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LitCovid-sentences  

PMC:7146662 JSONTXT 18 Projects

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Id Subject Object Predicate Lexical cue
T1 0-69 Sentence denotes Novel Approach to Reduce Transmission of COVID-19 During Tracheostomy
T2 71-291 Sentence denotes Severe infection involving the novel coronavirus 2019 (COVID-19) has been associated with acute respiratory distress syndrome, which subsequently requires patients to be intubated and dependent on mechanical ventilation.
T3 292-398 Sentence denotes In the setting of the recent pandemic, there is a greater need to perform tracheostomy for these patients.
T4 399-603 Sentence denotes With the high transmissibility of the virus, there has been an increasing concern for the development of techniques to perform surgical intervention while mitigating the risk for infecting hospital staff.
T5 604-749 Sentence denotes As more data emerge pertaining to viral shedding in various bodily fluids, it has become more important to give special attention to precautions.
T6 750-900 Sentence denotes In this article, we submit a novel approach for better protection and therefore, reduced transmission for tracheostomy in a COVID-19 positive patient.
T7 901-1082 Sentence denotes Importantly, this technique is functional, easy to set up, and can be used for additional operations that involve risk of aerosolization or droplet exposure to operating room staff.
T8 1083-1181 Sentence denotes COVID-19 has been associated with the highly contagious, novel strain of coronavirus (SARS-CoV-2).
T9 1182-1372 Sentence denotes The severity of the disease ranges broadly between a mild cough and development of acute respiratory distress syndrome, for which some patients require intubation and mechanical ventilation.
T10 1373-1679 Sentence denotes Its predilection for high transmissibility is threefold, as the virus can be spread via contact, droplets, and aerosol.1 This presents particular challenges for the healthcare team providing surgical intervention, especially tracheostomy, while mitigating the risk for increasing the spread of the disease.
T11 1680-1772 Sentence denotes Berkshire Medical Center is a 307-bed community teaching hospital located in Pittsfield, MA.
T12 1773-1855 Sentence denotes The first COVID-19 positive patient in the county was recognized on March 7, 2020.
T13 1856-2146 Sentence denotes By March 26, 2020, Pittsfield, MA had the ninth highest concentration of confirmed COVID-19 cases per 1,000 people by metro area in the entire world.2 Currently, there is little evidence or regulatory guidance to mitigate the intraoperative transmission of SARS-CoV-2 during a tracheostomy.
T14 2147-2340 Sentence denotes Therefore, we propose a protocol that is used by our surgery department to perform a tracheostomy for patients who suffer prolonged respiratory failure requiring mechanical ventilation support.
T15 2342-2361 Sentence denotes Protocol and set-up
T16 2362-2687 Sentence denotes At our institution, an anteroom is used, directly abutting our negative pressure operating room, for donning and doffing of personal protective equipment (PPE), including protective boot covers, a sterile gown, under gloves, a surgical mask, powered air-purifying respirators (PAPRs), and an overlying pair of sterile gloves.
T17 2688-2801 Sentence denotes On transfer to the operating room from the ICU, the patient is accompanied by an anesthesia provider in full PPE.
T18 2802-2959 Sentence denotes Once in the operating room, the patient is placed in the supine position on the operating table and draped in the usual sterile fashion with a thyroid drape.
T19 2960-3038 Sentence denotes Next, a magnetic instrument mat is placed overlying the patient’s upper chest.
T20 3039-3135 Sentence denotes An Omni-Tract retractor is mounted to the bed at the level of mid-abdomen, opposite the surgeon.
T21 3136-3213 Sentence denotes The retractor arms are placed in a wide-V configuration, over the upper body.
T22 3214-3452 Sentence denotes The Ecolab Scope Pillow Warmer Drape is a clear plastic material that is stretched over the retractor arms, forming a barrier between the operative field and the surgeon, while still allowing for good visualization of the operative field.
T23 3453-3601 Sentence denotes The drape is then secured with snaps to the self-retaining retractor to maintain the tightness of the drape; this will improve visibility (Fig. 1 ).
T24 3602-3757 Sentence denotes Figure 1 An Omni-Tract retractor mounted to the bed at the level of mid-abdomen, with retractor arms placed in a wide-V configuration, over the upper body.
T25 3758-3988 Sentence denotes The Ecolab Scope Pillow Warmer Drape is stretched over the retractor arms forming a barrier between the operative field and the surgeon and secured with snaps to the self-retaining retractor to maintain the tightness of the drape.
T26 3989-4121 Sentence denotes Additional self-retraining retractors that would suffice include a Bookwalter or Thompson retractor set; both can be used (Fig. 2 ).
T27 4122-4182 Sentence denotes This is used as a protective shield for droplet precautions.
T28 4183-4272 Sentence denotes Figure 2 Thompson retractor in place of Omni-Tract retractor set up in a similar fashion.
T29 4273-4457 Sentence denotes Finally, the Buffalo Filter smoke evacuator tubing is connected to 2 heat moisture exchange (HME) filters and placed under the drape to provide further air filtration (Figs. 3 and 4 ).
T30 4458-4558 Sentence denotes The reason for the multifilter system is to attempt maximum efficiency in filtering viral particles.
T31 4559-4786 Sentence denotes According to the respective manufacturers, Buffalo Filter has 4 stages of filtration that reportedly ensure 99.999% efficiency, down to 0.1 to 0.2 microns, and HME filters provide bacterial and viral filtration exceeding 99.9%.
T32 4787-4941 Sentence denotes Figure 3 Buffalo Filter smoke evacuator tubing connected to 2 heat moisture exchange filters and placed under the drape to provide further air filtration.
T33 4942-5044 Sentence denotes Figure 4 Two heat moisture exchange filters connected in series to the Buffalo Filter smoke evacuator.
T34 5045-5254 Sentence denotes The operator and assistant will proceed with hands underneath the drape, allowing both the technician to pass instruments under the additional protection and the anesthesia team to access the airway (Fig. 5 ).
T35 5255-5401 Sentence denotes A practice run was conducted to ensure smooth operation of the protocol, including the donning and doffing procedure and transferring of patients.
T36 5402-5480 Sentence denotes Figure 5 Operator and assistant with hands underneath the clear sterile drape.
T37 5481-5628 Sentence denotes The open access set-up allows both the technician to pass instruments under the additional protection and the anesthesia team to access the airway.
T38 5630-5640 Sentence denotes Discussion
T39 5641-5793 Sentence denotes As with every hospital system, there is a constant and fluid balance between the number of patients and the resources available to provide optimal care.
T40 5794-5901 Sentence denotes The COVID-19 pandemic will soon present a new problem: prolonged ventilation and the need for tracheostomy.
T41 5902-6124 Sentence denotes At our institution, we have yet to be forced to use these procedures to free up resources (including ventilators), and recommend they be performed in a controlled and safe environment to minimize transmission to providers.
T42 6125-6267 Sentence denotes This protocol has been used on 1 patient who, over 28 days of intubation, had improved ventilator settings and had an opportunity of recovery.
T43 6268-6440 Sentence denotes Before the implementation of this protocol, we conducted numerous dry runs with special attention to the mechanics, ease of use and set-up, and visibility of surgical site.
T44 6441-6636 Sentence denotes Importantly, it was noted that if there is any malfunction regarding the overlying clear drape, simple removal of the drape can be done without redraping or further complication to the operation.
T45 6637-6758 Sentence denotes Ultimately, this protocol allows the hospital staff to minimize the risk and exposure of the virus to the hospital staff.
T46 6760-6771 Sentence denotes Conclusions
T47 6772-6948 Sentence denotes In the setting of the current global coronavirus pandemic, acute respiratory distress syndrome and respiratory failure requiring mechanical ventilation have become commonplace.
T48 6949-7057 Sentence denotes An increasing number of tracheostomy consults will be obtained by our medical colleagues for these patients.
T49 7058-7216 Sentence denotes The aforementioned is a plausible and technically feasible set up for any hospital to perform tracheostomy safely while reducing droplet and aerosol exposure.
T50 7218-7238 Sentence denotes Author Contributions
T51 7239-7267 Sentence denotes Study conception and design:
T52 7268-7292 Sentence denotes Knowles, Galvez, Bowling
T53 7293-7313 Sentence denotes Acquisition of data:
T54 7314-7318 Sentence denotes Toia
T55 7319-7355 Sentence denotes Analysis and interpretation of data:
T56 7356-7370 Sentence denotes Foster, Cheung
T57 7371-7394 Sentence denotes Drafting of manuscript:
T58 7395-7416 Sentence denotes Foster, Cheung, Baran
T59 7417-7435 Sentence denotes Critical revision:
T60 7436-7459 Sentence denotes Craft, Kryskow, DiSiena
T61 7462-7485 Sentence denotes Disclosure Information:
T62 7486-7506 Sentence denotes Nothing to disclose.