. There is not enough experience on how to perform tracheotomy in Covid-19 patients. Therefore, the surgical procedure and indications for tracheostomy should be revised during the covid-19 pandemic process. We aim to provide authoritative guidance for healthcare providers and healthcare systems by synthesizing our experience with tracheostomy, available evidence, and information in the literature data during the current COVID-19 pandemic.

Keywords

COVİD-19, PANDEMIA, TRACHEOSTOMY, TRACHEOSTOMY CARE

''TRACHEOSTOMY AND TRACHEOSTOMY CARE DURING THE COVID-19 PANDEMIC'', ''COVİD-19 PANDEMİSİ SIRASINDA TRAKEOSTOMİ VE TRAKEOSTOMİ BAKIMI''

Abstract

Abstract
Covid-19 pandemic is a global health problem that affects the whole world and can progress with asymptomatic or viral symptoms of pneumonia or cause severe acute respiratory failure. SARS-CoV-2 has spread much more widely and quickly than other viruses and has caused a significant number of life losses globally. Tracheostomy is a surgical procedure that is frequently performed by ENT and head & neck surgeons with various indications, and its implementation can facilitate weaning patients from mechanical ventilation, thereby potentially increasing the availability of beds in the intensive care unit (ICU). Since tracheostomy causes a large amount of aerosol formation, it is a serious risk process for the spread of covid-19 infection even if personal protective equipment (PPE) is used both during surgery and postoperative care. There is not enough experience on how to perform tracheotomy in Covid-19 patients. Therefore, the surgical procedure and indications for tracheostomy should be revised during the covid-19 pandemic process. We aim to provide authoritative guidance for healthcare providers and healthcare systems by synthesizing our experience with tracheostomy, available evidence, and information in the literature data during the current COVID-19 pandemic.
Özet
Covid-19 pandemisi tüm dünyayı etkisi altına alan, asemptomatik veya viral pnömoni semptomlarıyla seyredebileceği gibi ciddi akut solunum yetmezliğine de neden olabilen global bir sağlık problemidir. SARS-CoV-2, diğer virüslerden çok daha geniş ve hızlı bir şekilde yayılmıştır ve küresel olarak ciddi sayıda hayat kaybına yol açmıştır. Trakeostomi, KBB ve baş-boyun cerrahları tarafından çeşitli endikasyonlarla sıkça gerçekleştirilen cerrahi bir prosedürdür ve bu prosedürün uygulanması hastaları mekanik ventilasyondan ayırmayı kolaylaştırabilir ve böylece yoğun bakım ünitesindeki (YBÜ) yatakların kullanabilirliğini potansiyel olarak artırabilir. Trakeostomi yüksek miktarda aerosol oluşumuna neden olduğu için hem cerrahi sırasında hem de cerrahi sonrası bakım sırasında kişisel koruyucu ekipman (KKE) kullanılsa bile covid-19 enfeksiyonu yayılımı için ciddi risk oluşturan bir işlemdir. Covid-19 hastalarında trakeotominin nasıl yapılması gerektiği konusunda yeterli deneyim mevcut değildir.Bu yüzden covid-19 pandemisi sürecinde trakeostomi cerrahi prosedürü ve endikasyonları yeniden gözden geçirilmelidir. Mevcut COVID-19 pandemisi sırasında trakeostomi ile ilgili deneyimlerimizi, mevcut kanıtları ve literatürdeki bilgileri sentezleyerek sağlık hizmeti sağlayıcıları ve sağlık sistemleri için yetkili rehberlik sağlamayı amaçlıyoruz.

Keywords

Covid-19, Pandemi, TRACHEOSTOMY, TRACHEOSTOMY CARE

References

• REFERANSLAR [1] Ge, H., Wang, X., Yuan, X., Xiao, G., Wang, C., Deng, T., ... & Xiao, X. (2020). The epidemiology and clinical information about COVID-19. European journal of clinical microbiology & infectious diseases: official publication of the European Society of Clinical Microbiology, 39(6), 1011-9. [2] Shiba, T., Ghazizadeh, S., Chhetri, D., St John, M., & Long, J. (2020). Tracheostomy Considerations during the COVID-19 Pandemic. OTO open, 4(2), 2473974X20922528. [3] van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1564‐1567. doi:10.1056/NEJMc2004973. [4] Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012; 7: e35797. [5] Chu J, Yang N, Wei Y, et al. Clinical characteristics of 54 medicalstaff with COVID-19: a retrospective study in a single center inWuhan, China. J Med Virol 2020; published online March 29. DOI:10.1002/jmv.25793. [6] Mehta AB, Syeda SN, Bajpayee L, Cooke CR, Walkey AJ, Wiener RS. Trends in tracheostomy for mechanically ventilated patients in the United States. Am J Respir Crit Care Med 2015;192: 446–54. [7] Hosokawa K, Nishimura M, Egi M, Vincent J-L. Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials. Crit Care 2015; 19: 424–12. [8] Vargas M, Sutherasan Y, Brunetti I, et al. Mortality and long-term quality of life after percutaneous tracheotomy in intensive care unit: a prospective observational study. Minerva Anestesiol 2018; 84: 1024–31. [9] Zou L, Ruan F, Huang M, et al. SARS-CoV-2 viral load in upper respiratory specimens of infected patients. N Engl J Med 2020;382: 1177–79. [10] Chen C, Gao G, Xu Y, et al. SARS-CoV-2-positive sputum and feces after conversion of pharyngeal samples in patients with COVID-19. Ann Intern Med 2020; published online March 30. DOI:10.7326/M20-0991. [11] Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708–20. [12] Zhao J, Yuan Q, Wang H, et al. Antibody responses to SARS-CoV-2 in patients of novel coronavirus disease 2019. Clin Infect Dis 2020; published online March 28. DOI:10.1093/cid/ciaa344. [13] Wölfel R, Corman VM, Guggemos W, et al. Virological assessment of hospitalized patients with COVID-2019. Nature 2020; published online April 1. DOI:10.1038/s41586-020-2196-x. [14] Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA 2020; 323: 1545. [15] Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506. [16] Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a singlecentered, retrospective, observational study. Lancet Respir Med 2020;8: 475–81. [17] Young BE, Ong SWX, Kalimuddin S, et al. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 inSingapore. JAMA 2020; 323: 1488–94. [18] Mc Grath BA, Brenner MJ, Warillow SJ et al.Tracheostomy in the COVID-19 era: global and multidisciplinary guidance. Lancet Respir. Med. 2020 May 15 doi: 10.1016/S2213-2600(20)30230-7 [Epub ahead of print] [19] Marini JJ, Gattinoni L. Management of COVID-19 respiratory distress. JAMA 2020; published online April 24. DOI:10.1001/jama.2020.6825. [20] Takhar, A., Walker, A., Tricklebank, S., Wyncoll, D., Hart, N., Jacob, T., ... & Surda, P.(in press). Recommendation of a practical guideline for safe tracheostomy during the COVID-19 pandemic. European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. doi:10.1007/s00405-020-05993-x. [21] Heyd, C.P., Desiato, V.M., Nguyen, S.A., O'Rourke, A.K., Clemmens, C.S., Awad, M.I., ... & Day, T.A. (in press). Tracheostomy protocols during COVID-19 pandemic. Head & neck. doi:10.1002/hed.26192. [22] David AP, Russell MD, El-Sayed IH, Russell MS. (in press). Tracheostomy guidelines developed at a large academic medical center during the COVID-19 pandemic. Head & neck. doi:10.1002/hed.26191. [23] Pichi, B., Mazzola, F., Bonsembiante, A., Petruzzi, G., Zocchi, J., Moretto, S., ... & Pellini, R. (2020). CORONA-steps for tracheotomy in COVID-19 patients: A staff-safe method for airway management. Oral oncology, 105, 104682. [24] NTSP considerations for tracheostomy in the Covid-19 outbreak. National Tracheostomy Safety Project. 2020. https://d3n8a8pro7vhmx.cloudfront.net/gtc/pages/1/attachments/original/1584713595/NTSP-COVID-19-tracheostomy-guidance-20-Mar-2020.pdf?1584713595. [25] Botti, C., Lusetti, F., Castellucci, A., Costantini, M., & Ghidini, A.(in press). Safe tracheotomy for patients with COVID-19. American journal of otolaryngology. doi:10.1016/j.amjoto.2020.102533. [26] McGrath BA, Lynch K, Templeton R, et al. Assessment of scoring systems to describe the position of tracheostomy tubes within the airway – the lunar study. Br J Anaesthesia 2017; 118: 132–38. [27] Tien HC, Chughtai T, Jogeklar A, Cooper AB, Brenneman F. Elective and emergency surgery in patients with severe acute respiratory syndrome (SARS). Can J Surg 2005; 48: 71–74. [28] Chee VW, Khoo ML, Lee SF, Lai YC, Chin NM. Infection control measures for operative procedures in severe acute respiratory syndrome-related patients. Anesthesiology 2004; 100: 1394–98. [29] Tay JK, Khoo ML, Loh WS. Surgical Considerations for Tracheostomy During the COVID-19 Pandemic: Lessons Learned From the Severe Acute Respiratory Syndrome Outbreak. JAMA Otolaryngol Head Neck Surg. Published online March 31, 2020. doi:10.1001/jamaoto.2020.0764. [30] Harrison L, Ramsden J, Winter S, Rocke J, Heward E. Guidance for surgical tracheostomy and tracheostomy tube change during the COVID-19 pandemic. London: ENTUK, March 19, 2020. https://www.entuk.org/tracheostomy-guidance-during-covid-19- pandemic (accessed April 12, 2020). [31] Chan JYK, Wong EWY, Lam W. Practical aspects of otolaryngologic clinical services during the 2019 novel coronavirus epidemic: an experience in Hong Kong. JAMA Otolaryngol Head Neck Surg2020; published online March 20. DOI:10.1001/jamaoto.2020.0488. [32] Brusasco C, Corradi F, Vargas M, et al. In vitro evaluation of heat and moisture exchangers designed for spontaneously breathing tracheostomized patients. Respir Care 2013; 58: 1878–85.