Induced Apnea During Delayed Tracheostomy in Mechanically Ventilated Patients With COVID-19

Abstract

B oth conventional and modified tracheostomy techniques proposed for patients with COVID-19 (coronavirus disease 2019) entail a variable number of apnea periods [1][2][3][4] ; however, the duration and effects on patients and health care workers have been poorly described. Here, we performed an analysis of consecutive percutaneous dilatational tracheostomies (PDTs) performed in 2 hospitals' intensive care units (ICUs). We collected data from clinical records from March 25, 2020, to January 15, 2021.The adopted PDT technique differed from the standard bronchoscopy-guided Ciaglia's Blue-Rhino technique 5 in pausing mechanical ventilation during key steps and avoiding leaks. Both ICUs perform procedures within negative pressure rooms, and only 3 operators (2 surgeons, 1 intensivist) were present in the room. Should assistance be needed, an ICU nurse was available to enter the room. Personal protective equipment consisted of hair cover, surgical gown and boots, double gloves, goggles, and filtering facepiece N95 respirators. Patients were in a supine position under sedation, analgesia, and muscle paralysis; the intensivist was placed at the head of the bed for bronchoscopic guidance, to medicate the patient and monitor the clinical