Multidisciplinary Safety Recommendations After Tracheostomy During COVID-19 Pandemic: State of the Art Review.
Multidisciplinary Safety Recommendations After Tracheostomy During COVID-19 Pandemic: State of the Art Review.
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DOI：
10.1177/0194599820961990
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Brenner MJ
中科院分区：
文献类型：
--
作者：
Meister KD;Pandian V;Hillel AT;Walsh BK;Brodsky MB;Balakrishnan K;Best SR;Chinn SB;Cramer JD;Graboyes EM;McGrath BA;Rassekh CH;Bedwell JR;Brenner MJ
在COVID-19大流行的慢性阶段，有关气管造口术患者的护理和下游管理的问题出现了。本文综述了文献中关于气管切开术后护理的空白，强调多学科团队的安全性，协调复杂的护理需求，以及识别和管理长期插管和气管切开术的晚期并发症。PubMed、科克伦图书馆、Scopus、Google Scholar、机构指南文件回顾了截至2020年6月关于气管造口术患者护理的文献，包括共识声明、临床实践指南、机构指南以及关于COVID和SARS-CoV-2病毒学和免疫学的科学文献。在缺乏数据的情况下，对专家意见进行汇总和裁定，以达成协商一致的建议。COVID-19大流行期间气管切开术后患者护理的最佳实践是多方面的，包括气雾剂生成程序期间的预防措施;最大限度地减少医护人员、护理人员和患者的暴露风险;确保安全、及时的气管切开术护理;以及识别和处理喉气管损伤，例如声带损伤、后声门狭窄和声门下狭窄，这些损伤可能影响说话，吞咽，和气道保护。我们提出了气管造口术护理的建议方法，概述了对传统算法的修改，提高对出血或其他并发症风险的警惕，并提供个人防护设备（PPE），设备，护理方案和人员的建议。在COVID-19大流行中管理气管造口术患者需要有远见，并且可能与气管造口术的程序考虑因素相媲美。通过考虑患者特定因素、降低传播风险、优化临床环境和发现严重COVID-19的晚期表现，临床医生可以确保应有的警惕和优质护理。
In the chronic phase of COVID-19 pandemic, questions have arisen regarding care of patients with tracheostomy and downstream management. This review addresses gaps in the literature regarding post-tracheostomy care, emphasizing safety of multidisciplinary teams, coordinating complex care needs, and identifying and managing late complications of prolonged intubation and tracheostomy. PubMed, Cochrane Library, Scopus, Google Scholar, Institutional guidance documents Literature through June 2020 on care of tracheostomy patients was reviewed, including consensus statements, clinical practice guidelines, institutional guidance, and scientific literature on COVID and SARS-CoV-2 virology and immunology. Where data were lacking, expert opinions were aggregated and adjudicated to arrive at consensus recommendations. Best practices in caring for patients after tracheostomy during the COVID-19 pandemic are multifaceted, encompassing precautions during aerosol generating procedures; minimizing exposure risks to healthcare workers, caregivers, and patients; ensuring safe, timely tracheostomy care; and identifying and managing laryngotracheal injury, such as vocal fold injury, posterior glottic stenosis, and subglottic stenosis that may affect speech, swallowing, and airway protection. We present recommended approaches to tracheostomy care, outlining modifications to conventional algorithms, raising vigilance for heightened risks of bleeding or other complications, and offering recommendation for personal protective equipment (PPE), equipment, care protocols, and personnel. Management of patients with tracheostomy in COVID-19 pandemic requires foresight and may rival procedural considerations in tracheostomy in their complexity. By considering patient-specific factors, mitigating transmission risks, optimizing clinical environment, and detecting late manifestations of severe COVID-19, clinicians can ensure due vigilance and quality care.
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