COVID-19 Tracheostomy: Experience in a University Hospital With Intermediate Follow-up

Abstract

The benefits of percutaneous dilational tracheostomy (PDT) placement have been well documented in patients requiring prolonged mechanical ventilation. However, the data regarding the benefit of PDT in coronavirus-2019 (COVID-19) patients are scarce. The objective of this study is to evaluate the outcomes of a cohort of 37 patients who underwent tracheostomy as part of their COVID-19 care. Retrospective data from a series for 37 patients undergoing tracheostomy was collected using chart review. Primary outcomes included 30 and 60 day mortality, weaning rate, and decannulation rate. Secondary outcomes collected included admission demographics, comorbidities, and procedural information. Thirty-seven (37) patients requiring prolonged mechanical ventilation due to COVID-19. Of these 37 patients, 35 were alive 60 days post-PDT placement, 33 have been weaned from mechanical ventilation and 18 have been decannulated. The low mortality and high decannulation rates in this cohort in is a promising development in the care of critically ill COVID-19 patients. Of note, all participating physicians underwent routine polymerase chain reaction (PCR) testing for infection with the severe acute respiratory syndrome coronavirus-2 virus and no physician contracted COVID-19 as a result of their involvement. Overall, this case series describes the modified PDT technique used by our team and discusses the feasibility and potential benefit to PDT placement in COVID-19 patients requiring long-term mechanical ventilation.

The Feasibility of Percutaneous Dilatational Tracheostomy in Immunosuppressed ICU Patients with or without Thrombocytopenia

“…All COVID-19 patients were treated with PDT; none of the medical team was infected due to the procedure. The rate of complications was similar to other patient groups, and PDT can therefore be considered safe for COVID-19 patients, which is in line with the results of other studies [ 26 – 28 ].…”

Therapeutic and Interventional Bronchoscopy Performed in Critically ill COVID-19 patients: A Systematic Review

“…Meyer et al reported bronchoscope guided PDT decreased the risk of bleeding in comparison to open tracheostomies, considering the high rate of anti-coagulation therapy required for these patients. Guided PDT reduced transmission of virus to HCWs from critically ill COVID-19 patients [15, 68-69], although there was no major difference in complication rate in PDT compared to open tracheostomy [64, 61]. However, in a pre-COVID study demonstrated that use of bronchoscopes did not affect the overall outcome in patients with open or percutaneous tracheostomy [70].…”

“…Therapeutic and interventional bronchoscopy is an effective procedure utilized in severe or critically ill ICU admitted patients [12][13][14][15]. The use of therapeutic bronchoscopy was mainly used for the indications like acute lung failure, atelectasis, hyperaemia, routine clearance of obstructive airway in patient with lung transplantation due to COVID-19 pneumonia [16][17][18][19][20][21].…”

Interventional Pulmonology and the Esophagus: Tracheostomy and Percutaneous Endoscopic Gastrostomy Placement

“…53 54 In a recent study of 37 patients with COVID-19 undergoing tracheostomy, 35 were alive at 60 days of postplacement, 33 weaned from mechanical ventilation, and 18 decannulated. 55…”