Cirugía endoscópica transoral ultrasónica (TOUSS) en el diagnóstico del carcinoma de primario desconocido en cabeza y cuello / Transoral endoscopic ultrasonic surgery (TOUSS) in head and neck unknown primary carcinoma investigation

El carcinoma metastásico cervical de primario de origen desconocido (CPD) a las cadenas ganglionares linfáticas cervicales representa menos del 5% de todas las neoplasias malignas de cabeza y cuello. Publicaciones recientes avalan el uso de la cirugía transoral durante el proceso diagnóstico, a su vez la cirugía ultrasónica endoscópica transoral representa una alternativa técnica recientemente descrita. Se realizó un estudio piloto para evaluar la viabilidad de la mucosectomía transoral ultrasónica de la base de lengua (BDL) y la amigdalectomía bilateral en el diagnóstico de CPD. Se incluyeron 10 pacientes de forma consecutiva. En 2 casos (20%) se encontró el primario, uno en amígdala palatina derecha y otro en la BDL izquierda. De acuerdo con nuestros resultados, la cirugía ultrasónica transoral representa una técnica útil al momento de realizar una mucosectomía de la BDL, así como la amigdalectomía bilateral durante el proceso diagnóstico en pacientes con CPD. (AU)

Metastatic carcinoma of unknown primary (CUP) to cervical lymph nodes represents less than 5% of all head and neck malignancies. Recent publications support the use of transoral surgery during the diagnosis work-up, and transoral endoscopic ultrasonic surgery represents a recently described alternative technique in transoral surgery. A pilot study to assess the feasibility of trans-oral ultrasonic base of tongue (BOT) mucosectomy and bilateral tonsillectomy approach in CUP diagnosis work-up was conducted. Ten patients were included consecutively. In two cases (20%) the primary was found, in one case in the right tonsil, and another one in the left BOT. According to our results, the use of trans-oral ultrasonic surgery to perform the base of tongue mucosectomy and bilateral tonsillectomy in CUP patient's during the diagnosis work-up represents an effective option in patients with good anatomical exposure. (AU)

Lymph node metastasis in level IIb in oropharyngeal squamous cell carcinoma: a multicentric, longitudinal, retrospective analysis.

INTRODUCTION: Nowadays, 70% of patients in Europe and the USA are affected by a p16 + , potentially HPV driven oropharyngeal squamous cell carcinoma. However, despite the improved survival rate in this group, the quality-of-life remains low in cases which neck dissection took place. In this vein, in recent years, some surgeons have considered to avoid dissection of level IIB, proposing a supra-selective non-IIb neck dissection. MATERIALS AND METHODS: A retrospective, longitudinal, multicentric study was conducted, including patients with pathologically confirmed primary HPV + or HPV - OPSCC who went through surgical treatment for the primary lesion and neck dissection. RESULTS: 141 patients were included. Among them, 99 (70.2%) were male and 42 (29.8%) were female. The mean age was 62 ± 9 years (range 36-81). The most frequent anatomical location was the tonsil in 63 (44.7%) of patients. The most common approach was the classic transoral oropharyngectomy in 51 (36.2%) patients. Immunohistochemistry for p16 was positive in 62 (44%) patients. One-hundred and five (74.5%) patients received a unilateral ND, and a 36 (25.5%) a bilateral ND. Of those, a 12.8% (18/141) of patients were level IIb LN + . According to our results, level IIb ND should be considered in patients underwent therapeutic ND with positive LN metastasis in level IIa (OR = 9.83; 95% CI 3.463-27.917) or III (OR = 6.25; 95% CI 2.158-18.143), advanced (T3/T4) oropharyngeal primary tumors (OR = 3.38; 95% CI 1.366-8.405), and patients with ENE (OR = 6.56; 95% CI 2.182-19.770), regardless of p16 status. CONCLUSIONS: According to our results, level IIb ND should be considered in patients who underwent therapeutic ND with positive LN metastasis in level IIa or III, advanced oropharyngeal primary tumors, and patients with ENE, independently of p16 status. Prospective data are necessary to definitively ensure the safety of omitting ipsilateral or contralateral level IIb ND in cN - patients with early stage disease.

Transoral endoscopic ultrasonic surgery (TOUSS) in head & neck unknown primary carcinoma investigation.

Metastatic carcinoma of unknown primary (CUP) to cervical lymph nodes represents less than 5% of all head and neck malignancies. Recent publications support the use of transoral surgery during the diagnosis work-up, and transoral endoscopic ultrasonic surgery represent a recently described alternative technique in transoral surgery. A pilot study to assess the feasibility of trans-oral ultrasonic base of tongue (BOT) mucosectomy and bilateral tonsillectomy approach in CUP diagnosis work-up was conducted. Ten patients were included consecutively. In 2 cases (20%) the primary was found, in one case in the right tonsil, and another one in the left BOT. According to our results, the use of trans-oral ultrasonic surgery to perform the base of tongue mucosectomy and bilateral tonsillectomy in CUP patient's during the diagnosis work-up represents an effective option in patients with good anatomical exposure.

Patterns of practice regarding surgical site infection prevention in head & neck surgery: An international survey.

INTRODUCTION: Head & neck surgery encompasses a variety of surgical approaches for benign and malignant conditions. Due to the complexity in treating patients with head and neck pathology, it is necessary to adhere to basic surgical principles to decrease complications. Among them, surgical site infection can be prevented using a surgery quality protocol including the correct use of antibiotics and optimization of nutritional status. MATERIALS AND METHODS: A survey was sent through the YO-IFOS and SEORL-CCC international mailing list. RESULTS: A total of 435 surgeons completed the survey. Of the respondents, 97.7% confirm that they scrub their hands before surgery, 40.9% respondents recommend nutritional support according to sign and symptoms, 60.9% use of antibiotic prophylaxis in clean surgery and just 9.2% use clindamycin in combination. CONCLUSION: This survey has broadened the scope regarding H&N surgical safety around the globe. Identifying innovative ways in which surgical care may be improved is mandatory.

Patterns of practice regarding surgical site infection prevention in head & neck surgery: An international survey

IntroductionHead & neck surgery encompasses a variety of surgical approaches for benign and malignant conditions. Due to the complexity in treating patients with head and neck pathology, it is necessary to adhere to basic surgical principles to decrease complications. Among them, surgical site infection can be prevented using a surgery quality protocol including the correct use of antibiotics and optimization of nutritional status.Materials and methodsA survey was sent through the YO-IFOS and SEORL-CCC international mailing list.ResultsA total of 435 surgeons completed the survey. Of the respondents, 97.7% confirm that they scrub their hands before surgery, 40.9% respondents recommend nutritional support according to sign and symptoms, 60.9% use of antibiotic prophylaxis in clean surgery and just 9.2% use clindamycin in combination.ConclusionThis survey has broadened the scope regarding H&N surgical safety around the globe. Identifying innovative ways in which surgical care may be improved is mandatory. (AU)

IntroducciónLa cirugía de cabeza y cuello abarca una variedad de técnicas quirúrgicas dirigidas al tratamiento de un grupo de enfermedades benignas y malignas. Debido a la complejidad en el tratamiento de este tipo de pacientes el uso de protocolos quirúrgicos va a permitir disminuir las diversas complicaciones, entre ellas la infección del sitio quirúrgico, que será posible prevenirla mediante la adopción de protocolos de control quirúrgico que incluya, por ejemplo, el uso correcto de antibióticos y la optimización del estado nutricional.Materiales y métodosPara este estudio se envió una encuesta a través de la lista de correo electrónico del grupo internacional YO-IFOS y de la SEORL-CCC.ResultadosUn total de 435 cirujanos completaron la encuesta. El 97,7% de los encuestados confirmó practicar el lavado de manos antes de la cirugía, el 40,9% refirió recomendar el apoyo nutricional en el periodo perioperatorio según los signos y síntomas del paciente, el 60,9% refirió utilizar profilaxis antibiótica en cirugía limpia y solo el 9,2% utilizar clindamicina en combinación.ConclusiónEsta encuesta intenta analizar el alcance de los protocolos de seguridad quirúrgica a nivel mundial, con la intención de identificar formas innovadoras de mejorar los resultados quirúrgicos en cirugía de cabeza y cuello. (AU)

Unplanned Hospital Readmission and Visit to the Emergency Room in the First Thirty Days after Head and Neck Surgery: A Prospective, Single-center Study

Abstract Introduction Head and neck surgery remains a complex field; the patients can suffer important functional or life-threating complications after treatment that need unplanned readmissions, increasing the cost related to the treatment. Objective To evaluate the incidence risk factors and causes associated with 30-day unplanned hospital readmission and visit to the emergency room (ER) after surgery for head and neck cancer. Methods Prospective, longitudinal, nonrandomized study. Results A total of 834 patients were included, 726 in the major surgery group and 108 in the minor surgery group. The 30-day readmission rate for all causes was of 7,9% for the patients treated by a major surgery and of 0% for the patients treated in the outpatient clinic for minor procedures, to a total readmission rate of 6,8%. The rate of visit to the emergency room for all causes in the first 30 days was of 14% for the patients treated by a major surgery and of 2,7% for the patients treated in the outpatient clinic. Conclusion Major surgery, the American Society of Anesthesiologists (ASA) status and type of wound are conditions related to unplanned readmission or visit to the ER in the first 30 day after discharge. The most commonly associated causes are infections or wound complications. An evidence-based risk stratification of the patients can be important to improve decision-making and resource utilization. An educational strategy can provide possible ways to improve the rate of readmission and reduce the amount of money expended by healthcare systems.

Unplanned Hospital Readmission and Visit to the Emergency Room in the First Thirty Days after Head and Neck Surgery: A Prospective, Single-center Study.

Introduction Head and neck surgery remains a complex field; the patients can suffer important functional or life-threating complications after treatment that need unplanned readmissions, increasing the cost related to the treatment. Objective To evaluate the incidence risk factors and causes associated with 30-day unplanned hospital readmission and visit to the emergency room (ER) after surgery for head and neck cancer. Methods Prospective, longitudinal, nonrandomized study. Results A total of 834 patients were included, 726 in the major surgery group and 108 in the minor surgery group. The 30-day readmission rate for all causes was of 7,9% for the patients treated by a major surgery and of 0% for the patients treated in the outpatient clinic for minor procedures, to a total readmission rate of 6,8%. The rate of visit to the emergency room for all causes in the first 30 days was of 14% for the patients treated by a major surgery and of 2,7% for the patients treated in the outpatient clinic. Conclusion Major surgery, the American Society of Anesthesiologists (ASA) status and type of wound are conditions related to unplanned readmission or visit to the ER in the first 30 day after discharge. The most commonly associated causes are infections or wound complications. An evidence-based risk stratification of the patients can be important to improve decision-making and resource utilization. An educational strategy can provide possible ways to improve the rate of readmission and reduce the amount of money expended by healthcare systems.

Monitorización intraoperatoria del nervio facial durante la cirugía de la glándula parótida en servicios de otorrinolaringología - cirugía de cabeza y cuello / Intraoperative monitoring of the facial nerve during parotid gland surgery in Otolaryngology services - Head and Neck Surgery

Introducción: La lesión del nervio facial continúa siendo la complicación más grave de la cirugía de la glándula parótida. Debido a la creciente evidencia sobre las ventajas del uso de la monitorización intraoperatoria del nervio facial, se distribuyó una encuesta entre los miembros de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello con el objetivo de determinar los patrones de uso en nuestro medio.Material y métodosSe distribuyó un cuestionario que incluía 12 preguntas separadas en 3 secciones en formato e-mail a través del correo oficial de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. La primera sección de preguntas evaluaba las características demográficas, la segunda sección estaba relacionada con el patrón de uso de los sistemas de monitorización intraoperatoria del nervio facial y la tercera sección se refería a los litigios relacionados con la parálisis facial.ResultadosSe enviaron un total 1.544 cuestionarios anónimos. Recibimos un total de 255 encuestas, para una tasa de respuesta global del 16,5%. De estos, 233 (91,3%) realizaban cirugía de glándula parótida y 94% usaban monitorización intraoperatoria del nervio facial. Un 94% de los encuestado usaba la monitorización intraoperatoria del nervio facial si realizaba menos de 10 parotidectomías por año y un 93,8% si realizaban más de 10 parotidectomías por año (OR, 1,02; IC del 95%, 0,68-1,45; p=0,991).ConclusiónNuestros datos demuestran que la mayoría de los otorrinolaringólogos y cirujanos de cabeza y cuello en España están empleando la monitorización del nervio facial durante la cirugía de la glándula parótida. Casi todos coinciden en que esto busca mejorar las medidas de seguridad quirúrgica y consideran que la monitorización del nervio facial es útil para prevenir lesiones inadvertidas. (AU)

Introduction: Facial nerve injury remains the most severe complication of parotid gland surgery. Due to the increasing evidence about the advantage of the use of intraoperative facial nerve monitoring, a survey was distributed among members of the Spanish Society of Otorhinolaryngology-Head and Neck Surgery with the objective of determining patterns of its use.Material and methodsA questionnaire which included 12 separate questions in 3 sections was distributed via email through the official email of the Spanish Society of Otorhinolaryngology-Head and Neck Surgery. The first section of questions was in relation to demographic characteristics, the second section was related to the pattern of monitoring use and the third section referred to litigation related to facial palsy.Results1544 anonymous questionnaires were emailed. 255 surveys were returned, giving an overall response rate of 16.5%. From these, 233 (91.3%) respondents perform parotid gland surgery. Two-hundred nineteen (94%) respondents use intraoperative facial nerve monitoring. Of the respondents,94% used intraoperative facial nerve monitoring if in their current practice they performed fewer than 10 parotidectomies per year and 93.8% if they performed more than 10 (OR, 1.02; 95% CI, 0.68-1.45; p=.991). With regard to lawsuits, just 3 (1.2%) of the respondents had a history of a parotid gland surgery–associated lawsuit and in just one case the facial nerve monitor was not used.ConclusionOur data demonstrate that most otolaryngologists in Spain use intraoperative facial nerve monitoring during parotid gland surgery. Almost all of them use it to improve patient safety and consider that facial nerve monitoring should be helpful preventing inadvertent injury. (AU)

Functional Results of Transverse Extended Incision in Cervical Neck Dissection.

Introduction Multiple incisions have been described for the surgical approach of cervical neck nodes. All of these descriptions are associated with better or worse exposure of the surgical field as well as with different functional and aesthetic results, which are not always satisfactory. Objective Compare the transverse cervical incision with the classic incision in J or U. Methods This is a retrospective study of 47 patients who required cervical neck dissection between June 15, 2016 and June 15, 2017.A transversal incision was made in these surgeries, and their results were then compared with those of a group of 57 patients treated between January 1, 2010 and January 1, 2012, in whose cases an incision in J or U was made. Results Regarding the incision type, complications were present in 4 (8.5%) cases in the transversal incision group, and in 7 (12.2%) patients of the group of traditional incisions in J or U, without statistical differences ( p = 0.078). The only variables associated with complications of healing in the two groups was body mass index (BMI) < 18.5. The patients showed subjective satisfaction with the aesthetic result of the transverse incision, with an average of 7.51 vs 6.20 in the J or U incision. Conclusion The transverse incision represents a safe, aesthetic, and oncologically adequate option, associated with a lower cicatricial retraction rate, without significant complication rate and allowing adequate exposure of the surgical field, similar to the obtained with the classic incision in J or U.

Machine Learning Models for Predicting Facial Nerve Palsy in Parotid Gland Surgery for Benign Tumors.

BACKGROUND: Despite the increasing use of intraoperative facial nerve monitoring during parotid gland surgery (PGS) and the improvement in the preoperative radiological assessment, facial nerve injury (FNI) remains the most severe complication after PGS. Until now, no studies have been published regarding the application of machine learning (ML) for predicting FNI after PGS. We hypothesize that ML would improve the prediction of patients at risk. METHODS: Patients who underwent PGS for benign tumors between June 2010 and June 2019 were included. RESULTS: Regarding prediction accuracy and performance of each ML algorithm, the K-nearest neighbor and the random forest achieved the highest sensitivity, specificity, positive predictive value, negative predictive value F-score, receiver operating characteristic (ROC)-area under the ROC curve, and accuracy globally. The K-nearest neighbor algorithm achieved performance values above 0.9 for specificity, negative predictive value, F-score and ROC-area under the ROC curve, and the highest sensitivity and positive predictive value. CONCLUSIONS: This study demonstrates that ML prediction models can provide evidence-based predictions about the risk of FNI to otolaryngologists and patients. It is hoped that such algorithms, which use clinical, radiological, histological, and cytological information, can improve the information given to patients before surgery so that they can be better informed of any potential complications.

Predictive factors for simultaneous distant metastasis in head and neck cancer patients during the diagnostic work-up.

INTRODUCTION: The incidence of distant metastasis (DM) in patients affected by head and neck squamous cell carcinoma (HNSCC) is relatively low, and multiple risk factors were described for the development of distant metastasis. MATERIALS AND METHODS: Retrospective study of patients diagnosed with a HNSCC between July 2016 and July 2020 in a tertiary university hospital. RESULTS: Five-Hundred and sixty-nine patients meet inclusion criteria. In the univariate analysis we found a statistical correlation in those patients affected by a hypopharyngeal tumour (p = < 0.0001), patients older than 60 years old (p = 0.01), advanced T stage (p = < 0.0001), a proven positive lymph node (p = 0.02), poorly differentiated tumour (p = < 0.0001), patients with 3 or more positive lymph nodes (p = 0.0001), with ECS (p = 0.0001) and a second primary tumour (p = 0.03). However, according to those results from our multivariable analysis, the factor related to an increased or higher chance to detect a DM during the diagnosis work-up were the presence of a hypopharyngeal primary tumor with a hazard ratio (HR) of 1.14, p = < 0.0001, advanced T stage (T3-T4) with a HR of 1.21, p = 0.001, poorly differentiated tumor with a HR of 1.04, p = < 0.0001, have proven positive lymph node with a HR of 1.03, p = 0.04, have more than three positive lymph node metastases with a HR of 1.25, p = 0.003, the presence of ECS with a HR of 1.40, p = 0.002, and have a second primary tumor with a HR of 1.05, p = 0.01. CONCLUSION: According to the present study, factors such as hypopharyngeal tumours, advanced T-stage, poor differentiation grade, have more than three positive lymph nodes, ECS and have a second primary tumour should be considered as high-risk indicators for screening. Based on these results, the authors recommend considered an extensive diagnostic work-up in all patients with a high risk of DM development.

Functional Results of Transverse Extended Incision in Cervical Neck Dissection

Abstract Introduction Multiple incisions have been described for the surgical approach of cervical neck nodes. All of these descriptions are associated with better or worse exposure of the surgical field as well as with different functional and aesthetic results, which are not always satisfactory. Objective Compare the transverse cervical incision with the classic incision in J or U. Methods This is a retrospective study of 47 patients who required cervical neck dissection between June 15, 2016 and June 15, 2017.A transversal incision was made in these surgeries, and their results were then compared with those of a group of 57 patients treated between January 1, 2010 and January 1, 2012, in whose cases an incision in J or U was made. Results Regarding the incision type, complications were present in 4 (8.5 %) cases in the transversal incision group, and in 7 (12.2 %) patients of the group of traditional incisions in J or U, without statistical differences (p = 0.078). The only variables associated with complications of healing in the two groups was body mass index (BMI) < 18.5. The patients showed subjective satisfaction with the aesthetic result of the transverse incision, with an average of 7.51 vs 6.20 in the J or U incision. Conclusion The transverse incision represents a safe, aesthetic, and oncologically adequate option, associated with a lower cicatricial retraction rate, without significant complication rate and allowing adequate exposure of the surgical field, similar to the obtained with the classic incision in J or U.

A Pilot Study to Assess the Sialendoscopy-Assisted Transfacial Approach in Parotid Gland Sialolithiasis.

INTRODUCTION: Twenty percent of the total lithiasis that affect a major salivary gland will be found in the parotid gland. An exclusive sialoendoscopic approach has achieved success rates close to 80%. In a significant percentage of these remaining cases, combined transfacial approaches assisted by sialendoscopy are presented as an option to be taken into account. PATIENTS AND METHODS: A prospective analysis of cases treated by combined transfacial approach assisted by sialendoscopy for lithiasis of the parotid gland and the impact of the facial nerve stimulator used during surgery. RESULTS: Five patients were included; all of them operated satisfactorily. In 4 of them, the approach proposed by McGurk and modified by Capaccio was used, and in 1 of them, the approach proposed by Nahlieli was used. We suffered a complication in just case due to the appearance of postoperative sialocele. CONCLUSION: According to our results and those previously published, the transfacial approach assisted by sialendoscopy can be considered a useful technique. Proper planning ensures an optimal result in the treatment of parotid gland lithiasis. The use of facial nerve stimulator guarantees extra security when working near to a branch of the facial nerve is suspected.

Intraoperative Surgical Complications in Transoral Laser CO2 Microsurgery of the Larynx: An Observational, Prospective, Single-Center Study.

INTRODUCTION: Despite good outcomes of CO2 laser of the larynx, a lack of prospective data related to intraoperative complications in the indexed literature is evident. MATERIALS AND METHODS: An observational, prospective, nonrandomized study. RESULTS: One hundred and twenty-eight patients met the inclusion criteria. The total rate of intraoperative complications was 14.8% (19/128). The rate of complications according to anatomical location was 7 (38.8%) of 18 for supraglottic tumors and 11 (10.3%) of 107 for glottic tumors, and 1 (33.3%) of 3 for subglottic tumors (P = .001). We do not found difference in complications according to severity (minor vs major complication). CONCLUSION: Previous studies reported good oncologic outcomes and low complication rates with CO2 transoral laser microsurgery (TOLMS) compared to traditional open surgery. However, it is important to consider the different intraoperative surgical, major and minor complications related to CO2 TOLMS and discuss this with our patients during the preoperative assessment, especially in those patients who need a supraglottic tumor resection.

Intraoperative monitoring of the facial nerve during parotid gland surgery in Otolaryngology services - Head and Neck Surgery. / Monitorización intraoperatoria del nervio facial durante la cirugía de la glándula parótida en servicios de otorrinolaringología - cirugía de cabeza y cuello.

INTRODUCTION: Facial nerve injury remains the most severe complication of parotid gland surgery. Due to the increasing evidence about the advantage of the use of intraoperative facial nerve monitoring, a survey was distributed among members of the Spanish Society of Otorhinolaryngology-Head and Neck Surgery with the objective of determining patterns of its use. MATERIAL AND METHODS: A questionnaire which included 12 separate questions in 3 sections was distributed via email through the official email of the Spanish Society of Otorhinolaryngology-Head and Neck Surgery. The first section of questions was in relation to demographic characteristics, the second section was related to the pattern of monitoring use and the third section referred to litigation related to facial palsy. RESULTS: 1544 anonymous questionnaires were emailed. 255 surveys were returned, giving an overall response rate of 16.5%. From these, 233 (91.3%) respondents perform parotid gland surgery. Two-hundred nineteen (94%) respondents use intraoperative facial nerve monitoring. Of the respondents,94% used intraoperative facial nerve monitoring if in their current practice they performed fewer than 10 parotidectomies per year and 93.8% if they performed more than 10 (OR, 1.02; 95% CI, 0.68-1.45; p=.991). With regard to lawsuits, just 3 (1.2%) of the respondents had a history of a parotid gland surgery-associated lawsuit and in just one case the facial nerve monitor was not used. CONCLUSION: Our data demonstrate that most otolaryngologists in Spain use intraoperative facial nerve monitoring during parotid gland surgery. Almost all of them use it to improve patient safety and consider that facial nerve monitoring should be helpful preventing inadvertent injury.

Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica, y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19 / Consensus documentof the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on tracheotomy in patients with COVID-19 infection

La alta incidencia de insuficiencia respiratoria aguda en el contexto de la pandemia por COVID-19 ha conllevado el uso de ventilación mecánica hasta en un 15%. Dado que la traqueotomía es un procedimiento quirúrgico frecuente, este documento de consenso, elaborado por tres Sociedades Científicas, la SEMICYUC, la SEDAR y la SEORL-CCC, tiene como objetivo ofrecer una revisión de las indicaciones y contraindicaciones de traqueotomía, ya sea por punción o abierta, esclarecer las posibles ventajas y exponer las condiciones ideales en que deben realizarse y los pasos que considerar en su ejecución. Se abordan situaciones regladas y urgentes, así como los cuidados posoperatorios

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure,the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures

Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica, y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19 / Consensus document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on tracheotomy in patients with COVID-19 infection

La alta incidencia de insuficiencia respiratoria aguda en el contexto de la pandemia por COVID-19 ha conllevado el uso de ventilación mecánica hasta en un 15%. Dado que la traqueotomía es un procedimiento quirúrgico frecuente, este documento de consenso, elaborado por tres Sociedades Científicas, la SEMICYUC, la SEDAR y la SEORL-CCC, tiene como objetivo ofrecer una revisión de las indicaciones y contraindicaciones de traqueotomía, ya sea por punción o abierta, esclarecer las posibles ventajas y exponer las condiciones ideales en que deben realizarse y los pasos que considerar en su ejecución. Se abordan situaciones regladas y urgentes, así como los cuidados posoperatorios

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure,the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regularand emergency situations are displayed together with the postoperative measures

Recomendaciones de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello para la realización de traqueotomías en relación con pacientes infectados por coronavirus COVID-19 / Recommendations of the Spanish Society of Otolaryngology and Head and Neck Surgery for performing tracheotomies in patients infected by the coronavirus, Covid-19

La reciente pandemia por coronavirus COVID-19 está incrementando el número de pacientes que, debido a su situación ventilatoria pulmonar, pueden requerir de intubación orotraqueal. La infección por coronavirus COVID-19 ha demostrado una alta tasa de transmisibilidad, sobre todo por vía respiratoria y por dispersión de microgotas. La Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello, basándose en el artículo de Wei et al. de 2003 en relación con las traqueotomías realizadas por el síndrome respiratorio agudo grave (SARS), realiza una serie de recomendaciones para la realización segura de las traqueotomías

The recent COVID-19 (coronavirus) pandemic is causing an increase in the number of patients who, due to their pulmonary ventilatory status, may require orotracheal intubation. COVID-19 infection has demonstrated a high rate of transmissibility, especially via the respiratory tract and by droplet spread. The Spanish Society of Otolaryngology and Head and Neck Surgery, based on the article by Wei et al. of 2003 regarding tracheotomies performed due to severe acute respiratory syndrome (SARS), has made a series of recommendations for the safe performance of tracheotomies