Experience of percutaneous tracheostomy in critically ill COVID-19 patients

Abstract

Background Coronavirus disease 2019 (COVID-19) is a highly contagious disease that causes respiratory failure. Tracheostomy is an essential procedure in critically ill COVID-19 patients; however, it is an aerosol-generating technique and thus carries the risk of infection transmission. We report our experience with percutaneous tracheostomy and its safety in a real medical setting. Methods During the COVID-19 outbreak, 13 critically ill patients were admitted to the intensive care unit (ICU) at Daegu Catholic University Medical Center between February 24 and April 30, 2020. Seven of these patients underwent percutaneous tracheostomy using Ciaglia Blue Rhino. The medical environment, percutaneous tracheostomy method, and COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR) results were retrospectively reviewed. After treatment, the COVID-19 infection status of healthcare personnel was investigated by RT-PCR. Results The ICU contained negative pressure cohort areas and isolation rooms, and healthcare personnel wore a powered air-purifying respirator system. We performed seven cases of percutaneous tracheostomy in the same way as in patients without COVID-19. Five patients (71.4%) tested positive for COVID-19 by RT-PCR at the time of tracheostomy. The median cycle threshold value for the RNA-dependent RNA polymerase was 30.60 (interquartile range [IQR], 25.50–36.56) in the upper respiratory tract and 35.04 (IQR, 28.40–36.74) in the lower respiratory tract. All healthcare personnel tested negative for COVID-19 by RT-PCR. Conclusions Percutaneous tracheostomy was performed with conventional methods in the negative pressure cohort area. It was safe to perform percutaneous tracheostomy in an environment of COVID-19 infection.

Tracheostomy Practice in Mechanically Ventilated Patients With SARS-CoV-2 Induced Acute Respiratory Distress Syndrome: a Single-center Retrospective Study With Focus on Tracheomalacia

“…Tracheomalacia was diagnosed in 8 (5%) of studied patients. The diagnosis was performed 27 [21][22][23][24][25][26][27][28][29][30][31][32] days after endotracheal intubation. Compared to the remaining population (Table 2), more patients in whom tracheomalacia was diagnosed were female (75% vs. 20%, p = 0.002;…”

“…All patients diagnosed with tracheomalacia were treated with a tracheostomy for airway management (100% vs. 45%, p = 0.008). No difference was found regarding the use of the surgical approach (87.5% vs. 72.3% p = 0.671 with surgical approach), the timing of tracheostomy (11 [7][8][9][10][11][12][13][14] days vs. 11 [8][9][10][11][12][13][14][15][16][17] days, p = 0.371), and decannulation (35 days vs. 19 [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] p = 0.108) comparing patients that developed tracheomalacia with the remaining population. Conversely, the duration of mechanical ventilation (29 [22][23][24][25][26][27][28][29][30]…”

“…Sepsis was reported more frequently in patients with tracheomalacia (75% vs 35%, p = 0.057) and the median duration of antibiotic therapy was longer in patients who developed tracheomalacia (22 [5-28] vs. 6 [2][3][4][5][6][7][8][9][10][11][12][13][14][15] days, p = 0.018). Similarly, ICU and hospital length of stay were signi cantly longer in patients diagnosed with tracheomalacia (29 [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] vs. 14 [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]…”

“…Other authors investigated the use of tracheostomy in SARS-CoV-2 patients, describing the overall safety of the procedure [22,[24][25][26][27][28][29][30][31][32]. Several studies reported a longer ICU length of stay in tracheostomized patients [25,33].…”

Commentary: Coronavirus disease 2019 (COVID-19) tracheostomies—The “how” but not the “why” or “when”

“…2 Recent publications have detailed new algorithms and recommendations regarding tracheostomy placement in patients with COVID-19 at both the institutional and national levels, as shown in the author's Table E3. [3][4][5][6][7][8] A cursory review of this table, however, illustrates the absence of consensus about best practice. Nonetheless, Bribriesco and colleagues provide a thoughtful, multidisciplinary approach to tracheostomy placement in patients with COVID-19.…”