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1.
Lakartidningen ; 1182021 03 11.
Artigo em Sueco | MEDLINE | ID: mdl-33709387

RESUMO

The outbreak of SARS-CoV-2 has led to a sharp rise in intensive care unit (ICU) admissions and consequently a need to perform tracheotomies on patients with Covid-19. A number of guidelines have been published with recommendations for the timing of tracheostomy in Covid-19 patients, suggesting tracheotomy should be delayed until day 14-21 of mechanical ventilation.  We present the first 66 patients treated in the ICU at Södra Älvsborg hospital in Sweden as a result of Covid-19. A total of 29 patients received a tracheostomy, median time 9 days post oral intubation, which is earlier than recommended. The mortality rate was 21%, which is slightly lower than reported from The Swedish Intensive Care Registry (25%). None of the doctors performing tracheotomies developed Covid-19 linked to the tracheotomy procedure.


Assuntos
Traqueotomia , Humanos , Respiração Artificial , Suécia/epidemiologia , Fatores de Tempo , Traqueostomia/efeitos adversos
2.
Vestn Otorinolaringol ; 86(1): 36-40, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33720649

RESUMO

The purpose of work is to analyze the causes of tracheostomy in children hospitalized in a large multidisciplinary pediatric hospital. MATERIAL AND METHODS: Retrospective analysis of case of children treated in a multidisciplinary urgent hospital - GBUZ «Morozovskaya CCCH of MDH¼, which in the period from 01.01.16 to 31.12.18 was made operation «tracheostomy¼ was conducted. RESULTS: Tracheostomy was performed in 138 (0.064%) among 216 469 hospitalized children. Age at the time of tracheostomy ranged from 2 weeks to 17.5 years (on average 67.9±59.84 months, Me=47.5 months), and 36.2% of children had tracheostomy was done on the 1st year of life. 126 (91.3%) patients required prolonged tracheal intubation prior to tracheostomy placement; the duration of intubation ranged from 1 to 95 days (on average 19.9±13.42 days, Me=14 days). The main reasons of tracheostomy were the need for long-term mechanical ventilation/respiratory support; the need for constant sanitation of the lower respiratory tract with bulbar/pseudobulbar disorders; upper respiratory paths obstruction. The diseases that led to this condition can be grouped into 4 categories: CNS pathology - 76 (55.1%) patients; brain / spinal cord tumors - 36 (26.1%); neurodystrophy and stenosis of the upper respiratory tract of various etiology - 13 (9.4% each) patients. 68.1% of patients were found incurable and required palliative care. Mortality among patients with a known catamnesis was 39.1%, mainly due to progression of the underlying disease; the lethality associated with tracheal cannulation was 1.4%. CONCLUSION: Currently, pediatric tracheostomy is moving into the category of predominantly planned surgical interventions. More than 2/3 of children requiring tracheostomy are patients in need of palliative care with severe pathology of the central nervous system; in which the main indications for surgery are the need for respiration support and regular tracheobronchial care..


Assuntos
Obstrução das Vias Respiratórias , Traqueostomia , Criança , Humanos , Recém-Nascido , Intubação Intratraqueal , Respiração Artificial , Estudos Retrospectivos , Traqueostomia/efeitos adversos
3.
HNO ; 69(4): 303-311, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33666682

RESUMO

BACKGROUND: One of the main symptoms of severe infection with the new coronavirus­2 (SARS-CoV-2) is hypoxemic respiratory failure because of viral pneumonia with the need for mechanical ventilation. Prolonged mechanical ventilation may require a tracheostomy, but the increased risk for contamination is a matter of considerable debate. OBJECTIVE: Evaluation of safety and effects of surgical tracheostomy on ventilation parameters and outcome in patients with COVID-19. STUDY DESIGN: Retrospective observational study between March 27 and May 18, 2020, in a single-center coronavirus disease-designated ICU at a tertiary care German hospital. PATIENTS: Patients with COVID-19 were treated with open surgical tracheostomy due to severe hypoxemic respiratory failure requiring mechanical ventilation. MEASUREMENTS: Clinical and ventilation data were obtained from medical records in a retrospective manner. RESULTS: A total of 18 patients with confirmed SARS-CoV­2 infection and surgical tracheostomy were analyzed. The age range was 42-87 years. All patients received open tracheostomy between 2-16 days after admission. Ventilation after tracheostomy was less invasive (reduction in PEAK and positive end-expiratory pressure [PEEP]) and lung compliance increased over time after tracheostomy. Also, sedative drugs could be reduced, and patients had a reduced need of norepinephrine to maintain hemodynamic stability. Six of 18 patients died. All surgical staff were equipped with N99-masks and facial shields or with powered air-purifying respirators (PAPR). CONCLUSION: Our data suggest that open surgical tracheostomy can be performed without severe complications in patients with COVID-19. Tracheostomy may reduce invasiveness of mechanical ventilation and the need for sedative drugs and norepinehprine. Recommendations for personal protective equipment (PPE) for surgical staff should be followed when PPE is available to avoid contamination of the personnel.


Assuntos
Pneumonia Viral , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Traqueostomia/efeitos adversos
4.
Medicine (Baltimore) ; 100(13): e25349, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787636

RESUMO

RATIONALE: Videofluoroscopic swallowing study (VFSS) is a noninvasive radiographic procedure that examines the oral, pharyngeal, and cervical esophageal stages of swallowing. Tracheoesophageal fistula (TEF) is difficult to diagnose depending on its size and location. However, how VFSS can be of benefit in the diagnosis of TEF has not been reported yet. PATIENT CONCERNS: A 64-year-old man who had been tracheostomized post spinal tumor resection surgery at the cervical level 1 to 2, had his tracheostomy tube removed approximately 25 years ago. After decannulation, he reported coughing while swallowing food, foreign sensation in the neck and repeated bouts of pneumonia ever since. DIAGNOSIS: VFSS revealed, for the first time, acquired TEF after tracheostomy decannulation as the cause of repetitive aspiration pneumonia. INTERVENTION: VFSS was performed in this case. OUTCOMES: In the background of suspected TEF based on VFSS results, the patient underwent a computed tomography scan of the chest and airway in the prone position, followed by bronchoscopy, which confirmed the existence of a TEF. He then underwent primary closure of the fistula. The patient had an uneventful recovery and is currently symptom-free 10 months after the surgery. LESSONS: This case alerts clinicians to the possibility of TEF as a diagnosis when the aspirate leaks from the upper esophagus and through the posterior wall of trachea in the esophageal phase of VFSS.


Assuntos
Deglutição/fisiologia , Fístula Traqueoesofágica/diagnóstico , Traqueostomia/efeitos adversos , Broncoscopia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Esôfago/diagnóstico por imagem , Esôfago/fisiologia , Fluoroscopia/métodos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Traqueia/diagnóstico por imagem , Traqueia/fisiologia , Fístula Traqueoesofágica/etiologia , Fístula Traqueoesofágica/fisiopatologia
6.
Laryngoscope ; 131(3): E719-E723, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33593035

RESUMO

OBJECTIVES: Tracheal A-frame deformity is a known consequence of tracheostomy that may lead to obstruction after decannulation. The goal of this study is to demonstrate the feasibility and success of endoscopic carbon dioxide (CO2 ) laser-assisted tracheoplasty of tracheal A-frame deformity in children. METHODS: Retrospective case series of symptomatic children with tracheal A-frame deformity with no other site of airway obstruction (2016-2018). All patients underwent CO2 -laser assisted endoscopic resection tracheoplasty. RESULTS: Eight patients (six male) were included with a median age of 15.4 (IQR 12.3-17.9) years. Patients had a median of two previous open airway surgeries (IQR 1-2.5) and all patients had a history of tracheostomy with successful decannulation. Tracheal A-frame deformity presented as dyspnea on exertion for all patients (n = 8, 100%). Obstructive sleep apnea was confirmed for all patients who underwent polysomnography (4/4, 100%). Median interval from decannulation to development of symptoms was 8.7 years (IQR 5.8-9.3). All patients sized with an age-appropriate endotracheal tube despite the deformity. Endoscopic A-frame tracheoplasty was successful for 7/8 (87.5%) patients and was performed with overnight observation for these patients (8/8, 100%). Unilateral A-frame tracheoplasty was performed successfully for five patients (62.5%), bilateral A-frame tracheoplasty was performed successfully for two patients (25.0%), and one patient (12.5%) did not have complete resolution of symptoms after bilateral A-frame tracheoplasty due to multi-level airway obstruction. CONCLUSIONS: CO2 laser-assisted tracheoplasty is an innovative endoscopic technique to relieve symptoms of airway obstruction for selected patients with tracheal A-frame deformity although avoiding the morbidity and hospital stay duration associated with tracheal resection. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E719-E723, 2021.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Endoscopia/métodos , Lasers de Gás/uso terapêutico , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traqueia/anormalidades , Adolescente , Extubação/efeitos adversos , Obstrução das Vias Respiratórias/etiologia , Criança , Estudos de Viabilidade , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Traqueia/cirurgia , Traqueostomia/efeitos adversos , Resultado do Tratamento
9.
J Laryngol Otol ; 135(2): 185-188, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33487184

RESUMO

OBJECTIVE: To highlight the importance of imaging in reducing an accidental injury to the anomalous brachiocephalic trunk and its branches during tracheal surgery. CASE REPORT: This paper reports two cases of accidental injury to the great vessels in the neck during tracheal surgery. The first incident occurred during a repeat tracheostomy, when the right common carotid artery was injured. On reviewing the computed tomography images, the bifurcation of the brachiocephalic artery was seen to the left of the midline, and the right common carotid artery was adherent just below the tracheostomy site. The second incident happened during surgery for tracheal stenosis, when there was an inadvertent injury to the main brachiocephalic trunk, which was adherent to the trachea in the lower neck region. CONCLUSION: For airway surgeons, radiological assessment of vascular structures in relation to the trachea prior to surgery is as important as the endoluminal airway assessment for the best outcome.


Assuntos
Lesões Acidentais/prevenção & controle , Tronco Braquiocefálico/anormalidades , Pescoço/cirurgia , Traqueia/cirurgia , Estenose Traqueal/cirurgia , Lesões Acidentais/epidemiologia , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/lesões , Tronco Braquiocefálico/cirurgia , Lesões das Artérias Carótidas/epidemiologia , Lesões das Artérias Carótidas/prevenção & controle , Artéria Carótida Primitiva/anormalidades , Artéria Carótida Primitiva/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/irrigação sanguínea , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/normas , Estenose Traqueal/diagnóstico por imagem , Traqueostomia/efeitos adversos , Resultado do Tratamento
11.
Khirurgiia (Mosk) ; (1): 5-14, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33395506

RESUMO

OBJECTIVE: To analyze the long-term postoperative outcomes in patients with cicatricial tracheal stenosis and to determine the indications for various surgical strategies. MATERIAL AND METHODS: There were 976 patients with benign cicatricial tracheal stenosis for the period 2001-2017. Tracheal stenosis occurred after mechanical ventilation and tracheostomy in 910 (93.2%) patients. Other causes were neck trauma, burns, previous surgery or tuberculosis. Idiopathic stenosis was observed in 41 (4.2%) patients. Multiple-stage reconstructive treatment was possible due to benign nature of disease. There were 2.4 operations per a patient, and 976 patients underwent 2327 procedures. Circular tracheal resection was preferred (n=396). RESULTS: Surgical complications occurred in 107 (4.6%) cases, mortality rate - 0.3%. In long-term period, 42 patients died for various causes. In most cases (n=34, 80.9%), mortality was associated with concomitant diseases or consequences of trauma rather cicatricial tracheal stenosis or its treatment. Eight patients died from cicatricial tracheal stenosis or its treatment (7 patients after staged repair, 1 after circular tracheal resection). Four patients died due to asphyxia following T-tube obturation with a tracheobronchial secret or unjustified decannulation. For various reasons, 41 (6.2%) patients continued their treatment in other hospitals (4 patients died). Mortality rate in this group was 9.8%. Favorable long-term outcome was observed in 90.1% of patients, good and unsatisfactory results - in 7.2% and 1.8% of patients, respectively. Circular tracheal resection ensured better functional outcome. CONCLUSION: Surgical treatment of cicatricial tracheal stenosis is associated with low incidence of postoperative complications and mortality. However, further improvement in long-term results is associated with advanced rehabilitation programs for concomitant diseases. Treatment of cicatricial tracheal stenosis should be carried out at specialized hospitals.


Assuntos
Cicatriz/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Estenose Traqueal , Cicatriz/etiologia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Humanos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traqueia/cirurgia , Estenose Traqueal/diagnóstico , Estenose Traqueal/etiologia , Estenose Traqueal/cirurgia , Traqueostomia/efeitos adversos , Resultado do Tratamento
12.
Anesth Analg ; 132(4): 1003-1011, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33369928

RESUMO

Tracheotomy is a surgical procedure through which a tracheostomy, an opening into the trachea, is created. Indications for tracheostomy include facilitation of airway management during prolonged mechanical ventilation, treatment of acute upper airway obstruction when tracheal intubation is unfeasible, management of chronic upper airway obstructive conditions, and planned airway management for major head and neck surgery. Patients who have a recent or long-term tracheostomy may present for a variety of surgical or diagnostic procedures performed under general anesthesia or sedation/analgesia. Airway management of these patients can be challenging and should be planned ahead of time. Anesthesia personnel should be familiar with the different components of cuffed and uncuffed tracheostomy devices and their connectivity to the anesthesia circuits. An appropriate airway management plan should take into account the indication of the tracheostomy, the maturity status of the stoma, the type and size of tracheostomy tube, the expected patient positioning, and presence of patient's concurrent health conditions. Management of the patient with a T-tube is highlighted. Importantly, there is a need for multidisciplinary care involving anesthesiologists, surgical specialists, and perioperative nurses. The aim of this narrative review is to discuss the anesthesia care of patients with a tracheostomy. Key aspects on relevant tracheal anatomy, tracheostomy tubes/devices, alternatives of airway management, and possible complications related to tracheostomy are summarized with a recommendation for an algorithm to manage intraoperative tracheostomy tube dislodgement.


Assuntos
Manuseio das Vias Aéreas , Cuidados Intraoperatórios , Traqueostomia , Manuseio das Vias Aéreas/efeitos adversos , Algoritmos , Técnicas de Apoio para a Decisão , Humanos , Cuidados Intraoperatórios/efeitos adversos , Segurança do Paciente , Medição de Risco , Fatores de Risco , Traqueostomia/efeitos adversos , Traqueostomia/instrumentação
13.
J Surg Res ; 260: 38-45, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33316758

RESUMO

BACKGROUND: Urgent guidance is needed on the safety for providers of percutaneous tracheostomy in patients diagnosed with COVID-19. The objective of the study was to demonstrate that percutaneous dilational tracheostomy (PDT) with a period of apnea in patients requiring prolonged mechanical ventilation due to COVID-19 is safe and can be performed for the usual indications in the intensive care unit. METHODS: This study involves an observational case series at a single-center medical intensive care unit at a level-1 trauma center in patients diagnosed with COVID-19 who were assessed for tracheostomy. Success of a modified technique included direct visualization of tracheal access by bronchoscopy and a blind dilation and tracheostomy insertion during a period of patient apnea to reduce aerosolization. Secondary outcomes include transmission rate of COVID-19 to providers and patient complications. RESULTS: From April 6th, 2020 to July 21st, 2020, 2030 patients were admitted to the hospital with COVID-19, 615 required intensive care unit care (30.3%), and 254 patients required mechanical ventilation (12.5%). The mortality rate for patients requiring mechanical ventilation was 29%. Eighteen patients were assessed for PDT, and 11 (61%) underwent the procedure. The majority had failed extubation at least once (72.7%), and the median duration of intubation before tracheostomy was 15 d (interquartile range 13-24). The median positive end-expiratory pressure at time of tracheostomy was 10.8. The median partial pressure of oxygen (PaO2)/FiO2 ratio on the day of tracheostomy was 142.8 (interquartile range 104.5-224.4). Two patients had bleeding complications. At 1-week follow-up, eight patients still required ventilator support (73%). At the most recent follow-up, eight patients (73%) have been liberated from the ventilator, one patient (9%) died as a result of respiratory/multiorgan failure, and two were discharged on the ventilator (18%). Average follow-up was 20 d. None of the surgeons performing PDT have symptoms of or have tested positive for COVID-19. CONCLUSIONS: and relevance: PDT for patients with COVID-19 is safe for health care workers and patients despite higher positive end-expiratory pressure requirements and should be performed for the same indications as other causes of respiratory failure.


Assuntos
Broncoscopia/efeitos adversos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Respiração Artificial/efeitos adversos , Traqueostomia/efeitos adversos , Adulto , Idoso , Extubação/estatística & dados numéricos , Broncoscopia/instrumentação , Broncoscopia/métodos , Broncoscopia/normas , /mortalidade , /estatística & dados numéricos , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/estatística & dados numéricos , Unidades de Terapia Intensiva/normas , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Traqueostomia/instrumentação , Traqueostomia/métodos , Traqueostomia/normas , Resultado do Tratamento
14.
Am J Otolaryngol ; 42(1): 102791, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33130531

RESUMO

INTRODUCTION: Tracheostomy management is a routine aspect of care in the critical care setting. While there are multiple complications that can arise in the post-operative setting after creation of a tracheostomy, dislodgement of a tracheostomy tube is associated with high mortality requiring rapid intervention. It is therefore important to prevent the occurrence with proper securement of the tracheostomy. In this study, we look at two methods commonly used to secure tracheostomy tubes: suturing of the lateral flanges to the skin with the use of cloth neck ties versus cloth neck ties alone. METHODS: This is a retrospective study with data collected from 1355 consecutive tracheostomy cases at a single institution. Our institution serves the County of San Bernardino, California as a level II trauma center. Patient selection occurred between 2004 and 2018, with distribution of patients to skin-sutured with neck tie tracheostomies (ST) and non-sutured neck tied only tracheostomies (NST) groups occurring by date of tracheostomy surgery. Our study investigates the dislodgement rate of percutaneous tracheostomies secured by either of these two methods. Due to a greater morbidity of tracheostomy dislodgement before a mature fistula tract is formed, we were specifically interested in the dislodgement rate within 7 days. RESULTS: In total, 328 cases of NST and 1027 cases of ST were collected. Overall, there was no statistically significant difference regarding the dislodgement and accidental decannulation rate between NST and ST (2.32% vs 4.46% for NST and ST, respectively, p = 0.1476). There was also no statistically significant difference regarding rates of dislodgement and accidental decannulation within 7 days between NST and ST (1.54% vs 1.11% for NST and ST, respectively, p = 0.5608). DISCUSSION: It takes 5-7 days for a tracheostomy tract to mature, and therefore most dislodgement occurs perioperatively within the first week after placement. Dislodgement of the tracheostomy tube can lead to devastating complications for those patients. To our knowledge, there has been no study investigating dislodgement in the early post-operative period in relation to tracheostomy securement method. CONCLUSION: Due to the emergent nature of tracheostomy dislodgement and loss of airway, prevention of this complication is critical. Our investigation found no statistically significant difference in the rate of early tracheostomy dislodgement in the skin sutured with neck tie and non-sutured neck tie only groups. This study contributes further data to the available literature regarding tracheostomy securement methods and dislodgement rate, specifically within the early post-operative period. LEVEL OF EVIDENCE: 2b.


Assuntos
Pescoço/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Pele , Âncoras de Sutura , Técnicas de Sutura , Traqueostomia/efeitos adversos , Traqueostomia/métodos , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Tempo
16.
Artigo em Espanhol | LILACS | ID: biblio-1148365

RESUMO

A la fecha de redacción de este artículo, más de 500 mil personas han sido afectadas por el virus SARS-CoV-2 en Chile, manifestando diferentes grados de la enfermedad COVID-19. Aquellas que sobrellevan condiciones más severas generan una condición que requiere soporte ventilatorio invasivo y tratamiento en unidades de cuidados intensivos, que de prolongarse en el tiempo deriva en la necesidad de una traqueostomía. A pesar de los beneficios que posee esta en la recuperación de personas con dificultades respiratorias, su implementación se asocia a alteraciones deglutorias que se suman a las generadas por COVID-19. Condición que supone un desafío para los/as fonoaudiólogos/as, quienes están expuestos/as al virus debido a su proceder en estructuras del tracto aerodigestivo y la realización de procedimientos potencialmente generadores de aerosol. El objetivo de este artículo es entregar orientaciones y herramientas clínicas para la intervención en la deglución de personas con traqueostomía y COVID-19. Estas emanan de un análisis pragmático de la evidencia disponible a la fecha, interpretadas bajo nuestra experiencia de atender a más de 561 personas con dicha condición. Se espera contribuir a la rehabilitación de la deglución en personas con COVID-19 y traqueostomía. Para ello se expone sobre las características de la deglución en esta población, su tratamiento, consideraciones para el uso de técnicas específicas, y orientaciones para la mejora de la calidad de vida mediante la mantención y/o recuperación de la funcionalidad deglutoria. Siempre bajo un esquema centrado en el cuidado y protección de las personas hospitalizadas y el equipo de salud.


At the time of writing this article, more than a million people have been affected by the SARS-CoV-2 virus in Chile, displaying different degrees of COVID-19 disease. Severe infections generate a condition that requires invasive ventilatory support and treatment in intensive care units, which, when extended in time, makes necessary conducting a tracheostomy. Despite its benefits for the recovery of patients with respiratory difficulties, it is linked to swallowing disorders that add to the problems generated by COVID-19. This represents a challenge for speech pathologists, who are potentially exposed to the virus because they work on structures of the aerodigestive tract and becuase they conduct procedures that may be aerosol-generating. The aim of this article is to provide guidance and clinical tools for swallowing-intervention in people with tracheostomies and COVID-19. Thees tools spring from a pragmatic analysis of the currently available evidence , interpreted based on our experience of caring more than561 infected patients. We hope to contribute to the rehabilitation of swallowing of patients with COVID-19 and a tracheostomy. The characteristics of swallowing in this population, its treatment, considerations for the use of specific techniques, and guidelines for improving the quality of life through the maintenance and/or recovery of swallowing functionality are discussed, focused caring and protecting hospitalized patients and the health team.


Assuntos
Humanos , Pneumonia Viral/cirurgia , Traqueostomia/efeitos adversos , Transtornos de Deglutição/etiologia , Infecções por Coronavirus/cirurgia , Fonoaudiologia/normas , Pneumonia Viral/complicações , Pneumonia Viral/reabilitação , Qualidade de Vida , Transtornos de Deglutição/reabilitação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/reabilitação , Cuidados Críticos , Fonoaudiologia/métodos , Pandemias , Betacoronavirus
17.
Rev. chil. fonoaudiol. (En línea) ; 19: 1-9, nov. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1148401

RESUMO

La enfermedad COVID-19 fue declarada pandemia por la Organización Mundial de la Salud. Su presentación más severa genera una condición que requiere tratamiento en unidades de cuidados intensivos, condición que al prolongarse en el tiempo requiere la implementación de una traqueostomía para facilitar la entrega de soporte ventilatorio invasivo. Si bien este dispositivo posee importantes ventajas que favorecen la recuperación y rehabilitación, también es cierto que genera diversas complicaciones en la comunicación de las personas, condición que se suma a los efectos propios del COVID-19 y la frecuente historia de intubación endotraqueal previa. El objetivo de este artículo es proveer orientaciones y herramientas clínicas para el tratamiento de la fonación para la comunicación en personas con traqueostomía y COVID-19. Se considera para ello las recomendaciones de la literatura existentes a la fecha, bajo un análisis pragmático y basado en nuestra experiencia de atender a más de 561 personas con esta condición. Se exponen las características de la comunicación en esta población, su tratamiento, consideraciones para el uso de técnicas específicas y orientaciones para la mejora de la calidad de vida. Siempre con un enfoque orientado al cuidado y protección de las/os usuarias/os y el equipo de salud, en particular fonoaudiólogas y fonoaudiólogos del país.


The COVID-19 disease was declared a pandemic by the World Health Organization. When most severe, it generates a condition that requires treatment in intensive care units, which, when extended in time, requires implementing of a tracheostomy to facilitate invasive ventilatory support. Although ventilatory support has important advantages that favor recovery and rehabilitation, it generates various complications for patients' communication, a condition that adds to the effects of COVID-19 and the frequent history of previous endotracheal intubation. The aim of this article is to provide guidance and clinical tools for the treatment of phonation to facilitate communication in people with tracheostomy and COVID-19. For this, the recommendations of the existing available literature are considered, under a pragmatic analysis and based on our experience of treating more than 561 infected patients. The characteristics of communication in this population, its treatment, considerations for the use of specific techniques and guidelines to improve quality of life are exposed. Always with an approach oriented to the care and protection of users and the health team, in particular speech-language pathologists in the country.


Assuntos
Humanos , Pneumonia Viral/cirurgia , Traqueostomia/efeitos adversos , Distúrbios da Voz/etiologia , Infecções por Coronavirus/cirurgia , Transtornos da Comunicação/etiologia , Fonoaudiologia/normas , Fonação , Pneumonia Viral/complicações , Pneumonia Viral/reabilitação , Qualidade de Vida , Relações Hospital-Paciente , Distúrbios da Voz/reabilitação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/reabilitação , Comunicação , Transtornos da Comunicação/reabilitação , Cuidados Críticos , Fonoaudiologia/métodos , Pandemias , Betacoronavirus , Intubação Intratraqueal
19.
Br J Anaesth ; 125(6): 872-879, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32988602

RESUMO

BACKGROUND: The role of tracheostomy in coronavirus disease 2019 (COVID-19) is unclear, with several consensus guidelines advising against this practice. We developed both a dedicated airway team and coordinated education programme to facilitate ward management of tracheostomised COVID-19 patients. Here, we report outcomes in the first 100 COVID-19 patients who underwent tracheostomy at our institution. METHODS: This was a prospective observational cohort study of patients confirmed to have COVID-19 who required mechanical ventilation at Queen Elizabeth Hospital, Birmingham, UK. The primary outcome measure was 30-day survival, accounting for severe organ dysfunction (Acute Physiology and Chronic Health [APACHE]-II score>17). Secondary outcomes included duration of ventilation, ICU stay, and healthcare workers directly involved in tracheostomy care acquiring COVID-19. RESULTS: A total of 164 patients with COVID-19 were admitted to the ICU between March 9, 2020 and April 21, 2020. A total of 100 patients (mean [standard deviation] age: 55 [12] yr; 29% female) underwent tracheostomy; 64 (age: 57 [14] yr; 25% female) did not undergo tracheostomy. Despite similar APACHE-II scores, 30-day survival was higher in 85/100 (85%) patients after tracheostomy, compared with 27/64 (42%) non-tracheostomised patients {relative risk: 3.9 (95% confidence intervals [CI]: 2.3-6.4); P<0.0001}. In patients with APACHE-II scores ≥17, 68/100 (68%) tracheotomised patients survived, compared with 12/64 (19%) non-tracheotomised patients (P<0.001). Tracheostomy within 14 days of intubation was associated with shorter duration of ventilation (mean difference: 6.0 days [95% CI: 3.1-9.0]; P<0.0001) and ICU stay (mean difference: 6.7 days [95% CI: 3.7-9.6]; P<0.0001). No healthcare workers developed COVID-19. CONCLUSION: Independent of the severity of critical illness from COVID-19, 30-day survival was higher and ICU stay shorter in patients receiving tracheostomy. Early tracheostomy appears to be safe in COVID-19.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Traqueostomia/efeitos adversos , Traqueostomia/métodos , APACHE , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Cuidados Críticos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pandemias , Equipe de Assistência ao Paciente , Segurança do Paciente , Seleção de Pacientes , Estudos Prospectivos , Respiração Artificial/métodos , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
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