Elective tracheostomy during COVID-19 outbreak: to whom, when, how? Early experience from Venice, Italy

Abstract

PurposeThe need for prolonged invasive mechanical ventilation in COVID-19 patients is placing the Otorhinolaryngologist in front of an increasing request for tracheostomy. Nowadays, there is uncertainty regarding the timing of tracheostomy, the prognosis of these patients and safety of healthcare workers. The aim of this study is to evaluate the efficacy and safety of tracheostomy placement in patients with COVID-19. MethodsIt wasconducted a retrospective cohort study on 23 COVID 19 patients, in order to analyse the timing of tracheostomy, the risk factors associated with in-hospital death and theinfection of the involved health care workers. Early tracheostomy was defined as ≤ 10 days and late ones > 10 days.ResultsThe mortality rate of COVID-19 patients admitted to ICU that underwent tracheostomy was 18%. The overall mortality of patients admitted to ICU was 53%. The univariate analysis revealed that early tracheostomy, SOFA score > 6, D-Dimer level > 4 were significantly associated with a greater risk of death. At the multivariate analysis SOFA score > 6 and D-Dimer level > 4 resulted as significant factors for a higher risk of death. No health care workers associated with tracheostomy are confirmed to be infected by SARS- CoV2.ConclusionWe suggest to wait at least 14 days to perform tracheostomy. In patients with SOFA score > 6, and D dimer > 4 tracheostomy should not be performed or should be postponed. Optimized procedures and enhanced personal protective equipment can make the tracheostomy safe and beneficial in COVID-19 patients.

Safety of bedside surgical tracheostomy during COVID-19 pandemic: A retrospective observational study

“…Several articles regarding tracheostomy in COVID-19 patients has been published [ 13 – 20 ]. Martin-Villares et al [ 13 ] performed a multicenter prospective observational study of 1890 COVID-19 patients undergoing tracheostomy (81.3% surgical and 22.7% percutaneous) performed by otolaryngologists across 120 hospitals in Spain.…”

“…Mattioli et al [ 19 ] reported 28 tracheostomies (surgical and percutaneous) on COVID-19 ICU patients without significant complications; some procedures were performed within 7 days from intubation without reported infections among proceduralists. Volo et al [ 20 ] performed a retrospective cohort study on 23 COVID-19 patients undergoing ICU bedside tracheostomy (22 surgical and 1 percutaneous) performed by otolaryngologists. The average time between the intubation date and the tracheostomy date was 13 days.…”

“…However, tracheostomy is an aerosol-generating procedure and several concerns in COVID-19 patients on to its safety has been raised [ 10 – 12 ]. Despite some studies published during COVID-19 pandemic [ 13 – 20 ], more data are necessary to better elucidate the role of tracheostomy in this setting. The aim of this study was therefore to evaluate the safety of bedside surgical tracheostomy in COVID-19 patients admitted to ICU.…”

Tracheostomy in Covid-19 Patients: Surgical Concerns and Considerations

“…In patients with severely compromised gas exchange placement of the tracheostomy tube can be unsafe as they do not tolerate a loss of positive airway pressure during the procedure [ 2 ]. Also, these patients may require invasive ventilation in the prone position in the early phase, making a tracheostomy contraindicated [ 5 ].…”

Tracheostomy in coronavirus disease 2019: timing, outcomes, prognosis and technique

“…Tracheostomy for weaning critically ill patients with Covid-19 who are receiving invasive mechanical ventilation remains a matter of debate. [2][3][4] Controversy exists regarding timing, outcomes, prognosis, and optimal technique (open vs percutaneous vs hybrid techniques) to reduce aerosol generation and risk of transmission to healthcare workers. The paper by Takhar et al primarily aimed to analyse the intra-operative and posttracheostomy outcomes in 81 patients with Covid-19 pneumonitis requiring prolonged mechanical ventilation.…”