CHEST Annual Meeting
CHEST Annual Meeting
Source/Disclosures
Source:

Illuzzi E, et al. Lessons from the ICU: What have we learned about the management of COVID-19. Presented at: CHEST Annual Meeting 2020; Oct. 18-22, 2020 (virtual meeting).

Disclosures: Illuzzi reports no relevant financial disclosures.
October 26, 2020
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Dedicated tracheostomy team, planning avoided delays in care for COVID-19 pneumonia

Source/Disclosures
Source:

Illuzzi E, et al. Lessons from the ICU: What have we learned about the management of COVID-19. Presented at: CHEST Annual Meeting 2020; Oct. 18-22, 2020 (virtual meeting).

Disclosures: Illuzzi reports no relevant financial disclosures.
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A dedicated tracheostomy team and following standard of care for timing of tracheostomy avoided delaying necessary procedures in patients with COVID-19 pneumonia, without increasing risk for transmission to the care team.

“With the recent COVID-19 pandemic, an unprecedented surge in patients requiring prolonged mechanical ventilation led to an increase in the need for tracheostomies,” Ella Illuzzi, NP, adult care nurse practitioner at Mount Sinai Health System, New York, said during a presentation at the virtual CHEST Annual Meeting. “Tracheostomy is an aerosol-generating procedure that raises potential risk to the proceduralist. Therefore, international professional total laryngology and surgical organizations published guidelines which recommended delaying tracheostomy to after 21 days in order to assure viral clearance prior to the procedure. In the setting of well-intended practice guidelines, intensivists are faced with a new dilemma: following the standard of care for tracheostomy planning vs. delaying the procedure without evidence to support the new recommended guidelines.”

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In April, 111 tracheostomy procedures were performed in patients with COVID-19 pneumonia in nine ICUs by a dedicated, multidisciplinary Institute for Critical Care Medicine tracheostomy team, with experts across departments, including critical care, general surgery, cardiac and thoracic surgery, and otolaryngology. The multidisciplinary team evaluated each patient’s clinical status and discussed wishes after goals of care.

Procedures were conducted within 1 day of tracheostomy request unless delayed by medical instability or revisiting goals of care were needed. Median time from translaryngeal intubation to tracheostomy was 11 days. All cases were performed using a percutaneous dilatational technique with bronchoscopic guidance. Real-time ultrasound guidance was used in patients with difficult anatomical landmarks, according to the abstract.

Of the 111 tracheostomy procedures for COVID-19 prolonged respiratory failure, 35 patients were discharged to home alive, 23 patients were weaned from mechanical ventilation but remained hospitalized on a non-ICU floor, 33 patients died, and 20 patients remained in the ICU or were undergoing active weaning in a designated weaning unit at the time of data collection.

None of the proceduralists tested positive for COVID-19 infection and all tested negative for antibodies.

“This may be due to the thorough procedural planning, adherence to protocols and vigilance in maintaining infection control guidelines,” Illuzzi said.

Illuzzi concluded: “Our results support creating a dedicated tracheostomy team and following standard of care without the need to delay a necessary procedure for COVID-19 pneumonia patients. Furthermore, this is deemed safe when infection control protocols were strictly followed.”

Reference:

Illuzzi E, et al. Chest. 2020;doi:10.1016/j.chest.2020.08.563.