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TEST0

Id Subject Object Predicate Lexical cue
32951058-237-242-6837 2747-2748 ["32091533"] denotes 2
32951058-106-111-6838 2978-2979 ["32091533"] denotes 2
32951058-234-239-6839 4352-4353 ["29255970"] denotes 4
32951058-226-231-6840 4654-4655 ["22563403"] denotes 5
32951058-86-91-6841 14319-14320 ["32091533"] denotes 2
32951058-89-94-6842 14322-14323 ["31986264"] denotes 6
32951058-234-239-6843 14584-14585 ["32312571"] denotes 9
32951058-117-122-6844 18429-18430 ["32312571"] denotes 7
32951058-112-117-6845 18772-18773 ["32312571"] denotes 7
32951058-157-163-6846 19028-19030 ["32195705"] denotes 15
32951058-161-167-6847 19032-19034 ["32195699"] denotes 16
32951058-127-133-6848 19962-19964 ["32321662"] denotes 18
32951058-83-89-6849 21566-21568 ["32278111"] denotes 19
32951058-235-241-6850 21811-21813 ["32294813"] denotes 20
32951058-136-142-6851 21952-21954 ["32311771"] denotes 21
32951058-235-241-6852 22485-22487 ["21152051"] denotes 22
32951058-126-132-6853 23808-23810 ["32321662"] denotes 18
32951058-130-136-6854 23812-23814 ["32278111"] denotes 19
32951058-134-140-6855 23816-23818 ["32404630"] denotes 23
32951058-138-144-6856 23820-23822 ["32396455"] denotes 24

LitCovid-PD-HP

Id Subject Object Predicate Lexical cue hp_id
T1 1395-1426 Phenotype denotes progressive respiratory failure http://purl.obolibrary.org/obo/HP_0002093
T2 1472-1477 Phenotype denotes shock http://purl.obolibrary.org/obo/HP_0031273
T3 2620-2629 Phenotype denotes pneumonia http://purl.obolibrary.org/obo/HP_0002090
T4 7007-7012 Phenotype denotes cough http://purl.obolibrary.org/obo/HP_0012735
T5 8905-8917 Phenotype denotes hypertension http://purl.obolibrary.org/obo/HP_0000822
T6 8926-8943 Phenotype denotes diabetes mellitus http://purl.obolibrary.org/obo/HP_0000819
T7 9403-9422 Phenotype denotes respiratory failure http://purl.obolibrary.org/obo/HP_0002878
T8 9779-9792 Phenotype denotes breast cancer http://purl.obolibrary.org/obo/HP_0003002
T9 9831-9838 Phenotype denotes obesity http://purl.obolibrary.org/obo/HP_0001513
T10 9928-9933 Phenotype denotes shock http://purl.obolibrary.org/obo/HP_0031273
T11 10063-10074 Phenotype denotes Bradycardia http://purl.obolibrary.org/obo/HP_0001662
T12 10125-10136 Phenotype denotes lung cancer http://purl.obolibrary.org/obo/HP_0100526
T13 10492-10504 Phenotype denotes hypertension http://purl.obolibrary.org/obo/HP_0000822
T14 10695-10705 Phenotype denotes pneumoniae http://purl.obolibrary.org/obo/HP_0002090
T15 10827-10838 Phenotype denotes lung cancer http://purl.obolibrary.org/obo/HP_0100526
T16 10858-10869 Phenotype denotes lung cancer http://purl.obolibrary.org/obo/HP_0100526
T17 10875-10888 Phenotype denotes breast cancer http://purl.obolibrary.org/obo/HP_0003002
T18 10908-10921 Phenotype denotes breast cancer http://purl.obolibrary.org/obo/HP_0003002
T19 10962-10971 Phenotype denotes carcinoma http://purl.obolibrary.org/obo/HP_0030731
T20 11020-11037 Phenotype denotes diabetes mellitus http://purl.obolibrary.org/obo/HP_0000819
T21 13783-13814 Phenotype denotes progressive respiratory failure http://purl.obolibrary.org/obo/HP_0002093
T22 13950-13955 Phenotype denotes shock http://purl.obolibrary.org/obo/HP_0031273
T23 14350-14369 Phenotype denotes respiratory failure http://purl.obolibrary.org/obo/HP_0002878
T24 14405-14424 Phenotype denotes pulmonary infection http://purl.obolibrary.org/obo/HP_0006532
T25 14551-14571 Phenotype denotes respiratory distress http://purl.obolibrary.org/obo/HP_0002098
T26 14831-14851 Phenotype denotes pulmonary infections http://purl.obolibrary.org/obo/HP_0006532
T27 15185-15199 Phenotype denotes tracheomalacia http://purl.obolibrary.org/obo/HP_0002779
T28 15204-15221 Phenotype denotes tracheal stenosis http://purl.obolibrary.org/obo/HP_0002777
T29 19736-19741 Phenotype denotes cough http://purl.obolibrary.org/obo/HP_0012735

0_colil

Id Subject Object Predicate Lexical cue
32951058-32091533-6837 2747-2748 32091533 denotes 2
32951058-32091533-6838 2978-2979 32091533 denotes 2
32951058-29255970-6839 4352-4353 29255970 denotes 4
32951058-22563403-6840 4654-4655 22563403 denotes 5
32951058-32091533-6841 14319-14320 32091533 denotes 2
32951058-31986264-6842 14322-14323 31986264 denotes 6
32951058-32312571-6843 14584-14585 32312571 denotes 9
32951058-32312571-6844 18429-18430 32312571 denotes 7
32951058-32312571-6845 18772-18773 32312571 denotes 7
32951058-32195705-6846 19028-19030 32195705 denotes 15
32951058-32195699-6847 19032-19034 32195699 denotes 16
32951058-32321662-6848 19962-19964 32321662 denotes 18
32951058-32278111-6849 21566-21568 32278111 denotes 19
32951058-32294813-6850 21811-21813 32294813 denotes 20
32951058-32311771-6851 21952-21954 32311771 denotes 21
32951058-21152051-6852 22485-22487 21152051 denotes 22
32951058-32321662-6853 23808-23810 32321662 denotes 18
32951058-32278111-6854 23812-23814 32278111 denotes 19
32951058-32404630-6855 23816-23818 32404630 denotes 23
32951058-32396455-6856 23820-23822 32396455 denotes 24

2_test

Id Subject Object Predicate Lexical cue
32951058-32091533-28905003 2747-2748 32091533 denotes 2
32951058-32091533-28905004 2978-2979 32091533 denotes 2
32951058-29255970-28905005 4352-4353 29255970 denotes 4
32951058-22563403-28905006 4654-4655 22563403 denotes 5
32951058-32091533-28905007 14319-14320 32091533 denotes 2
32951058-31986264-28905008 14322-14323 31986264 denotes 6
32951058-32312571-28905009 14584-14585 32312571 denotes 9
32951058-32312571-28905010 18429-18430 32312571 denotes 7
32951058-32312571-28905011 18772-18773 32312571 denotes 7
32951058-32195705-28905012 19028-19030 32195705 denotes 15
32951058-32195699-28905013 19032-19034 32195699 denotes 16
32951058-32321662-28905014 19962-19964 32321662 denotes 18
32951058-32278111-28905015 21566-21568 32278111 denotes 19
32951058-32294813-28905016 21811-21813 32294813 denotes 20
32951058-32311771-28905017 21952-21954 32311771 denotes 21
32951058-21152051-28905018 22485-22487 21152051 denotes 22
32951058-32321662-28905019 23808-23810 32321662 denotes 18
32951058-32278111-28905020 23812-23814 32278111 denotes 19
32951058-32404630-28905021 23816-23818 32404630 denotes 23
32951058-32396455-28905022 23820-23822 32396455 denotes 24

LitCovid-PubTator

Id Subject Object Predicate Lexical cue tao:has_database_id
4 54-62 Species denotes patients Tax:9606
5 39-53 Disease denotes critically ill MESH:D016638
6 68-92 Disease denotes coronavirus disease 2019 MESH:C000657245
7 94-102 Disease denotes COVID-19 MESH:C000657245
12 247-255 Species denotes patients Tax:9606
13 174-198 Disease denotes Coronavirus disease 2019 MESH:C000657245
14 200-208 Disease denotes COVID-19 MESH:C000657245
15 232-246 Disease denotes Critically ill MESH:D016638
20 627-635 Species denotes patients Tax:9606
21 612-626 Disease denotes critically ill MESH:D016638
22 641-649 Disease denotes COVID-19 MESH:C000657245
23 665-684 Disease denotes bedside tracheotomy
35 866-874 Species denotes patients Tax:9606
36 1299-1307 Species denotes patients Tax:9606
37 1379-1386 Species denotes patient Tax:9606
38 1436-1443 Species denotes patient Tax:9606
39 895-903 Disease denotes COVID-19 MESH:C000657245
40 913-927 Disease denotes critically ill MESH:D016638
41 987-996 Disease denotes infection MESH:D007239
42 1030-1039 Disease denotes infection MESH:D007239
43 1407-1426 Disease denotes respiratory failure MESH:D012131
44 1465-1477 Disease denotes septic shock MESH:D012772
45 1536-1544 Disease denotes infected MESH:D007239
51 1589-1597 Species denotes patients Tax:9606
52 1574-1588 Disease denotes critically ill MESH:D016638
53 1603-1611 Disease denotes COVID-19 MESH:C000657245
54 1841-1850 Disease denotes infection MESH:D007239
55 1975-1984 Disease denotes infection MESH:D007239
67 2042-2087 Species denotes severe acute respiratory syndrome coronavirus Tax:694009
68 2089-2099 Species denotes SARS-CoV-2 Tax:2697049
69 2346-2352 Species denotes people Tax:9606
70 2396-2402 Species denotes people Tax:9606
71 2123-2147 Disease denotes coronavirus disease 2019 MESH:C000657245
72 2149-2157 Disease denotes COVID-19 MESH:C000657245
73 2170-2178 Disease denotes COVID-19 MESH:C000657245
74 2195-2223 Disease denotes pulmonary infectious disease MESH:D003141
75 2354-2362 Disease denotes COVID-19 MESH:C000657245
76 2367-2375 Disease denotes infected MESH:D007239
77 2440-2446 Disease denotes deaths MESH:D003643
82 2550-2558 Species denotes patients Tax:9606
83 2646-2654 Species denotes patients Tax:9606
84 2564-2572 Disease denotes COVID-19 MESH:C000657245
85 2620-2629 Disease denotes pneumonia MESH:D011014
88 3222-3230 Species denotes patients Tax:9606
89 2793-2801 Disease denotes COVID-19 MESH:C000657245
96 3474-3482 Species denotes patients Tax:9606
97 3633-3640 Species denotes patient Tax:9606
98 3850-3858 Species denotes patients Tax:9606
99 3252-3260 Disease denotes COVID-19 MESH:C000657245
100 3413-3422 Disease denotes infection MESH:D007239
101 3459-3473 Disease denotes critically ill MESH:D016638
115 4006-4014 Species denotes patients Tax:9606
116 4730-4738 Species denotes patients Tax:9606
117 4757-4765 Species denotes patients Tax:9606
118 5031-5039 Species denotes patients Tax:9606
119 5246-5254 Species denotes patients Tax:9606
120 3991-4005 Disease denotes Critically-ill MESH:D016638
121 4306-4315 Disease denotes mortality MESH:D003643
122 4477-4484 Disease denotes trachea MESH:C557675
123 4780-4804 Disease denotes dilatational tracheotomy MESH:D002311
124 5016-5030 Disease denotes critically ill MESH:D016638
125 5045-5053 Disease denotes COVID-19 MESH:C000657245
126 5184-5192 Disease denotes COVID-19 MESH:C000657245
127 5325-5345 Disease denotes nosocomial infection MESH:D003428
129 5386-5394 Species denotes PATIENTS Tax:9606
131 5563-5581 Disease denotes infectious disease MESH:D003141
140 5648-5656 Species denotes patients Tax:9606
141 5863-5871 Species denotes patients Tax:9606
142 6063-6071 Species denotes patients Tax:9606
143 6376-6386 Species denotes SARS-CoV-2 Tax:2697049
144 5662-5670 Disease denotes COVID-19 MESH:C000657245
145 5848-5862 Disease denotes critically ill MESH:D016638
146 5895-5903 Disease denotes COVID-19 MESH:C000657245
147 6153-6182 Disease denotes secondary pneumatic infection MESH:D060085
151 6830-6838 Species denotes patients Tax:9606
152 7007-7012 Disease denotes cough MESH:D003371
153 7243-7250 Disease denotes trachea MESH:C557675
156 8162-8170 Species denotes patients Tax:9606
157 8128-8161 Disease denotes coronavirus disease 2019-positive MESH:C000657245
170 8282-8290 Species denotes patients Tax:9606
171 8514-8522 Species denotes patients Tax:9606
172 8742-8750 Species denotes patients Tax:9606
173 8798-8806 Species denotes patients Tax:9606
174 9002-9010 Species denotes patients Tax:9606
175 8321-8341 Disease denotes SARS-CoV-2 infection MESH:C000657245
176 8541-8555 Disease denotes critically ill MESH:D016638
177 8666-8674 Disease denotes COVID-19 MESH:C000657245
178 8905-8917 Disease denotes hypertension MESH:D006973
179 8926-8943 Disease denotes diabetes mellitus MESH:D003920
180 8948-8970 Disease denotes coronary heart disease MESH:D003324
181 9015-9035 Disease denotes secondary infections MESH:D060085
198 9775-9778 Gene denotes PPR Gene:100528023
199 9324-9338 Disease denotes Lung infection MESH:D012141
200 9384-9388 Disease denotes Died MESH:D003643
201 9403-9422 Disease denotes respiratory failure MESH:D012131
202 9517-9520 Disease denotes CHD
203 9578-9581 Disease denotes CHD
204 9634-9637 Disease denotes CHD
205 9786-9792 Disease denotes cancer MESH:D009369
206 9831-9847 Disease denotes obesity MDR-KPN MESH:D009765
207 9902-9906 Disease denotes Died MESH:D003643
208 9921-9933 Disease denotes septic shock MESH:D012772
209 9962-9965 Disease denotes CHD
210 10063-10074 Disease denotes Bradycardia MESH:D001919
211 10122-10136 Disease denotes PP-lung cancer MESH:D008175
212 10189-10193 Disease denotes AICH
213 9883-9886 CellLine denotes D56 CVCL:5769
218 9136-9144 Species denotes patients Tax:9606
219 9121-9135 Disease denotes critically ill MESH:D016638
220 9150-9158 Disease denotes COVID-19 MESH:C000657245
221 9175-9195 Disease denotes bedside tracheostomy
241 10244-10267 Species denotes Acinetobacter baumannii Tax:470
242 10684-10705 Species denotes Klebsiella pneumoniae Tax:573
243 10800-10822 Species denotes Pseudomonas aeruginosa Tax:287
244 10977-11005 Species denotes Stenotrophomonas maltophilia Tax:40324
245 10269-10273 Disease denotes AICH
246 10281-10306 Disease denotes intracerebral haemorrhage MESH:D002543
247 10308-10311 Disease denotes CHD
248 10313-10335 Disease denotes coronary heart disease MESH:D003324
249 10341-10360 Disease denotes cerebral infarction MESH:D002544
250 10372-10396 Disease denotes coronavirus disease 2019 MESH:C000657245
251 10492-10504 Disease denotes hypertension MESH:D006973
252 10707-10721 Disease denotes Lung infection MESH:D012141
253 10753-10767 Disease denotes lung infection MESH:D012141
254 10824-10838 Disease denotes PP-lung cancer MESH:D008175
255 10858-10869 Disease denotes lung cancer MESH:D008175
256 10871-10888 Disease denotes PPR-breast cancer MESH:D001943
257 10908-10921 Disease denotes breast cancer MESH:D001943
258 10962-10971 Disease denotes carcinoma MESH:D009369
259 11020-11037 Disease denotes diabetes mellitus MESH:D003920
266 12082-12090 Species denotes patients Tax:9606
267 11153-11161 Disease denotes COVID-19 MESH:C000657245
268 11162-11171 Disease denotes infection MESH:D007239
269 11213-11222 Disease denotes infection MESH:D007239
270 11538-11554 Disease denotes obvious bleeding MESH:D006470
271 11642-11650 Disease denotes infected MESH:D007239
273 12785-12788 CellLine denotes D56 CVCL:5769
282 13373-13381 Species denotes patients Tax:9606
283 13448-13456 Species denotes patients Tax:9606
284 13515-13523 Species denotes patients Tax:9606
285 13702-13710 Species denotes patients Tax:9606
286 13761-13768 Species denotes Patient Tax:9606
287 13820-13827 Species denotes patient Tax:9606
288 13795-13814 Disease denotes respiratory failure MESH:D012131
289 13943-13955 Disease denotes septic shock MESH:D012772
294 14027-14035 Species denotes patients Tax:9606
295 14012-14026 Disease denotes critically ill MESH:D016638
296 14041-14049 Disease denotes COVID-19 MESH:C000657245
297 14216-14231 Disease denotes CoV-2 infection MESH:C000657245
319 14333-14341 Species denotes patients Tax:9606
320 14640-14648 Species denotes patients Tax:9606
321 14791-14799 Species denotes patients Tax:9606
322 14975-14983 Species denotes patients Tax:9606
323 15262-15270 Species denotes patients Tax:9606
324 15543-15551 Species denotes patients Tax:9606
325 14233-14241 Disease denotes COVID-19 MESH:C000657245
326 14265-14277 Disease denotes inflammation MESH:D007249
327 14283-14298 Disease denotes alveolar damage MESH:D055370
328 14350-14369 Disease denotes respiratory failure MESH:D012131
329 14373-14383 Disease denotes hypoxaemia
330 14405-14424 Disease denotes pulmonary infection MESH:D012141
331 14545-14580 Disease denotes acute respiratory distress syndrome MESH:D012128
332 14625-14639 Disease denotes critically ill MESH:D016638
333 14684-14701 Disease denotes fungal infections MESH:D009181
334 14821-14851 Disease denotes secondary pulmonary infections MESH:D060085
335 14877-14894 Disease denotes fungal infections MESH:D009181
336 15088-15099 Disease denotes obstruction MESH:D000402
337 15118-15153 Disease denotes necrosis of the mucosa of the mouth MESH:D009336
338 15158-15165 Disease denotes trachea MESH:C557675
339 15185-15221 Disease denotes tracheomalacia and tracheal stenosis MESH:D014135
345 15636-15646 Species denotes SARS-CoV-2 Tax:2697049
346 16610-16618 Species denotes patients Tax:9606
347 16499-16508 Disease denotes infection MESH:D007239
348 16645-16653 Disease denotes COVID-19 MESH:C000657245
349 16654-16663 Disease denotes infection MESH:D007239
354 16957-16965 Species denotes patients Tax:9606
355 16942-16956 Disease denotes critically ill MESH:D016638
356 16971-16979 Disease denotes COVID-19 MESH:C000657245
357 17192-17211 Disease denotes secondary infection MESH:D060085
362 18506-18517 Species denotes coronavirus Tax:11118
363 17361-17369 Disease denotes COVID-19 MESH:C000657245
364 17422-17431 Disease denotes infection MESH:D007239
365 18638-18658 Disease denotes nosocomial infection MESH:D003428
373 19442-19450 Species denotes patients Tax:9606
374 20583-20593 Species denotes SARS-CoV-2 Tax:2697049
375 20687-20695 Chemical denotes chlorine MESH:D002713
376 19307-19316 Disease denotes infection MESH:D007239
377 19427-19441 Disease denotes critically ill MESH:D016638
378 19736-19750 Disease denotes cough reflexes MESH:D003371
379 20075-20082 Disease denotes trachea MESH:C557675
391 20726-20734 Species denotes patients Tax:9606
392 21975-21983 Species denotes patients Tax:9606
393 22141-22156 Species denotes influenza virus Tax:11309
394 22643-22650 Species denotes patient Tax:9606
395 22735-22742 Species denotes patient Tax:9606
396 23234-23242 Species denotes Patients Tax:9606
397 22209-22218 Species denotes influenza Tax:11309
398 21735-21761 Disease denotes mucosal compression injury MESH:D009408
399 21989-21997 Disease denotes COVID-19 MESH:C000657245
400 23519-23528 Disease denotes infection MESH:D007239
401 23538-23547 Disease denotes tightness MESH:C536920
409 23764-23772 Species denotes patients Tax:9606
410 24594-24604 Species denotes SARS-CoV-2 Tax:2697049
411 23700-23708 Disease denotes COVID-19 MESH:C000657245
412 23778-23786 Disease denotes COVID-19 MESH:C000657245
413 24003-24027 Disease denotes open bedside tracheotomy MESH:D005597
414 24130-24154 Disease denotes open bedside tracheotomy MESH:D005597
415 24687-24696 Disease denotes infection MESH:D007239
425 24904-24912 Species denotes patients Tax:9606
426 25008-25016 Species denotes patients Tax:9606
427 25083-25090 Species denotes patient Tax:9606
428 25424-25432 Species denotes patients Tax:9606
429 24877-24885 Disease denotes COVID-19 MESH:C000657245
430 24889-24903 Disease denotes critically ill MESH:D016638
431 24942-24951 Disease denotes infection MESH:D007239
432 25154-25168 Disease denotes lung infection MESH:D012141
433 25569-25578 Disease denotes infection MESH:D007239
435 26104-26107 Gene denotes Xin Gene:165904
519 26634-26642 Disease denotes COVID-19 MESH:C000657245
521 26643-26667 Disease denotes Coronavirus disease 2019 MESH:C000657245

MyTest

Id Subject Object Predicate Lexical cue
32951058-32091533-28905003 2747-2748 32091533 denotes 2
32951058-32091533-28905004 2978-2979 32091533 denotes 2
32951058-29255970-28905005 4352-4353 29255970 denotes 4
32951058-22563403-28905006 4654-4655 22563403 denotes 5
32951058-32091533-28905007 14319-14320 32091533 denotes 2
32951058-31986264-28905008 14322-14323 31986264 denotes 6
32951058-32312571-28905009 14584-14585 32312571 denotes 9
32951058-32312571-28905010 18429-18430 32312571 denotes 7
32951058-32312571-28905011 18772-18773 32312571 denotes 7
32951058-32195705-28905012 19028-19030 32195705 denotes 15
32951058-32195699-28905013 19032-19034 32195699 denotes 16
32951058-32321662-28905014 19962-19964 32321662 denotes 18
32951058-32278111-28905015 21566-21568 32278111 denotes 19
32951058-32294813-28905016 21811-21813 32294813 denotes 20
32951058-32311771-28905017 21952-21954 32311771 denotes 21
32951058-21152051-28905018 22485-22487 21152051 denotes 22
32951058-32321662-28905019 23808-23810 32321662 denotes 18
32951058-32278111-28905020 23812-23814 32278111 denotes 19
32951058-32404630-28905021 23816-23818 32404630 denotes 23
32951058-32396455-28905022 23820-23822 32396455 denotes 24

LitCovid-sentences

Id Subject Object Predicate Lexical cue
T1 0-142 Sentence denotes Safety and efficacy of tracheotomy for critically ill patients with coronavirus disease 2019 (COVID-19) in Wuhan: a case series of 14 patients
T2 144-152 Sentence denotes Abstract
T3 153-161 Sentence denotes Abstract
T4 163-173 Sentence denotes OBJECTIVES
T5 174-231 Sentence denotes Coronavirus disease 2019 (COVID-19) is a global pandemic.
T6 232-399 Sentence denotes Critically ill patients often require prolonged intubation for mechanical ventilation to support breathing; thus, the artificial airway must be managed by tracheotomy.
T7 400-539 Sentence denotes Therefore, studies exploring appropriate and safe methods for tracheotomy that minimize the risks of nosocomial transmission are important.
T8 541-548 Sentence denotes METHODS
T9 549-849 Sentence denotes A retrospective analysis of the clinical characteristics of 14 critically ill patients with COVID-19, who underwent bedside tracheotomy from March to April 2020 was conducted to summarize the indications for tracheotomy and key points related to personal protective equipment and surgical procedures.
T10 851-858 Sentence denotes RESULTS
T11 859-928 Sentence denotes All 14 patients were diagnosed with COVID-19 and were critically ill.
T12 929-1004 Sentence denotes All tracheotomies were performed in the late phase of the infection course.
T13 1005-1142 Sentence denotes The interval between the infection and tracheotomy was 33 days, and the median interval between intubation and tracheotomy was 25.5 days.
T14 1143-1291 Sentence denotes The reverse transcription-polymerase chain reaction results of secretions from the operative incision and inside the tracheotomy tube were negative.
T15 1292-1374 Sentence denotes Twelve patients improved after tracheotomy, with SpO2 levels maintained above 96%.
T16 1375-1478 Sentence denotes One patient died of progressive respiratory failure; another patient died of uncontrolled septic shock.
T17 1479-1545 Sentence denotes No medical staff who participated in the tracheotomy was infected.
T18 1547-1558 Sentence denotes CONCLUSIONS
T19 1559-1754 Sentence denotes Tracheotomy in critically ill patients with COVID-19 who meet the indications for tracheotomy potentially represents a safer approach to manage the airway and help improve the treatment outcomes.
T20 1755-1851 Sentence denotes A tracheotomy performed in the late phase of the disease has a relatively low risk of infection.
T21 1852-1985 Sentence denotes Adherence to key steps in the tracheotomy procedure and donning adequate personal protection will help medical staff avoid infection.
T22 1987-1999 Sentence denotes INTRODUCTION
T23 2000-2169 Sentence denotes Beginning in December 2019, a new form of severe acute respiratory syndrome coronavirus (SARS-CoV-2) caused an outbreak of coronavirus disease 2019 (COVID-19) worldwide.
T24 2170-2282 Sentence denotes COVID-19 is a contagious pulmonary infectious disease that is transmitted via respiratory droplets and aerosols.
T25 2283-2459 Sentence denotes Because of its long latency and ability to spread easily among people, COVID-19 has infected more than 2 million people worldwide, causing 160 120 confirmed deaths to date [1].
T26 2460-2750 Sentence denotes According to a report from the Chinese Center for Disease Control and Prevention, ∼81% of patients with COVID-19 show mild disease presentation with no or mild pneumonia, while 5–15% of patients with severe symptoms are admitted to the intensive care unit (ICU) in a critical condition [2].
T27 2751-2871 Sentence denotes China was the first country to report the COVID-19 pandemic worldwide, with most cases located in Wuhan, Hubei Province.
T28 2872-2981 Sentence denotes The high rate of hospital and ICU admissions provoked serious overcrowding in hospitals throughout Wuhan [2].
T29 2982-3231 Sentence denotes The government completely locked down the city and mobilized tens of thousands of medical practitioners and tons of medical supplies to Wuhan from all over the country to stop the transmission and provide sufficient medical services to the patients.
T30 3232-3423 Sentence denotes The quick spread of COVID-19 placed extreme pressure on the healthcare system and led to a personal protective equipment (PPE) shortage, which put medical staff at a higher risk of infection.
T31 3424-3803 Sentence denotes Various respiratory treatments for critically ill patients, such as intubation, manual ventilation with a resuscitator, non-invasive ventilation, high-flow nasal cannula, bronchoscopy examination, suction and patient transportation, are considered high-risk factors for nosocomial transmission because of their greater possibility of causing or worsening the spread of the virus.
T32 3804-3886 Sentence denotes According to data from Italy, ∼10% of Italian patients are healthcare workers [3].
T33 3887-3990 Sentence denotes Therefore, medical staff must be fully equipped to minimize the possibility of nosocomial transmission.
T34 3991-4117 Sentence denotes Critically-ill patients often require prolonged intubation for mechanical ventilation, which requires safer airway management.
T35 4118-4355 Sentence denotes A recent systematic review revealed that early tracheotomy performed in the first 7 days after orotracheal intubation is associated with reductions in the mechanical ventilation duration, mortality rate and length of stay in the ICU [4].
T36 4356-4657 Sentence denotes Although surgical tracheotomy is a routine procedure for otolaryngology surgeons in daily practice, direct access to the trachea and mechanical ventilation during this procedure might spurt tremendous amounts of droplets and aerosols, placing surgeons and ICU workers in the highest risk category [5].
T37 4658-4766 Sentence denotes Therefore, surgical tracheotomy is preferable for sedated and intubated patients rather than awake patients.
T38 4767-4947 Sentence denotes Percutaneous dilatational tracheotomy is not optimal because mechanical ventilation should not be stopped for long periods, and droplet emission inevitably occurs at a higher rate.
T39 4948-5141 Sentence denotes To date, our team has performed 14 cases of surgical tracheotomy in critically ill patients with COVID-19 in the ICU while employing proper protective measures, with no nosocomial transmission.
T40 5142-5384 Sentence denotes Due to the increasing number of confirmed COVID-19 cases and the increasing need for tracheotomy in ICU patients, we summarize our experience with tracheotomy to minimize the risk of nosocomial infection and avoid healthcare worker shortages.
T41 5386-5406 Sentence denotes PATIENTS AND METHODS
T42 5407-5461 Sentence denotes This study was approved by our local ethics committee.
T43 5462-5621 Sentence denotes Written informed consent was waived by the Ethics Commission of the designated hospital for emerging infectious disease due to the urgent need to collect data.
T44 5622-5768 Sentence denotes The clinical data from 14 patients with COVID-19 in our ICU who underwent a tracheotomy from February to April 2020 were retrospectively analysed.
T45 5769-6058 Sentence denotes This unit, which was established under emergency conditions to accept the most critically ill patients during the outbreak of COVID-19, was managed by a multidisciplinary team from Peking Union Medical College Hospital in the Sino–French New City Branch of Tongji Hospital in Wuhan, China.
T46 6059-6208 Sentence denotes All patients were evaluated for the clinical course, intubation timing, surgical indications, secondary pneumatic infection and past medical history.
T47 6209-6411 Sentence denotes Samples from the operative incision and secretions from the endotracheal tube were collected for reverse transcription-polymerase chain reaction (PCR) analyses of the SARS-CoV-2 RNA after the operation.
T48 6412-6549 Sentence denotes In addition, viral RNAs from oropharyngeal swabs and serum IgM and IgG antibody titres were routinely measured during the disease course.
T49 6550-6644 Sentence denotes Tracheotomy was performed in the same manner as the conventional operation beside the ICU bed.
T50 6645-6755 Sentence denotes The appropriate setting and PPE (Fig. 1A–D) worn during the procedure are described in the discussion section.
T51 6756-6881 Sentence denotes The anaesthetist maintained the analgesia status of intubated and sedated patients and carefully monitored their vital signs.
T52 6882-7022 Sentence denotes Furthermore, the dose of the drug used for neuromuscular blockade was adjusted by the anaesthetist to prevent swallowing and cough reflexes.
T53 7023-7113 Sentence denotes Secretions of the oropharynx and in endotracheal tube were collected before the operation.
T54 7114-7157 Sentence denotes Oxygenation was achieved with a ventilator.
T55 7158-7313 Sentence denotes After the tissue at the front of the neck was dissected and the anterior wall of the trachea (2–4 rings) was exposed clearly, the ventilator was suspended.
T56 7314-7420 Sentence denotes Then, the surgeon quickly completed the tracheal anterior wall incision and inserted the tracheotomy tube.
T57 7421-7578 Sentence denotes The cuff was inflated immediately and confirmed to avoid leakage, and then the anaesthetist reconnected the ventilator and restarted the assisting breathing.
T58 7579-7711 Sentence denotes The anaesthetist monitored the ventilator waveform to ensure that the endotracheal tube was placed in the correct position (Fig. 2).
T59 7712-7721 Sentence denotes Figure 1:
T60 7723-8063 Sentence denotes Two layers of personal protective equipment. (A) Inner layer including a N95 medical protective mask and coverall suit. (B) Outer layer including surgical goggles, another surgical mask and gown outside. (C) Second outer layer with a pressure air-purifying respirator. (D) Two otolaryngologists and an anaesthetist performing a tracheotomy.
T61 8064-8073 Sentence denotes Figure 2:
T62 8075-8171 Sentence denotes Illustration of the steps for a safe tracheostomy in coronavirus disease 2019-positive patients.
T63 8172-8220 Sentence denotes Blue steps are performed by an otolaryngologist.
T64 8221-8265 Sentence denotes Red steps are performed by the anaesthetist.
T65 8267-8274 Sentence denotes RESULTS
T66 8275-8509 Sentence denotes All 14 patients (6 males and 8 females) had a SARS-CoV-2 infection confirmed by reverse transcription PCR for viral RNA in respiratory samples, in combination with the clinical history and pulmonary chest computed tomography findings.
T67 8510-8736 Sentence denotes All patients were diagnosed as critically ill according to the diagnostic criteria of China’s seventh version of the diagnosis and treatment guidelines for COVID-19 (3 March 2020) and treated by our multidisciplinary ICU team.
T68 8737-8793 Sentence denotes Most patients were senior citizens aged 55–80 years old.
T69 8794-8985 Sentence denotes All patients had previously been diagnosed with one or multiple chronic underlying diseases, including primary hypertension, type 2 diabetes mellitus and coronary heart disease, among others.
T70 8986-9079 Sentence denotes Twelve (85.71%) patients had secondary infections with other pathogens in the lung (Table 1).
T71 9080-9088 Sentence denotes Table 1:
T72 9090-9215 Sentence denotes Clinical characteristics of 14 critically ill patients with COVID-19 who underwent a bedside tracheostomy in the ICU in Wuhan
T73 9216-9219 Sentence denotes No.
T74 9221-9349 Sentence denotes Age/sex Diagnosis date Intubation date Tracheotomy date I-T interval (days) Past medical history Lung infection Prognosis
T75 9350-9422 Sentence denotes 1 74/F D13 D31 D58 27 HTN Died on D71 due to respiratory failure
T76 9423-9489 Sentence denotes 2 69/M D13 D24 D48 24 HTN, T2DM, CI MDR-PAE Off ventilator
T77 9490-9539 Sentence denotes 3 55/F D3 D24 D50 26 CHD PAE, MDR-ABA IMV
T78 9540-9606 Sentence denotes 4 65/F D9 D12 D33 21 HTN, T2DM, CHD MDR-ABA Off ventilator
T79 9607-9671 Sentence denotes 5 69/M D9 D25 D57 32 CHD MDR-ABA, MDR-PAE Off ventilator
T80 9672-9742 Sentence denotes 6 70/M D8 D10 D37 27 R-NPC, CI MDR-PAE, Candida Off ventilator
T81 9743-9798 Sentence denotes 7 67/F D7 D24 D41 17 HTN, PPR-breast cancer IMV
T82 9799-9863 Sentence denotes 8 55/F D6 D14 D40 26 HTN, obesity MDR-KPN Off ventilator
T83 9864-9933 Sentence denotes 9 80/F D12 D41 D56 15 HTN PAE Died on D50 due to septic shock
T84 9934-9986 Sentence denotes 10 66/M D9 D27 D60 33 CHD PAE Off ventilator
T85 9987-10033 Sentence denotes 11 58/F D0 D37 D70 33 HTN, T2DM SM IMV
T86 10034-10093 Sentence denotes 12 77/M D28 D65 D90 25 Bradycardia, CPI Candida IMV
T87 10094-10159 Sentence denotes 13 69/M D7 D10 D42 32 PP-lung cancer, CPI MDR-ABA, SM IMV
T88 10160-10238 Sentence denotes 14 68/F D12 D25 D38 13 AICH, HTN, T2DM MDR-ABA, Candida Off ventilator
T89 10239-10243 Sentence denotes ABA:
T90 10244-10683 Sentence denotes Acinetobacter baumannii; AICH: acute intracerebral haemorrhage; CHD: coronary heart disease; CI: cerebral infarction; COVID-19: coronavirus disease 2019; CPI: cardiac pacemaker implantation; Diagnosis date: diagnosis date after disease onset; HTN: hypertension; ICU: intensive care unit; IMV: invasive mechanical ventilation; Intubation date: intubation date after disease onset; I-T Interval: interval from intubation to tracheotomy; KPN:
T91 10684-10799 Sentence denotes Klebsiella pneumoniae; Lung infection: pathogens causing a secondary lung infection; MDR: multidrug-resistant; PAE:
T92 10800-10976 Sentence denotes Pseudomonas aeruginosa; PP-lung cancer: postoperative for lung cancer; PPR-breast cancer: postoperative for breast cancer; R-NPC: radiotherapy for nasopharyngeal carcinoma; SM:
T93 10977-11094 Sentence denotes Stenotrophomonas maltophilia; T2DM: type 2 diabetes mellitus; Tracheotomy date: tracheotomy date after disease onset.
T94 11095-11183 Sentence denotes All tracheotomies were performed in the late phase of the COVID-19 infection (≥15 days).
T95 11184-11289 Sentence denotes The minimal interval between infection and tracheotomy was 33 days (range: from 33 to 90 days) (Table 1).
T96 11290-11397 Sentence denotes The median interval between intubation and tracheotomy was 25.5 days (range: from 13 to 33 days) (Table 1).
T97 11398-11517 Sentence denotes The average operation time was ∼30 min, and the respiratory and circulatory functions were stable during the operation.
T98 11518-11575 Sentence denotes The wound showed no obvious bleeding after the operation.
T99 11576-11651 Sentence denotes None of the medical staff who participated in the tracheotomy was infected.
T100 11652-11814 Sentence denotes Viral RNA reverse transcription PCR analyses of samples from the operative incision and endotracheal discharge were performed on the same day after the operation.
T101 11815-11872 Sentence denotes The results of all these samples were negative (Table 2).
T102 11873-12000 Sentence denotes PCR of the oropharyngeal swabs collected before and after the operation and analysed within 1 week all showed negative results.
T103 12001-12058 Sentence denotes The serum IgM and IgG antibody titres were also measured.
T104 12059-12262 Sentence denotes In the late phase, all patients showed IgG seropositivity, and most of them even showed strong seropositivity (85.71%), while only a minor proportion of them showed IgM seropositivity (18.57%) (Table 2).
T105 12263-12271 Sentence denotes Table 2:
T106 12273-12356 Sentence denotes Results of PCR analyses of otolaryngeal swabs and serum IgM and IgG antibody titres
T107 12357-12360 Sentence denotes No.
T108 12362-12414 Sentence denotes Tracheotomy date Swab Antibody type Level (AU/ml)
T109 12415-12444 Sentence denotes 1 D58 D54 Neg IgM 2.33 –
T110 12445-12458 Sentence denotes IgG 17.79 ↑
T111 12459-12489 Sentence denotes 2 D48 D48 Neg IgM 29.04 ↑
T112 12490-12504 Sentence denotes IgG 97.07 ↑↑
T113 12505-12534 Sentence denotes 3 D50 D53 Neg IgM 0.33 –
T114 12535-12548 Sentence denotes IgG 20.78 ↑
T115 12549-12578 Sentence denotes 4 D33 D33 Neg IgM 1.51 –
T116 12579-12594 Sentence denotes IgG 117.7 ↑↑↑
T117 12595-12624 Sentence denotes 5 D57 D57 Neg IgM 4.57 –
T118 12625-12639 Sentence denotes IgG 96.97 ↑↑
T119 12640-12669 Sentence denotes 6 D37 D39 Neg IgM 6.27 –
T120 12670-12684 Sentence denotes IgG 79.48 ↑↑
T121 12685-12716 Sentence denotes 7 D41 D39 Neg IgM 20.69 ↑↑
T122 12717-12733 Sentence denotes IgG 389.66 ↑↑↑
T123 12734-12764 Sentence denotes 8 D40 D40 Neg IgM 45.12 ↑
T124 12765-12781 Sentence denotes IgG 220.13 ↑↑↑
T125 12782-12810 Sentence denotes 9 D56 D50 Neg IgM 2.3 –
T126 12811-12824 Sentence denotes IgG 49.6 ↑↑
T127 12825-12856 Sentence denotes 10 D60 D66 Neg IgM 17.38 ↑
T128 12857-12873 Sentence denotes IgG 101.46 ↑↑↑
T129 12874-12904 Sentence denotes 11 D70 D68 Neg IgM 0.74 –
T130 12905-12919 Sentence denotes IgG 46.42 ↑↑
T131 12920-12950 Sentence denotes 12 D90 D92 Neg IgM 2.74 –
T132 12951-12965 Sentence denotes IgG 84.47 ↑↑
T133 12966-12996 Sentence denotes 13 D42 D36 Neg IgM 5.39 –
T134 12997-13013 Sentence denotes IgG 104.24 ↑↑↑
T135 13014-13044 Sentence denotes 14 D38 D35 Neg IgM 0.43 –
T136 13045-13059 Sentence denotes IgG 62.62 ↑↑
T137 13060-13333 Sentence denotes ‘-’: <10 AU/ml (normal range); ‘↑’: ≥10–50 AU/ml; ‘↑↑’: ≥50–100 AU/ml; ‘↑↑↑’: ≥100 AU/ml; Neg: negative; PCR: polymerase chain reaction; Swab: date of the PCR test and result of oropharyngeal swab after disease onset; Tracheotomy date: tracheotomy date after disease onset.
T138 13334-13432 Sentence denotes The treatment outcomes of 12 of the 14 patients improved after the tracheotomy to varying degrees.
T139 13433-13676 Sentence denotes Seven of these patients were removed from mechanical ventilation, and the other 5 patients were receiving anti-infective and supportive treatment with continuous invasive mechanical ventilation until the date our data were collected (Table 1).
T140 13677-13760 Sentence denotes The conditions of all 12 patients were stable, with SpO2 levels maintained at >96%.
T141 13761-13772 Sentence denotes Patient no.
T142 13773-13831 Sentence denotes 1 died of progressive respiratory failure, and patient no.
T143 13832-13956 Sentence denotes 9 underwent vein–vein extracorporeal membrane oxygenation treatment after tracheotomy and died of uncontrolled septic shock.
T144 13958-13968 Sentence denotes DISCUSSION
T145 13969-14108 Sentence denotes In this study, we report the results of 14 critically ill patients with COVID-19 who underwent bedside conventional tracheotomy in the ICU.
T146 14109-14232 Sentence denotes Tracheotomy was safe when proper biosafety precautions were implemented to protect medical staff from SARS-CoV-2 infection.
T147 14233-14325 Sentence denotes COVID-19 displays viral exuding inflammation with alveolar damage in the early stage [2, 6].
T148 14326-14587 Sentence denotes If the patients exhibit respiratory failure or hypoxaemia with signs of severe pulmonary infection, international experts recommend that immediate intubation with mechanical ventilation in the prone position to correct acute respiratory distress syndrome [7–9].
T149 14588-14766 Sentence denotes With the progression of the disease, critically ill patients may develop secondary bacterial or fungal infections and the retention of secretions that obstruct the small airways.
T150 14767-14959 Sentence denotes In our study, 85.71% of patients (12/14) had combined secondary pulmonary infections, including bacterial and fungal infections, which led to increased respiratory secretions and thick sputum.
T151 14960-15222 Sentence denotes Moreover, many patients are unable to tolerate prolonged orotracheal intubation, which potentially renders the cannula prone to obstruction by secretions and necrosis of the mucosa of the mouth and trachea, even resulting in tracheomalacia and tracheal stenosis.
T152 15223-15487 Sentence denotes In contrast, tracheotomy may allow the patients to become more comfortable and increase the safety of airway management, including the administration of fewer sedative agent doses, easier secretion suction and drainage and faster recovery of spontaneous breathing.
T153 15488-15599 Sentence denotes Therefore, tracheotomy does not bring more benefits to patients than orotracheal intubation in the early stage.
T154 15600-15697 Sentence denotes The detection of antibodies against SARS-CoV-2 reflects the course of the disease to some extent.
T155 15698-15869 Sentence denotes It is recommended as an effective supplementary indicator for suspected cases with negative viral RNA detection or in conjunction with RNA detection for disease diagnosis.
T156 15870-16031 Sentence denotes A retrospective analysis from China revealed that the RNA test for sputum specimens had the highest detectability rate (92.3%), followed by throat swabs (69.2%).
T157 16032-16151 Sentence denotes Antibody detection showed lower positive rates (IgM, 23.0% and IgG, 53.8%) in the early phase of the disease (<8 days).
T158 16152-16280 Sentence denotes However, the sensitivity of antibody detection exceeded the RNA test beginning on day 8 after onset (IgM, 50.0% and IgG, 87.5%).
T159 16281-16452 Sentence denotes In the late phase (≥15 days), the sensitivity of IgM and IgG tests increased to 52.2% and 91.3%, respectively, while the positive rate of throat swabs was only 13.0% [10].
T160 16453-16605 Sentence denotes In our unit, the minimal interval between the infection and tracheotomy was 33 days, and the interval between intubation and tracheotomy was ∼2–4 weeks.
T161 16606-16675 Sentence denotes All patients were in the late phase of COVID-19 infection (≥15 days).
T162 16676-16888 Sentence denotes During this phase, viral RNA detection (otolaryngeal swabs, endotracheal secretions and operative incisions) was negative, IgG was detected at a 100% positive rate and IgM was only detected at low positive rates.
T163 16889-17278 Sentence denotes We recommend indications for surgical tracheotomy in critically ill patients with COVID-19, including (i) mechanical ventilation during a prolonged intubation time (more than 2 weeks) and a long intubation time expected (more than 2 weeks), (ii) intolerance to orotracheal intubation and (iii) combined secondary infection with other pathogens or increasing amounts of secretion discharge.
T164 17279-17463 Sentence denotes Because tracheotomy is one of the highest risk procedures during the treatment of COVID-19, medical staff must be appropriately protected from infection when performing this procedure.
T165 17464-17535 Sentence denotes To date, evidence-based guidelines on the use of PPE are not available.
T166 17536-17654 Sentence denotes The basic principle of covering should be multilayer donning and doffing to minimize the possibility of contamination.
T167 17655-17741 Sentence denotes In our practice, medical staff should wear level 3 PPE equipment during the procedure.
T168 17742-17935 Sentence denotes As the inner layer, we wear surgical scrubs or a work uniform, 1 KN95 (China), N95 (USA) or FFP2 (Europe) medical protective mask, coverall suit, shoe cover and surgical latex gloves (Fig. 1A).
T169 17936-18163 Sentence denotes As the outer layer, we wear another surgical mask outside, surgical s and another layer of shoe covers up to the knees, surgical gown and gloves, then put on a powered positive pressure air-purifying respirator (Fig. 1B and C).
T170 18164-18311 Sentence denotes If a pressure air-purifying respirator is not available in some hospitals, it can be replaced with a completely enclosed surgical helmet (Fig. 1D).
T171 18312-18439 Sentence denotes Uncertainty and variable practices regarding PPE remain worldwide, and some countries recommend lower levels of PPE [7, 11–14].
T172 18440-18587 Sentence denotes However, evidence of the association between the level of PPE and coronavirus transmission is currently lacking and requires further investigation.
T173 18588-18659 Sentence denotes Therefore, we used a higher level of PPE to avoid nosocomial infection.
T174 18660-18775 Sentence denotes Uncertainty exists regarding whether an N95 mask should be worn if a pressure air-purifying respirator is used [7].
T175 18776-18870 Sentence denotes We chose to wear the N95 mask to protect us from self-contamination during the doffing of PPE.
T176 18871-19036 Sentence denotes Recent studies also confirmed that the risk of disease transmission to healthcare workers is very low when a similar level of PPE as described here is used [15, 16].
T177 19037-19253 Sentence denotes After being completely equipped in the buffer room as described above, the surgical team, which was composed of 2 otolaryngology surgeons, 1 anaesthetist and 2 nurses, entered the isolated negative pressure ICU room.
T178 19254-19322 Sentence denotes Other medical staff remained outside to minimize the infection risk.
T179 19323-19518 Sentence denotes The procedure was performed at the bedside to minimize the risks of spreading the virus and endangering critically ill patients during the process of transporting them to the operating room [17].
T180 19519-19662 Sentence denotes The presence of 2 experienced surgeons ensured a fast and effective tracheotomy compared with less experienced surgeons or residents (Fig. 1D).
T181 19663-19834 Sentence denotes The anaesthetist administered aesthetic agents to prevent swallowing and cough reflexes, control the ventilator and remove the tube after tracheal incision (Fig. 1D) [17].
T182 19835-19966 Sentence denotes The critical and most important steps should be performed by the anaesthetist and the otolaryngologist in skilled cooperation [18].
T183 19967-20112 Sentence denotes The anaesthetist stops the ventilator and deflates the cuff, and the surgeon opens the anterior wall of the trachea and quickly inserts the tube.
T184 20113-20208 Sentence denotes The cuff is then inflated immediately and the lack of leakage is confirmed by the anaesthetist.
T185 20209-20307 Sentence denotes A scrub nurse and an assistant nurse should handle the surgical table and assist the anaesthetist.
T186 20308-20467 Sentence denotes In addition to the necessary surgical instruments, a non-fenestrated cuffed tracheotomy tube of the expected diameter should be prepared on the surgical table.
T187 20468-20696 Sentence denotes After the tracheotomy, reusable medical devices should be disinfected according to the disinfection procedures for SARS-CoV-2, and all surfaces of objects should be wiped with a disinfectant containing 1000 mg/l active chlorine.
T188 20697-20780 Sentence denotes The nurses providing care to patients after tracheotomy also face an exposure risk.
T189 20781-20963 Sentence denotes We chose a completely closed sputum aspirator to prevent the airway from directly opening and generating droplets and aerosol contamination, which will promote virus spread (Fig. 3).
T190 20964-21148 Sentence denotes In addition, the breathing circuit should be maintained in the closed position during mechanical ventilation, and virus filters are inserted in both the inhalation and expiration ends.
T191 21149-21251 Sentence denotes If no obvious contamination is detected, the breathing circuit does not need to be replaced routinely.
T192 21252-21482 Sentence denotes In terms of airway protection, the cuff pressure should be maintained at 25–30 cmH2O (1 cmH2O = 0.098 kPa), and it should be monitored every 6–8 h after the artificial airway (orotracheal intubation or tracheotomy) is established.
T193 21483-21570 Sentence denotes We recommend that cannula management should be performed by trained nursing staff [19].
T194 21571-21815 Sentence denotes With this range of cuff pressures, we are able to ensure effective ventilation, reduce air leakage contamination caused by inadequate cuff sealing and avoid airway mucosal compression injury caused by the overinflation of intubation cuffs [20].
T195 21816-22081 Sentence denotes Because airborne transmission is presumed to occur when respiratory particles <5 μm in diameter are inhaled and deposited in the lungs [21], we recommend that patients with COVID-19 avoid unnecessary inhalation therapy as much as possible for airway humidification.
T196 22082-22489 Sentence denotes The results of aerosol aerodynamic transmission studies of influenza virus (another airborne RNA virus) showed that 65% of the influenza RNA was contained in particles ≤4 µm in aerodynamic diameter (23% in particles 1–4 µm and 42% in particles <1 µm), indicating that most of the viral RNA is contained within particles in the respirable size range and the airborne route may be a transmission pathway [22].
T197 22490-22757 Sentence denotes Although the drug aerosol diffused during airway humidification has a lower risk of spreading the disease than the aerosol particles discharged from the patient, the aerosol generated during atomization may still carry the virus expelled in the patient's exhaled air.
T198 22758-22838 Sentence denotes Therefore, unnecessary inhalation therapy should be avoided during the pandemic.
T199 22839-23078 Sentence denotes Regarding ventilation in the prone position, 1 staff member should stand at the head of the bed, handle the tracheal intubation, and place the U-shaped pillow cushion on the pressure side to prevent the tracheal tube from being compressed.
T200 23079-23233 Sentence denotes Changes in the waveform, tidal volume and minute ventilation volume must be monitored, and an arterial blood gas analysis could be performed if necessary.
T201 23234-23457 Sentence denotes Patients who have undergone a tracheotomy may need to retain the cannula for a period of time after being weaned from mechanical ventilation, and thus we recommend the use of a filter to provide airway warming and humidity.
T202 23458-23595 Sentence denotes The dressing of the wound should be changed daily to prevent infection, and the tightness of neck fixation should be monitored routinely.
T203 23596-23605 Sentence denotes Figure 3:
T204 23607-23681 Sentence denotes Completely enclosed sputum aspirator. (A) Anterior view. (B) Lateral view.
T205 23682-23920 Sentence denotes Due to the recent COVID-19 pandemic, several studies on tracheotomy management in patients with COVID-19 have been published [18, 19, 23, 24], with the aim of providing helpful information to minimize the risks of nosocomial transmission.
T206 23921-24075 Sentence denotes To our knowledge, we are the first group to summarize our own experiences with an open bedside tracheotomy at a centre in the hardest-hit region of China.
T207 24076-24254 Sentence denotes Compared with open tracheotomy in the operating room, open bedside tracheotomy might reduce potential exposure risks associated with transport between the ICU and operating room.
T208 24255-24404 Sentence denotes Additionally, we systematically described the procedures for donning PPE in detail, which will allow medical staff to easily follow the instructions.
T209 24405-24527 Sentence denotes Nursing work, particularly work related to airway humidification and ventilation in the prone position, was also reported.
T210 24528-24818 Sentence denotes Importantly, our study described and analysed the PCR results for SARS-CoV-2 and serum IgM and IgG antibody titres, which might be valuable for evaluating the infection risks of these invasive procedures and assessing clinicians in determining the indications for and timing of tracheotomy.
T211 24820-24831 Sentence denotes CONCLUSIONS
T212 24832-24952 Sentence denotes A tracheotomy performed in the late phase of COVID-19 in critically ill patients has a relatively low risk of infection.
T213 24953-25075 Sentence denotes Proper extension of the intubation time (2–4 weeks) of patients who require invasive mechanical ventilation is acceptable.
T214 25076-25274 Sentence denotes If the patient shows intolerance to orotracheal intubation or has a secondary lung infection, tracheotomy might represent a safer method to manage the airway and help improve the treatment outcomes.
T215 25275-25501 Sentence denotes Compared with conventional tracheotomy, the modified tracheotomy procedure should include the use of neuromuscular blockade to completely sedate the patients, along with the suspension of ventilation before opening the airway.
T216 25502-25579 Sentence denotes Donning adequate personal protection will help medical staff avoid infection.
T217 25580-25616 Sentence denotes Conflict of interest: none declared.
T218 25618-25638 Sentence denotes Author contributions
T219 25639-25653 Sentence denotes Surita Aodeng:
T220 25654-25716 Sentence denotes Data curation; Project administration; Writing—original draft.
T221 25717-25730 Sentence denotes Weiqing Wang:
T222 25731-25784 Sentence denotes Data curation; Investigation; Writing—original draft.
T223 25785-25793 Sentence denotes Yu Chen:
T224 25794-25828 Sentence denotes Project administration; Resources.
T225 25829-25842 Sentence denotes Guodong Feng:
T226 25843-25900 Sentence denotes Formal analysis; Investigation; Writing—review & editing.
T227 25901-25911 Sentence denotes Jian Wang:
T228 25912-25969 Sentence denotes Formal analysis; Investigation; Writing—review & editing.
T229 25970-25977 Sentence denotes Wei Lv:
T230 25978-26035 Sentence denotes Formal analysis; Investigation; Writing—review & editing.
T231 26036-26045 Sentence denotes Hua Yang:
T232 26046-26103 Sentence denotes Formal analysis; Investigation; Writing—review & editing.
T233 26104-26113 Sentence denotes Xin Ding:
T234 26114-26137 Sentence denotes Project administration.
T235 26138-26152 Sentence denotes Kaicheng Song:
T236 26153-26176 Sentence denotes Project administration.
T237 26177-26188 Sentence denotes Sirui Zhao:
T238 26189-26212 Sentence denotes Project administration.
T239 26213-26225 Sentence denotes Jiazhen Liu:
T240 26226-26249 Sentence denotes Project administration.
T241 26250-26264 Sentence denotes Shuyang Zhang:
T242 26265-26327 Sentence denotes Project administration; Supervision; Writing—review & editing.
T243 26328-26341 Sentence denotes Zhiqiang Gao:
T244 26342-26404 Sentence denotes Project administration; Supervision; Writing—review & editing.
T245 26406-26426 Sentence denotes Reviewer information
T246 26427-26618 Sentence denotes European Journal of Cardio-Thoracic Surgery thanks Riyad Karmy-Jones, Masafumi Kawamura and the other, anonymous reviewer(s) for their contribution to the peer-review process of this article.
T247 26620-26633 Sentence denotes ABBREVIATIONS
T248 26634-26667 Sentence denotes COVID-19 Coronavirus disease 2019
T249 26668-26691 Sentence denotes ICU Intensive care unit
T250 26692-26721 Sentence denotes PCR Polymerase chain reaction
T251 26722-26755 Sentence denotes PPE Personal protective equipment
T252 26756-26812 Sentence denotes SARS-CoV-2 Severe acute respiratory syndrome coronavirus