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Recommendations of the Spanish Society of Otolaryngology and Head and Neck Surgery for Performing Tracheotomies in Patients Infected by the Coronavirus, Covid-19
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
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"Recommendations of the Spanish Society of Otolaryngology and Head and Neck Surgery for Performing Tracheotomies in Patients Infected by the Coronavirus, Covid-19" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "253" "paginaFinal" => "255" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pedro Díaz de Cerio Canduela, Eduardo Ferrandis Perepérez, Pablo Parente Arias, Fernando López Álvarez, Jon Alexander Sistiaga Suarez" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Pedro" "apellidos" => "Díaz de Cerio Canduela" "email" => array:1 [ 0 => "pdiazcerio@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Eduardo" "apellidos" => "Ferrandis Perepérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Pablo" "apellidos" => "Parente Arias" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Fernando" "apellidos" => "López Álvarez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Jon Alexander" "apellidos" => "Sistiaga Suarez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] 5 => array:1 [ "colaborador" => "on behalf of the SEORL-CCC Head and Neck and Skull Base Commission" ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Hospital San Pedro, Logroño, La Rioja, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto Valenciano de Oncología, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital Universitario Lucus Augusti, Lugo, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Hospital Universitario Donosti, San Sebastián, Guipúzcoa, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "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" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The recent COVID-19 coronavirus pandemic is increasing the number of patients who, due to their pulmonary ventilatory status, may require orotracheal intubation. COVID-19 coronavirus infection has demonstrated a high rate of transmissibility, especially through the respiratory tract and by droplet spread. Based on the 2003 article by Wei et al., in relation to tracheotomies performed for severe acute respiratory syndrome,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> the Spanish Society of Otolaryngology and Head and Neck Surgery proposes the following recommendations.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">General Recommendations</span><p id="par0010" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0015" class="elsevierStylePara elsevierViewall">Use of standard surgical material for tracheotomy.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0020" class="elsevierStylePara elsevierViewall">As far as possible, avoid electrical or ultrasonic cutting and coagulation systems or any system that can spread aerial macroparticles. Preferably use cold material and conventional haemostasis systems.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0025" class="elsevierStylePara elsevierViewall">Use closed circuit suction systems with anti-viral filters.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0030" class="elsevierStylePara elsevierViewall">Perform the tracheotomy in the operating theatre or isolated intensive care room and, if possible, with a negative pressure system.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0035" class="elsevierStylePara elsevierViewall">Have the minimum number of personnel present during the technique.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6.</span><p id="par0040" class="elsevierStylePara elsevierViewall">Have the tracheotomy performed by the most experienced personnel, over the shortest time possible</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7.</span><p id="par0045" class="elsevierStylePara elsevierViewall">Use the appropriate protective measures (according to the regulations of the preventive medicine service of each centre): personal protective equipment, gown, cap and disposable and waterproof shoe covers. Disposable, plastic and waterproof full-screen eye and face protection. N95 protection mask (FFP2 or FFP3). Preferably use double surgical gloves.</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Recommendations for Elective Tracheotomy (Intubated Patient)</span><p id="par0050" class="elsevierStylePara elsevierViewall">Prolonged intubation is a frequent indication for tracheotomy, which in many cases is the responsibility of ENT services.<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">1.</span><p id="par0055" class="elsevierStylePara elsevierViewall">Consider the general recommendations as described in the first section.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">2.</span><p id="par0060" class="elsevierStylePara elsevierViewall">Establish adequate preoxygenation for the patient (100% oxygen over 5<span class="elsevierStyleHsp" style=""></span>min).</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">3.</span><p id="par0065" class="elsevierStylePara elsevierViewall">Full muscle relaxation of the patient throughout the procedure and especially when intubation and cannulation are removed, to prevent coughing and aerosolisation.</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">4.</span><p id="par0070" class="elsevierStylePara elsevierViewall">Before starting the technique, proceed with the withdrawal of mechanical ventilation.</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">5.</span><p id="par0075" class="elsevierStylePara elsevierViewall">Perform the tracheotomy, withdraw the endotracheal intubation tube until possible to place the balloon cannula, inflate the balloon.</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">6.</span><p id="par0080" class="elsevierStylePara elsevierViewall">Connect the ventilator; when correct ventilation has been verified, remove the endotracheal tube and attach the tracheotomy cannula.</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">7.</span><p id="par0085" class="elsevierStylePara elsevierViewall">Collect all the tracheotomy material.</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">8.</span><p id="par0090" class="elsevierStylePara elsevierViewall">Remove all protective equipment from the surgeon in the operating theatre or room according to the regulations in force.</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">9.</span><p id="par0095" class="elsevierStylePara elsevierViewall">Exit the operating theatre or room according to the regulations.</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Recommendations for Emergency Tracheotomy (Non-intubated Patient)</span><p id="par0100" class="elsevierStylePara elsevierViewall">On occasion, depending on whether the patient's ventilation has deteriorated, an emergency tracheotomy may be required in patients who have not been intubated beforehand. In these cases, it a cricothyroidotomy using a predesigned set may be necessary. Because it is performed under unsuitable conditions, emergency tracheotomy should be avoided as far as possible. Intensive or emergency departments are advised to give advance notice to the ENT department of any difficult intubation that could require access to the airway by tracheotomy or cricothyroidotomy.<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">1.</span><p id="par0105" class="elsevierStylePara elsevierViewall">Consider the general recommendations as described in the first section.</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">2.</span><p id="par0110" class="elsevierStylePara elsevierViewall">Establish adequate preoxygenation for the patient (100% oxygen for 5<span class="elsevierStyleHsp" style=""></span>min).</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">3.</span><p id="par0115" class="elsevierStylePara elsevierViewall">Full muscle relaxation to avoid patient movement and coughing.</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">4.</span><p id="par0120" class="elsevierStylePara elsevierViewall">If a tracheotomy is not possible, perform a cricothyroidotomy according to technique.</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">5.</span><p id="par0125" class="elsevierStylePara elsevierViewall">Place the tracheotomy cannula and inflate the balloon.</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">6.</span><p id="par0130" class="elsevierStylePara elsevierViewall">Connect the mechanical ventilator and proceed to stabilise the patient.</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">7.</span><p id="par0135" class="elsevierStylePara elsevierViewall">Attach the cannula.</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">8.</span><p id="par0140" class="elsevierStylePara elsevierViewall">If a cricothyroidotomy has been performed, once the patient has been stabilised, perform a regulated tracheotomy using a different incision. Close the cricothyroidotomy incision after removing the cricothyroidotomy cannula and placing the cannula in the tracheotomy.</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">9.</span><p id="par0145" class="elsevierStylePara elsevierViewall">Connect the mechanical ventilator and check the patient's ventilation.</p></li><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">10.</span><p id="par0150" class="elsevierStylePara elsevierViewall">Collect all the tracheotomy material.</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">11.</span><p id="par0155" class="elsevierStylePara elsevierViewall">Remove all protective equipment from the surgeon in the operating theatre or room according to the regulations in force.</p></li><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">12.</span><p id="par0160" class="elsevierStylePara elsevierViewall">Exit the operating theatre or room according to the regulations.</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of Interests</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1362647" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1252642" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1362648" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1252643" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "General Recommendations" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Recommendations for Elective Tracheotomy (Intubated Patient)" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Recommendations for Emergency Tracheotomy (Non-intubated Patient)" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of Interests" ] 8 => array:1 [ "titulo" => "Reference" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1252642" "palabras" => array:2 [ 0 => "Coronavirus" 1 => "Tracheotomy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1252643" "palabras" => array:2 [ 0 => "Coronavirus" 1 => "Traqueotomía" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">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. (2003) regarding tracheotomies performed due to severe acute respiratory syndrome (SARS), has made a series of recommendations for the safe performance of tracheotomies.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">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.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Díaz de Cerio Canduela P, Ferrandis Perepérez E, Parente Arias P, López Álvarez F, Sistiaga Suarez JA, en representación de la Comisión de cabeza y cuello y base de cráneo de la SEORL-CCC. 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. Acta Otorrinolaringol Esp. 2020;71:253–255.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Reference" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:1 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safe tracheostomy for patients with severe acute respiratory syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W.I. Wei" 1 => "H.H. Tuen" 2 => "R.W. Ng" 3 => "L.K. Lam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00005537-200310000-00022" "Revista" => array:6 [ "tituloSerie" => "Laryngoscope" "fecha" => "2003" "volumen" => "113" "paginaInicial" => "1777" "paginaFinal" => "1779" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14520105" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735735/0000007100000004/v1_202007150730/S2173573520300570/v1_202007150730/en/main.assets" "Apartado" => array:4 [ "identificador" => "5884" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Special Article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735735/0000007100000004/v1_202007150730/S2173573520300570/v1_202007150730/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573520300570?idApp=UINPBA00004N" ]
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