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  1. Article ; Online: Recommendation of a practical guideline for safe tracheostomy during the COVID-19 pandemic

    Takhar, Arunjit / Walker, Abigail / Tricklebank, Stephen / Wyncoll, Duncan / Hart, Nicholas / Jacob, Tony / Arora, Asit / Skilbeck, Christopher / Simo, Ricard / Surda, Pavol

    European Archives of Oto-Rhino-Laryngology

    2020  Volume 277, Issue 8, Page(s) 2173–2184

    Keywords Otorhinolaryngology ; General Medicine ; covid19
    Language English
    Publisher Springer Science and Business Media LLC
    Publishing country us
    Document type Article ; Online
    ZDB-ID 1017359-6
    ISSN 0937-4477
    ISSN 0937-4477
    DOI 10.1007/s00405-020-05993-x
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Recommendation of a practical guideline for safe tracheostomy during the COVID-19 pandemic.

    Takhar, Arunjit / Walker, Abigail / Tricklebank, Stephen / Wyncoll, Duncan / Hart, Nicholas / Jacob, Tony / Arora, Asit / Skilbeck, Christopher / Simo, Ricard / Surda, Pavol

    European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery

    2020  Volume 277, Issue 8, Page(s) 2173–2184

    Abstract: Purpose: The COVID-19 pandemic is placing unprecedented demand upon critical care services for invasive mechanical ventilation. There is current uncertainty regarding the role of tracheostomy for weaning ventilated patients with COVID-19 pneumonia. This ...

    Abstract Purpose: The COVID-19 pandemic is placing unprecedented demand upon critical care services for invasive mechanical ventilation. There is current uncertainty regarding the role of tracheostomy for weaning ventilated patients with COVID-19 pneumonia. This is due to a number of factors including prognosis, optimal healthcare resource utilisation, and safety of healthcare workers when performing such a high-risk aerosol-generating procedure.
    Methods: Literature review and proposed practical guideline based on the experience of a tertiary healthcare institution with 195 critical care admissions for COVID-19 up until 4th April 2020.
    Results: A synthesis of the current international literature and reported experience is presented with respect to prognosis, viral load and staff safety, thus leading to a pragmatic recommendation that tracheostomy is not performed until at least 14 days after endotracheal intubation in COVID-19 patients. Practical steps to minimise aerosol generation in percutaneous tracheostomy are outlined and we describe the process and framework for setting up a dedicated tracheostomy team.
    Conclusion: In selected COVID-19 patients, there is a role for tracheostomy to aid in weaning and optimise healthcare resource utilisation. Both percutaneous and open techniques can be performed safely with careful modifications to technique and appropriate enhanced personal protective equipment. ORL-HNS surgeons can play a valuable role in forming tracheostomy teams to support critical care teams during this global pandemic.
    MeSH term(s) Aerosols ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/epidemiology ; Coronavirus Infections/prevention & control ; Coronavirus Infections/transmission ; Humans ; Infectious Disease Transmission, Patient-to-Professional/prevention & control ; Intubation, Intratracheal/standards ; Pandemics/prevention & control ; Personal Protective Equipment ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/prevention & control ; Pneumonia, Viral/transmission ; Practice Guidelines as Topic ; Respiration, Artificial/standards ; SARS-CoV-2 ; Tracheostomy/methods ; Tracheostomy/standards
    Chemical Substances Aerosols
    Keywords covid19
    Language English
    Publishing date 2020-04-21
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 1017359-6
    ISSN 1434-4726 ; 0937-4477
    ISSN (online) 1434-4726
    ISSN 0937-4477
    DOI 10.1007/s00405-020-05993-x
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  3. Article ; Online: Tracheostomy, ventilatory wean, and decannulation in COVID-19 patients.

    Tornari, Chrysostomos / Surda, Pavol / Takhar, Arunjit / Amin, Nikul / Dinham, Alison / Harding, Rachel / Ranford, David A / Archer, Sally K / Wyncoll, Duncan / Tricklebank, Stephen / Ahmad, Imran / Simo, Ricard / Arora, Asit

    European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery

    2020  Volume 278, Issue 5, Page(s) 1595–1604

    Abstract: Purpose: COVID-19 patients requiring mechanical ventilation can overwhelm existing bed capacity. We aimed to better understand the factors that influence the trajectory of tracheostomy care in this population to facilitate capacity planning and improve ... ...

    Abstract Purpose: COVID-19 patients requiring mechanical ventilation can overwhelm existing bed capacity. We aimed to better understand the factors that influence the trajectory of tracheostomy care in this population to facilitate capacity planning and improve outcomes.
    Methods: We conducted an observational cohort study of patients in a high-volume centre in the worst-affected region of the UK including all patients that underwent tracheostomy for COVID-19 pneumonitis ventilatory wean from 1st March 2020 to 10th May 2020. The primary outcome was time from insertion to decannulation. The analysis utilised Cox regression to account for patients that are still progressing through their tracheostomy pathway.
    Results: At the point of analysis, a median 21 days (IQR 15-28) post-tracheostomy and 39 days (IQR 32-45) post-intubation, 35/69 (57.4%) patients had been decannulated a median of 17 days (IQR 12-20.5) post-insertion. The overall median age was 55 (IQR 48-61) with a male-to-female ratio of 2:1. In Cox regression analysis, FiO
    Conclusion: Higher FiO
    MeSH term(s) COVID-19 ; Device Removal ; Female ; Humans ; Male ; Middle Aged ; Respiration, Artificial ; SARS-CoV-2 ; Tracheostomy
    Keywords covid19
    Language English
    Publishing date 2020-08-01
    Publishing country Germany
    Document type Journal Article ; Observational Study
    ZDB-ID 1017359-6
    ISSN 1434-4726 ; 0937-4477
    ISSN (online) 1434-4726
    ISSN 0937-4477
    DOI 10.1007/s00405-020-06187-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Ul II Zs.50: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular
    ab Jg. 2022: Lesesaal (EG)

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  4. Article ; Online: Tracheostomy, ventilatory wean, and decannulation in COVID-19 patients

    Tornari, Chrysostomos / Surda, Pavol / Takhar, Arunjit / Amin, Nikul / Dinham, Alison / Harding, Rachel / Ranford, David A. / Archer, Sally K. / Wyncoll, Duncan / Tricklebank, Stephen / Ahmad, Imran / Simo, Ricard / Arora, Asit

    European Archives of Oto-Rhino-Laryngology ; ISSN 0937-4477 1434-4726

    2020  

    Keywords Otorhinolaryngology ; General Medicine ; covid19
    Language English
    Publisher Springer Science and Business Media LLC
    Publishing country us
    Document type Article ; Online
    DOI 10.1007/s00405-020-06187-1
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Article: Recommendation of a practical guideline for safe tracheostomy during the COVID-19 pandemic

    Takhar, Arunjit / Walker, Abigail / Tricklebank, Stephen / Wyncoll, Duncan / Hart, Nicholas / Jacob, Tony / Arora, Asit / Skilbeck, Christopher / Simo, Ricard / Surda, Pavol

    Eur Arch Otorhinolaryngol

    Abstract: PURPOSE: The COVID-19 pandemic is placing unprecedented demand upon critical care services for invasive mechanical ventilation. There is current uncertainty regarding the role of tracheostomy for weaning ventilated patients with COVID-19 pneumonia. This ... ...

    Abstract PURPOSE: The COVID-19 pandemic is placing unprecedented demand upon critical care services for invasive mechanical ventilation. There is current uncertainty regarding the role of tracheostomy for weaning ventilated patients with COVID-19 pneumonia. This is due to a number of factors including prognosis, optimal healthcare resource utilisation, and safety of healthcare workers when performing such a high-risk aerosol-generating procedure. METHODS: Literature review and proposed practical guideline based on the experience of a tertiary healthcare institution with 195 critical care admissions for COVID-19 up until 4th April 2020. RESULTS: A synthesis of the current international literature and reported experience is presented with respect to prognosis, viral load and staff safety, thus leading to a pragmatic recommendation that tracheostomy is not performed until at least 14 days after endotracheal intubation in COVID-19 patients. Practical steps to minimise aerosol generation in percutaneous tracheostomy are outlined and we describe the process and framework for setting up a dedicated tracheostomy team. CONCLUSION: In selected COVID-19 patients, there is a role for tracheostomy to aid in weaning and optimise healthcare resource utilisation. Both percutaneous and open techniques can be performed safely with careful modifications to technique and appropriate enhanced personal protective equipment. ORL-HNS surgeons can play a valuable role in forming tracheostomy teams to support critical care teams during this global pandemic.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #88519
    Database COVID19

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  6. Article ; Online: Timing of Tracheostomy for Prolonged Respiratory Wean in Critically Ill Coronavirus Disease 2019 Patients: A Machine Learning Approach.

    Takhar, Arunjit / Surda, Pavol / Ahmad, Imran / Amin, Nikul / Arora, Asit / Camporota, Luigi / Denniston, Poppy / El-Boghdadly, Kariem / Kvassay, Miroslav / Macekova, Denisa / Munk, Michal / Ranford, David / Rabcan, Jan / Tornari, Chysostomos / Wyncoll, Duncan / Zaitseva, Elena / Hart, Nicholas / Tricklebank, Stephen

    Critical care explorations

    2020  Volume 2, Issue 11, Page(s) e0279

    Abstract: Objectives: To propose the optimal timing to consider tracheostomy insertion for weaning of mechanically ventilated patients recovering from coronavirus disease 2019 pneumonia. We investigated the relationship between duration of mechanical ventilation ... ...

    Abstract Objectives: To propose the optimal timing to consider tracheostomy insertion for weaning of mechanically ventilated patients recovering from coronavirus disease 2019 pneumonia. We investigated the relationship between duration of mechanical ventilation prior to tracheostomy insertion and in-hospital mortality. In addition, we present a machine learning approach to facilitate decision-making.
    Design: Prospective cohort study.
    Setting: Guy's & St Thomas' Hospital, London, United Kingdom.
    Patients: Consecutive patients admitted with acute respiratory failure secondary to coronavirus disease 2019 requiring mechanical ventilation between March 3, 2020, and May 5, 2020.
    Interventions: Baseline characteristics and temporal trends in markers of disease severity were prospectively recorded. Tracheostomy was performed for anticipated prolonged ventilatory wean when levels of respiratory support were favorable. Decision tree was constructed using C4.5 algorithm, and its classification performance has been evaluated by a leave-one-out cross-validation technique.
    Measurements and main results: One-hundred seventy-six patients required mechanical ventilation for acute respiratory failure, of which 87 patients (49.4%) underwent tracheostomy. We identified that optimal timing for tracheostomy insertion is between day 13 and day 17. Presence of fibrosis on CT scan (odds ratio, 13.26; 95% CI [3.61-48.91];
    Conclusions: We propose that the optimal window for consideration of tracheostomy for ventilatory weaning is between day 13 and 17. Late predictors of mortality may serve as adverse factors when considering tracheostomy, and our decision tree provides a degree of decision support for clinicians.
    Keywords covid19
    Language English
    Publishing date 2020-11-17
    Publishing country United States
    Document type Journal Article
    ISSN 2639-8028
    ISSN (online) 2639-8028
    DOI 10.1097/CCE.0000000000000279
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Extramedullary haematopoiesis in axillary lymph nodes following neoadjuvant chemotherapy for locally advanced breast cancer.

    Takhar, Arunjit Singh / Ney, Alex / Patel, Meera / Sharma, Anup

    BMJ case reports

    2013  Volume 2013

    Abstract: We report the case of a 53-year-old lady who presented with a lump in her left breast. Her initial investigations demonstrated a grade III invasive ductal carcinoma of the breast that was tethered to the pectoralis major; imaging and cytology also ... ...

    Abstract We report the case of a 53-year-old lady who presented with a lump in her left breast. Her initial investigations demonstrated a grade III invasive ductal carcinoma of the breast that was tethered to the pectoralis major; imaging and cytology also revealed metastatic nodes in the left axilla. After undergoing neoadjuvant chemotherapy with evidence of clinical and radiological tumour response, a wire-guided wide local excision and axillary node clearance was performed. When a histological analysis of the specimen was performed, there was no evidence of a viable metastatic tumour in the axillary lymph nodes, but there were several areas of extramedullary haematopoiesis. There are only two other reports in the literature of this finding. This could represent a potential source of false-positive diagnosis of axillary metastasis from breast cancer. It would be prudent to consider biopsy prior to clearance if there are megakaryocytes in axillary node cytology.
    MeSH term(s) Antineoplastic Agents/therapeutic use ; Axilla/pathology ; Axilla/surgery ; Biopsy ; Breast Neoplasms/drug therapy ; Breast Neoplasms/pathology ; Breast Neoplasms/surgery ; Carcinoma, Ductal, Breast/drug therapy ; Carcinoma, Ductal, Breast/pathology ; Carcinoma, Ductal, Breast/surgery ; Chemotherapy, Adjuvant ; Cytodiagnosis ; Female ; Hematopoiesis, Extramedullary ; Humans ; Lymph Node Excision ; Lymph Nodes/pathology ; Lymph Nodes/surgery ; Lymphatic Metastasis/diagnosis ; Megakaryocytes ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Staging
    Chemical Substances Antineoplastic Agents
    Language English
    Publishing date 2013-05-22
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2013-008943
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: Tracheostomy, ventilatory wean, and decannulation in COVID-19 patients

    Tornari, Chrysostomos / Surda, Pavol / Takhar, Arunjit / Amin, Nikul / Dinham, Alison / Harding, Rachel / Ranford, David A / Archer, Sally K / Wyncoll, Duncan / Tricklebank, Stephen / Ahmad, Imran / Simo, Ricard / Arora, Asit

    Eur. arch. oto-rhino-laryngol

    Abstract: PURPOSE: COVID-19 patients requiring mechanical ventilation can overwhelm existing bed capacity. We aimed to better understand the factors that influence the trajectory of tracheostomy care in this population to facilitate capacity planning and improve ... ...

    Abstract PURPOSE: COVID-19 patients requiring mechanical ventilation can overwhelm existing bed capacity. We aimed to better understand the factors that influence the trajectory of tracheostomy care in this population to facilitate capacity planning and improve outcomes. METHODS: We conducted an observational cohort study of patients in a high-volume centre in the worst-affected region of the UK including all patients that underwent tracheostomy for COVID-19 pneumonitis ventilatory wean from 1st March 2020 to 10th May 2020. The primary outcome was time from insertion to decannulation. The analysis utilised Cox regression to account for patients that are still progressing through their tracheostomy pathway. RESULTS: At the point of analysis, a median 21 days (IQR 15-28) post-tracheostomy and 39 days (IQR 32-45) post-intubation, 35/69 (57.4%) patients had been decannulated a median of 17 days (IQR 12-20.5) post-insertion. The overall median age was 55 (IQR 48-61) with a male-to-female ratio of 2:1. In Cox regression analysis, FiO2 at tracheostomy ≥ 0.4 (HR 1.80; 95% CI 0.89-3.60; p = 0.048) and last pre-tracheostomy peak cough flow (HR 2.27; 95% CI 1.78-4.45; p = 0.001) were independent variables associated with prolonged time to decannulation. CONCLUSION: Higher FiO2 at tracheostomy and higher pre-tracheostomy peak cough flow are associated with increased delay in COVID-19 tracheostomy patient decannulation. These finding comprise the most comprehensive report of COVID-19 tracheostomy decannulation to date and will assist service planning for future peaks of this pandemic.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #692740
    Database COVID19

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