No1-2(3) 2020
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DOI 10.37219/2528-8253-2020-1-33 |
Shchuruk OZ, Shchuruk GZ, Marunchak AM
Our algorithms for organizing and performing tracheostomy of COVID-19
patients who are put on a prolonged invasive artificial ventilation |
Shchuruk Olexander Z.
Volyn Regional Clinical Hospital (Lutsk)
sashashchuruk@gmail.com
Shchuruk Georgy Z.
Volyn Regional Clinical Hospital (Lutsk)
georgeshchuruk@gmail.com |
Abstract
The coronavirus COVID-19 pandemic, caused by virus SARS-CoV-2, is the
greatest challenge of modern healthcare. The COVID-19 pandemic is changing
the common medical and surgical approaches to the general procedures, some
of them are radically modified to facilitate safety and minimize the risk of
viral spread. So, there is great controversy around the role of tracheostomy
as a part of the treatment process of COVID-19 patients.
Severe acute respiratory infection, caused by coronavirus SARS-CoV-2, is
characterized by the rapid respiratory decompensation. Statistical
calculation shows that 3-17% of hospitalized patients need endotracheal
intubation and a ventilator.
According to the operational data of the Ministry of Healthcare of Ukraine
on pandemic situation of outbreaks of COVID-19 in Ukraine by May, 7, 2020
(the date when the article was written), on average, 1,89-4,17% of
hospitalized patients with COVID-19 have been in the past, are at present
and will be in future potential candidates for tracheostomy.
Surgical (open) tracheostomy is an aerosol generating procedure and carries
a very high risk of contamination by exposing the airway secretions to the
clinical staff involved. That’s why, this procedure should be thoroughly and
appropriately planned and carefully executed to minimize the risk of viral
spread and to ensure clinical staff safety.
For this reason, drawing on the experience of our colleagues, taking into
consideration “Recommendations for examination and treatment of patients
with ENT pathology during the COVID-19 pandemic” developed by State
Institution «O.S. Kolomiychenko Institute of otolaryngology of National
academy of medical sciences of Ukraine», guidance of the University of
Pennsylvania Health System and ENT UK’s Recommendations regarding
tracheostomy in a COVID-19 patient and taking into account the realities of
our life and medicine in COVID-19 pandemic we developed our own rules and
algorithm of performance of tracheostomy for COVID-19 patients who are put
on prolonged invasive artificial ventilation.
The COVID-19 pandemic has changed us as personalities and professionals,
made us adapt to different work environments. The need for surgical
tracheostomies will be increasing for the next weeks or even months.
That’s why, we should execute them confidently and observe safety rules. Our
experience has let us detect some critical moments and weaknesses and take
them into consideration to ensure clinical staff safety since low staff
number in hospitals because of self-isolation can be really tangible and the
need for clinical staff is constantly increasing. |
Keywords
COVID-19, tracheostomy, recommendations. |
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