RESUMO
En nuestros días los hospitales llevan a cuestas una gran lucha contra el mortal enemigo COVID-19 y hemos aprendido que las armas más valiosas son los antinflamatorios y los sistemas de asistencia ventilatoria intrahospitalaria; sin embargo, el incremento masivo de los casos ha superado la disponibilidad de estos últimos, así nació la idea de usar todo lo que esté a nuestro alcance para logar una suficiente administración de oxígeno a los pacientes. El Dr. Renato Favero, en Italia, y su válvula Charlotte que adaptaba a las máscaras de buceo tipo snorkel iniciaron la carrera creativa para tal fin.
RESUMO
OBJECTIVES: To provide evidence-based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS: A taskforce composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified, of which 226 publications were chosen. The taskforce generated a total of 19 recommendations, 10 positive (1B, 3; 2C, 3; 2D, 4) and 9 negative (1B, 8; 2C, 1). A recommendation was not possible in 6 questions. CONCLUSIONS: Percutaneous techniques are associated with a lower risk of infections compared with surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.