Percutaneous Tracheostomy With Apnea During Coronavirus Disease 2019 Era: A Protocol and Brief Report of Cases.

Autor:	Niroula A; Section of Interventional Pulmonology, Division of Pulmonary Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA., Van Nostrand KM; Section of Interventional Pulmonology, Division of Pulmonary Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA., Khullar OV; Division of Cardiothoracic Surgery, Emory University, Atlanta, GA., Force S; Division of Cardiothoracic Surgery, Emory University, Atlanta, GA., Jaber WS; Section of Interventional Pulmonology, Division of Pulmonary Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA., Sardi AH; Section of Interventional Pulmonology, Division of Pulmonary Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA., Berkowitz DM; Section of Interventional Pulmonology, Division of Pulmonary Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA.
Jazyk:	angličtina
Zdroj:	Critical care explorations [Crit Care Explor] 2020 May 22; Vol. 2 (5), pp. e0134. Date of Electronic Publication: 2020 May 22 (Print Publication: 2020).
DOI:	10.1097/CCE.0000000000000134
Abstrakt:	Objective: To assess feasibility of modified protocol during percutaneous tracheostomy in coronavirus disease 2019 pandemic era. Design: A retrospective review of cohort who underwent percutaneous tracheostomy with modified protocol. Settings: Medical, surgical, and neurologic ICUs. Subjects: Patients admitted in medical, surgical, and neurologic units with prolonged need of mechanical ventilation or inability to liberate from the ventilator. Interventions: A detailed protocol was written. Steps were defined to be performed before apnea and during apnea. A feasibility study of 28 patients was conducted. The key aerosol-generating portions of the procedure were performed with the ventilator switched to standby mode with the patient apneic. Measurements and Main Results: Data including patient demographics, primary diagnosis, age, body mass index, and duration of apnea time during the tracheostomy were collected. Average ventilator standby time (apnea) during the procedure was 238 seconds (3.96 min) with range 149 seconds (2.48 min) to 340 seconds (5.66 min). Single-use (disposable) bronchoscopes (Ambu A/S [Ballerup, Denmark] or Glidescope [Verathon, Inc., Bothell, WA]) were used during all procedures except in nine. No desaturation events occurred during any procedure. Conclusions: Percutaneous tracheostomy performed with apnea protocol may help minimize aerosolization, reducing risk of exposure of coronavirus disease 2019 to staff. It can be safely performed with portable bronchoscopes to limit staff and minimize the surfaces requiring disinfection post procedure. Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
Databáze:	MEDLINE
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