ResearchPad - airway-management Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Tracheostomy guidelines developed at a large academic medical center during the COVID‐19 pandemic]]> During the SARS‐CoV‐2 pandemic, tracheostomy may be required for COVID‐19 patients requiring long‐term ventilation in addition to other conditions such as airway compromise from head and neck cancer. As an aerosol‐generating procedure, tracheostomy increases the exposure of health care workers to COVID‐19 infection. Performing surgical tracheostomy and tracheostomy care requires a strategy that mitigates these risks and maintains the quality of patient care.MethodsThis study is a multidisciplinary review of institutional tracheostomy guidelines and clinical pathways. Modifications to support clinical decision making in the context of COVID‐19 were derived by consensus and available evidence.ResultsModified guidelines for all phases of tracheostomy care at an academic tertiary care center in the setting of COVID‐19 are presented.DiscussionDuring the various phases of the COVID‐19 pandemic, clinicians must carefully consider the indications, procedural precautions, and postoperative care for tracheostomies. We present guidelines to mitigate risk to health care workers while preserving the quality of care. ]]> <![CDATA[Tracheostomy protocols during COVID‐19 pandemic]]> The COVID‐19 pandemic has resulted in the implementation of rapidly changing protocols and guidelines related to the indications and perioperative precautions and protocols for tracheostomy. The purpose of this study was to evaluate current guidelines for tracheostomy during the COVID‐19 pandemic to provide a framework for health systems to prepare as the science evolves over the upcoming months and years.MethodsLiterature review was performed. Articles reporting clinical practice guidelines for tracheostomy in the context of COVID‐19 were included.ResultsA total of 13 tracheotomy guidelines were identified. Two were available via PubMed, five in society or organization websites, and six identified via health system websites or other sources. Five were from Otolaryngology‐Head and Neck Surgery specialties, six from Anesthesiology and one from Pulmonary/Critical Care. All (100%) studies recommended postponing elective OR cases in COVID‐19 positive patients, while seven recommended reducing team members to only essential staff and three recommended forming a designated tracheostomy team. Recommendations with supporting references are summarized in the article.ConclusionsTracheostomy guidelines during the COVID‐19 pandemic vary by physician groups and specialty, hospital systems, and supply‐chain/resource availability. This summary is provided as a point‐in‐time current state of the guidelines for tracheotomy management in April 2020 and is expected to change in coming weeks and months as the COVID‐19 pandemic, virus testing and antibody testing evolves. ]]> <![CDATA[Tracheostomy during SARS‐CoV‐2 pandemic: Recommendations from the New York Head and Neck Society]]> The rapid spread of SARS‐CoV‐2 in 2019 and 2020 has resulted in a worldwide pandemic characterized by severe pulmonary inflammation, effusions, and rapid respiratory compromise. The result of this pandemic is a large and increasing number of patients requiring endotracheal intubation and prolonged ventilator support. The rapid rise in endotracheal intubations coupled with prolonged ventilation requirements will certainly lead to an increase in tracheostomy procedures in the coming weeks and months. Performing tracheostomy in the setting of active SARS‐CoV‐2, when necessary, poses a unique situation, with unique risks and benefits for both the patient and the health care providers. The New York Head and Neck Society has collaborated on this document to provide guidance on the performance of tracheostomies during the SARS‐CoV‐2 pandemic.

<![CDATA[Glottic visibility for laryngeal surgery: Tritube vs. microlaryngeal tube]]>


Good visibility is essential for successful laryngeal surgery. A Tritube with outer diameter 4.4 mm, combined with flow-controlled ventilation (FCV), enables ventilation by active expiration with a sealed trachea and may improve laryngeal visibility.


We hypothesised that a Tritube with FCV would provide better laryngeal visibility and surgical conditions for laryngeal surgery than a conventional microlaryngeal tube (MLT) with volume-controlled ventilation (VCV).


Randomised, controlled trial.


University Medical Centre.


A total of 55 consecutive patients (>18 years) undergoing elective laryngeal surgery were assessed for participation, providing 40 evaluable data sets with 20 per group.


Random allocation to intubation with Tritube and ventilation with FCV (Tritube–FCV group) or intubation with MLT 6.0 and ventilation with VCV (MLT–VCV) as control. Tidal volumes of 7 ml kg−1 predicted body weight, and positive end-expiratory pressure of 7 cmH2O were standardised between groups.


Primary endpoint was the tube-related concealment of laryngeal structures, measured on videolaryngoscopic photographs by appropriate software. Secondary endpoints were surgical conditions (categorical four-point rating scale), respiratory variables and change of end-expiratory lung volume from atmospheric airway pressure to ventilation with positive end-expiratory pressure. Data are presented as median [IQR].


There was less concealment of laryngeal structures with the Tritube than with the MLT; 7 [6 to 9] vs. 22 [18 to 27] %, (P < 0.001). Surgical conditions were rated comparably (P = 0.06). A subgroup of residents in training perceived surgical conditions to be better with the Tritube compared with the MLT (P = 0.006). Respiratory system compliance with the Tritube was higher at 61 [52 to 71] vs. 46 [41 to 51] ml cmH2O−1 (P < 0.001), plateau pressure was lower at 14 [13 to 15] vs. 17 [16 to 18] cmH2O (P < 0.001), and change of end-expiratory lung volume was higher at 681 [463 to 849] vs. 414 [194 to 604] ml, (P = 0.023) for Tritube–FCV compared with MLT–VCV.


During laryngeal surgery a Tritube improves visibility of the surgical site but not surgical conditions when compared with a MLT 6.0. FCV improves lung aeration and respiratory system compliance compared with VCV.