A Systematic Review on Tracheostomy in COVID-19 Patients: Current Guidelines and Safety Measures
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A Systematic Review on Tracheostomy in COVID-19 Patients: Current Guidelines and Safety Measures Amitabha Mandal1 • Sourabh Nandi1 Mukurdipi Ray1
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Madiwalesh Chhebbi1 • Abhijit Basu2
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Received: 25 August 2020 / Accepted: 14 September 2020 Ó Association of Otolaryngologists of India 2020
Abstract At this moment the world is fighting with COVID-19 pandemic. Because of increasing number of critical cases, the ICU admissions are also increasing and overwhelming the hospital. These group of patients often required Tracheostomy for proper management and ventilation. As Surgeons we often required to examine and perform procedures in head and neck patients and are in high risk of exposure to aerosol and droplet contamination. We did a literature search for research regarding tracheostomy and its post procedure care during the ongoing COVID-19 pandemic. In this review various international guidelines and sources were put together, and we aim to summarize in a systematic way the available recommendations: indications, timing, technique and safety measures for tracheostomy for COVID-19 patients, from all over the world. Keywords COVID-19 Tracheostomy Coronavirus SARS-CoV-2 Guidelines
& Sourabh Nandi [email protected] Amitabha Mandal [email protected] Madiwalesh Chhebbi [email protected] Abhijit Basu [email protected] Mukurdipi Ray [email protected] 1
Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
2
Military Hospital, Jalandhar, India
Introduction First described case of coronavirus was identified in the Hubei region of China in December 2019, since then Coronavirus has been spreading rapidly across countries. World Health Organization (WHO) declared the SARSCoV-2 (COVID-19) a pandemic due to the increasing number of cases around the world on March 11th 2020. Most of the people who contracted COVID-19 presented with mild symptoms (80.9%), and according to WHO study approximately 14% patients develop severe disease [1, 2]. Patients who reach the severity of the disease and ICU requirement, the prognosis remains poor. Clinically patients affected by coronavirus shows symptoms associated with viral pneumonia, most commonly fever, cough, sore throat, myalgia, and fatigue [3–5]. Patients who develop severe disease are hypothesized to cause classic acute respiratory distress syndrome (ARDS) has led to the use of mechanical ventilation which is a matter of concern [6]. There are evidences that patients with mechanical ventilation have 100% mortality [7]. The timely intervention in the form of endotracheal intubation can be lifesaving but it has been seen that prolong ventilation and proper weaning can be difficult with endotracheal intubation. Hence in these patient tracheostomies becomes a necessary tool [8]. However it is an aerosol generating procedure and care must be taken to avoid contracting infection to the surgeon, critical care intensivist and other health care staffs. Surgical tracheostomy is relatively safer when done on sedat
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