RESUMO
COVID-19 has impacted how we deliver care to patients, and much remains unknown regarding optimal management of respiratory failure in this patient population. There are significant controversies regarding tracheostomy in patients with COVID-19 related to timing, location of procedure, and technique. In this narrative review, we explore the recent literature, publicly available guidelines, protocols from different institutions, and clinical reports to provide critical insights on how to deliver the most benefit to our patients while safeguarding the health care force. Consensus can be reached that patients with COVID-19 should be managed in a negative-pressure environment with proper personal protective equipment, and that performing tracheostomy is a complex decision that should be made through multidisciplinary discussions considering patient prognosis, institutional resources, staff experience, and risks to essential health care workers. A broad range of practices exist because there is no conclusive guidance regarding the optimal timing or technique for tracheostomy.
Assuntos
Infecções por Coronavirus , Controle de Infecções , Pandemias , Pneumonia Viral , Insuficiência Respiratória , Traqueostomia , Betacoronavirus , COVID-19 , Protocolos Clínicos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/normas , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/cirurgia , SARS-CoV-2 , Tempo para o Tratamento , Traqueostomia/métodos , Traqueostomia/normasRESUMO
We present the case of a 19-year-old woman who developed sudden severe left-sided tension pneumothorax in the recovery room after undergoing a 6-hour open reduction and internal fixation of an anterior and posterior pelvic fracture sustained in a motor vehicle accident 4 days prior to surgery. Additional preoperative injuries included a right-sided hemopneumothorax, right lung contusion, and liver laceration. The left lung was rapidly reexpanded using tube thoracostomy. The patient subsequently developed ipsilateral pulmonary edema and ultimately acute respiratory distress syndrome, which required vigorous treatment over the next several days. It is postulated that a variety of intraoperative and immediate postoperative maneuvers may have contributed to the development of this near fatal complication.