Resumen Sintetizamos la evidencia con respecto a las consideraciones logísticas y los eventos de seguridad asociados a la ventilación mecánica en posición prona (VMPP) y proponemos un flujograma para realizarla de manera segura en el escenario de la pandemia por COVID-19. Para ello, realizamos una búsqueda de la literatura en las bases de datos Medline vía PubMed, Embase, Lilacs, Cochrane Database of Systematic Reviews, Cochrane Central Register of Randomized Controlled Trials, Cochrane Database of Abstracts of Reviews of Effects, ProQuest Nursing and Allied Health Database y Google académico. Se incluyeron 31 artículos para ser analizados. La incidencia de eventos de seguridad relacionados a la VMPP varía entre 1 % a 11.9 %, las complicaciones más frecuentes son las úlceras por presión y de la vía aérea. Se recomienda iniciar nutrición enteral temprana y es posible realizar traslado de pacientes con VMPP. Existe controversia acerca de las contraindicaciones y recomendaciones de la VMPP. Las recomendaciones para realizarla de forma segura se basan en opiniones de expertos y en la instauración de protocolos para el entrenamiento del personal de salud. Se requieren estudios clínicos para determinar cuáles recomendaciones son necesarias para que la VMPP se realice de forma segura y reproducible durante esta pandemia.

Abstract The evidence regarding logistic considerations and safety events associated with prone position ventilation (PPV) is summarized and a flow diagrama for safe provision of mechanical ventilation in the setting of the COVID-19 pandemic is proposed. A review of the literature was conducted in the Medline via Pubmed, Embase, and Lilacs databases, the Cochrane Database of Systematic Reviews, Cochrane Central Register of Randomized Controlled Trials, Cochrane Database of Abstracts of Reviews of Effects, ProQuest Nursing and Allied Health Database, and Google scholar. Overall, 31 articles were selected for the analysis. The incidence of PPV-related safety events varies between 1% and 11.9% and the most frequent complications are pressure ulcers and airway complications. Early initiation of enteral nutrition is recommended, and transfers are possible in patients on PPV. There is controversy regarding contraindications and recommendations for PPV. Recommendations for its safe provision are based on expert opinions and the establishment of protocols for healthcare staff training. Clinical studies are required to determine which are the recommendations that should be considered for safe and reproducible PPV use during this pandemic.

Abstract Background: Perioperative management of Tracheal Resection and Reconstruction (TRR) presents many challenges to the physicians involved in airway management. Factors related to postoperative outcomes can be identified as early as the preoperative setting and can even be linked to demographic characteristics of patients affected by tracheal stenosis. The primary aim of this study is to describe the experience of patients undergoing TRR at our hospital from an anesthesiology perspective, describing as a second aim demography, preoperative conditions, and postoperative complications. Method: This was a single institution retrospective review of patients who underwent TRR between 2009 and 2020. We did a post-hoc exploratory analysis to identify possible associations between perioperative complications and perioperative management. Results: Forty-three ASA I-IV adult patients aged 18–72 years who underwent TRR were included. Prolonged intubation (72%) is the primary cause of tracheal stenosis. Intraoperative management: intravenous induction and laryngeal masks are now the most frequently used for airway management, especially in subglottic stenosis. Perioperative complications were vocal cord paralysis (25.6%), postoperative ventilatory support (20.9%), and need for surgical reintervention (20.9%). One patient (2%) died in the postoperative period due to anastomotic complication. After resection, dexmedetomidine is the preferred choice (48.8%) for sedoanalgesia in the ICU. Conclusion: Perioperative management of TRR at our hospital has a low mortality and high morbidity rate. We did not find an association between perioperative anesthetic interventions and postoperative complications. Further studies are needed to evaluate which anesthetic interventions may be associated with better outcomes.

Resumen La broncoscopia flexible es un procedimiento diagnóstico o terapéutico con baja incidencia de complicaciones (0,08-6,8%). El sangrado por biopsia transbronquial es una complicación rara (0-2,8% de los casos), suele ser leve y resuelve con medidas locales. No existe una definición clara de hemoptisis masiva y, por su baja incidencia, no hay guías de práctica clínica para el tratamiento de esta complicación, que puede ser catastrófica. Presentamos un caso de hemoptisis masiva durante la realización de una broncoscopia flexible más biopsia transbronquial y revisamos la literatura acerca del manejo intraoperatorio.

Abstract Flexible bronchoscopy is a diagnostic or therapeutic procedure with a low incidence of complications (0.08-6.8%). Bleeding after transbronchial biopsy is a rare complication (0-2.8% of the cases), usually resulting in minor bleeding that resolves with local measures. There is no clear definition of massive hemoptysis and due to the low incidence of this condition, there are no practical guidelines for the treatment of this complication that may be catastrophic. This case discusses the occurrence of massive hemoptysis during a transbronchial biopsy under flexible bronchoscopy, including a literature review on perioperative management.