Browsing by Author "Maie A. St. John"

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    Tracheostomy During the COVID-19 Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries
    (2021-06-01) Carol Bier-Laning; John D. Cramer; Soham Roy; Patrick A. Palmieri; Ayman Amin; José Manuel Añon; Cesar A. Bonilla-Asalde; Patrick J. Bradley; Pankaj Chaturvedi; David M. Cognetti; Fernando Dias; Arianna Di Stadio; Johannes J. Fagan; David J. Feller-Kopman; Sheng Po Hao; Kwang Hyun Kim; Petri Koivunen; Woei Shyang Loh; Jobran Mansour; Matthew R. Naunheim; Marcus J. Schultz; You Shang; Davud B. Sirjani; Maie A. St. John; Joshua K. Tay; Sébastien Vergez; Heather M. Weinreich; Eddy W.Y. Wong; Johannes Zenk; Christopher H. Rassekh; Michael J. Brenner; School of Medicine; Hospital Nacional Daniel Alcides Carrión; Universidad Privada San Juan Bautista; Universidad Norbert Wiener; University of Michigan Medical School; Stanford University School of Medicine; Pontifícia Universidade Católica do Rio de Janeiro; NUS Yong Loo Lin School of Medicine; University of Illinois College of Medicine; University of Texas Medical School at Houston; Shin-Kong Wu Ho-Su Memorial Hospital Taiwan; Wayne State University School of Medicine; Tata Memorial Hospital; Loyola University Medical Center; National University of Singapore; Oulu University Hospital; Thomas Jefferson University; University of Nottingham; Mahidol University; Chaim Sheba Medical Center Israel; Cairo University; Nuffield Department of Medicine; Hôpital Rangueil; University of Pennsylvania; David Geffen School of Medicine at UCLA; Massachusetts Eye and Ear Infirmary; Università degli Studi di Perugia; Chinese University of Hong Kong; Universidad Carlos III de Madrid; Tongji Medical College; Amsterdam UMC - University of Amsterdam; Johns Hopkins School of Medicine; Seoul National University College of Medicine; University of Cape Town; Evidence-Based Health Care South America: A Joanna Briggs Institute Affiliated Group; Global Tracheostomy Collaborative; Universitätsklinikum Augsburg Klinik für HNO-Heilkunde
    Objective: The coronavirus disease 2019 (COVID-19) pandemic has led to a global surge in critically ill patients requiring invasive mechanical ventilation, some of whom may benefit from tracheostomy. Decisions on if, when, and how to perform tracheostomy in patients with COVID-19 have major implications for patients, clinicians, and hospitals. We investigated the tracheostomy protocols and practices that institutions around the world have put into place in response to the COVID-19 pandemic. Data Sources: Protocols for tracheostomy in patients with severe acute respiratory syndrome coronavirus 2 infection from individual institutions (n = 59) were obtained from the United States and 25 other countries, including data from several low- and middle-income countries, 23 published or society-endorsed protocols, and 36 institutional protocols. Review Methods: The comparative document analysis involved cross-sectional review of institutional protocols and practices. Data sources were analyzed for timing of tracheostomy, contraindications, preoperative testing, personal protective equipment (PPE), surgical technique, and postoperative management. Conclusions: Timing of tracheostomy varied from 3 to >21 days, with over 90% of protocols recommending 14 days of intubation prior to tracheostomy. Most protocols advocate delaying tracheostomy until COVID-19 testing was negative. All protocols involved use of N95 or higher PPE. Both open and percutaneous techniques were reported. Timing of tracheostomy changes ranged from 5 to >30 days postoperatively, sometimes contingent on negative COVID-19 test results. Implications for Practice: Wide variation exists in tracheostomy protocols, reflecting geographical variation, different resource constraints, and limited data to drive evidence-based care standards. Findings presented herein may provide reference points and a framework for evolving care standards.