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• W4205598161 abstract "We thank McGrath et al1 for the interest in our article and, the further recommendations they give ultimately help in stressing the importance of several technical and general aspects in coronavirus disease 2019 (COVID-19) patients undergoing tracheostomy. A complete and definitive description of safety for operators is given in point 1, while an important recommendation for neuromuscular monitoring is advised, due to the risk of tachyphylaxis, in severe conditions (point 2). We totally agree with this statement even though prolonged neuromuscular block was not always necessary in our experience. In point 3, the authors refer to a significant possibility given by the exclusion of the upper airway undergoing manipulation. When the tube is advanced and the cuff is inflated, the proximal airway is excluded from ventilation and the risk for aerosol spread is eliminated. In that moment, the operator can perform the tracheotomy in a highly safe condition while the patient is still ventilated. Regarding the percutaneous technique, some important technical details are provided and help indeed to detail our original description (point 4).2 The presence of a dedicated assistant for the management of ventilator is expected in our operative protocol too. The need to defer the procedure as well as to abort any other possible ventilation adjustments are conclusively presented by the authors in point 5 and they assess the operators’ safety issues, reporting their own experience also. Following these considerations, we believe that the choice between percutaneous or surgical tracheostomy is equally important.3 Moreover, the proposal of safety barriers with plastic elements could be an additional option in particular circumstances especially related to local conditions (hospital, rooms, devices, etc). Staff experience and good training in using dedicated devices, personal protective equipment, and adherence to the protocol remain crucial for personal protection.4 Finally, as suggested by McGrath et al,1 a global collection of data to achieve a thorough understanding and, consequently, a standardized procedure, sounds a very promising initiative.5 Massimiliano Bassi, MDDepartment of Thoracic Surgery and Lung TransplantationUniversity of Rome SapienzaPoliclinico Umberto IRome, Italy Franco Ruberto, MDDepartment of Anesthesiology and Critical CareUniversity of Rome SapienzaPoliclinico Umberto IRome, Italy Camilla Poggi, MDDaniele Diso, MDMarco Anile, MDTiziano De Giacomo, MDYlenia Pecoraro, MDCarolina Carillo, MDDepartment of Thoracic Surgery and Lung TransplantationUniversity of Rome SapienzaPoliclinico Umberto IRome, Italy Francesco Pugliese, MDDepartment of Anesthesiology and Critical CareUniversity of Rome SapienzaPoliclinico Umberto IRome, Italy Federico Venuta, MDJacopo Vannucci, MDDepartment of Thoracic Surgery and Lung TransplantationUniversity of Rome SapienzaPoliclinico Umberto IRome, Italy[email protected]" @default.
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• W4205598161 date "2021-01-08" @default.
• W4205598161 modified "2023-09-24" @default.
• W4205598161 title "In Response" @default.
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• W4205598161 doi "https://doi.org/10.1213/ane.0000000000005420" @default.
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