Percutaneous Tracheostomy in COVID-19 Critically Ill Patients: Experience from 30 Consecutive Procedures

Abstract

Introduction Percutaneous tracheostomy (PT) in the intensive care unit (ICU) is a well-established practice that shows a reduced risk of wound infection compared with surgical tracheostomy, thus facilitating mechanical ventilation, nursing procedures, reduction in sedation and early mobilization. Objective This is an observational case-control study that compares the results of PT in ICU patients with coronavirus disease 2019 (COVID-19) prospectively enrolled to a similar group of subjects, retrospectively recruited, without COVID-19. Methods Ninety-eight consecutive COVID-19 patients admitted to the ICU at Pisa Azienda Ospedaliero Universitaria Pisana between March 11th and May 20th, 2020 were prospectively studied. Thirty of them underwent PT using different techniques. Another 30 non-COVID-19 ICU patients were used as a control-group. The main outcome was to evaluate the safety and feasibility of PT in COVID-19 patients. We measured the rate of complications. Results Percutaneous tracheostomy was performed with different techniques in 30 of the 98 COVID-19 ICU patients admitted to the ICU. Tracheostomy was performed on day 10 (mean 10 ± 3.3) from the time of intubation. Major tracheal complications occurred in 5 patients during the procedure. In the control group of 30 ICU patients, no differences were found with regards to the timing of the tracheostomy, whereas a statistically significant difference was observed regarding complications with only one tracheal ring rupture reported. Conclusion Percutaneous tracheostomy in COVID-19 patients showed a higher rate of complications compared with controls even though the same precautions and the same expertise were applied. Larger studies are needed to understand whether the coronavirus disease itself carries an increased risk of tracheal damage.

Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals

“…The database search generated 1877 citations, of which 156 (8.3%) underwent full-text review (Figure 1). Overall, 69 studies (N = 4669 patients) were included within the qualitative synthesis, and 14 studies were included in the meta-analyses . Interrater reliability between independent reviewers was 0.81 and 0.64 for the abstract screening and full-text stages, respectively.…”

Coronavirus disease tracheostomy complications: a scoping review

“…One of these studies found an increased incidence of tracheal injuries in Covid-19 patients. 16 The second of these studies found a significantly increased risk of bleeding in Covid-19 patients (20.3 per cent vs 5.97 per cent), but with no difference in length of hospital stay. 17 The final of these studies reported an increased time from intubation to tracheostomy in Covid-19 patients (25.4 days vs 22.9 days).…”

Whole-organ deceased donor tracheal allograft transplantation for the treatment of refractory tracheal stenosis: a case report

“…Indeed, innumerable percutaneous tracheostomies [16][17][18] , and prolonged intubations occurred during the pandemic [16] . This fact, along with potential direct tracheal damage from the infection itself [19] may increase the need for DDTAT in post-COVID-19 patients. This is the first DDTAT case being presented and future work depends upon further investigation and data collection and reporting.…”