Is Surgical Tracheostomy Better Than Percutaneous Tracheostomy in COVID-19–Positive Patients?

Bassi, Massimiliano; Ruberto, Franco; Poggi, Camilla; Diso, Daniele; Anile, Marco; Giacomo, Tiziano De; Pecoraro, Ylenia; Carillo, Carolina; Pugliese, Francesco; Venuta, Federico; Vannucci, Jacopo

doi:10.1213/ane.0000000000005100

Cited by 17 publications

(19 citation statements)

References 19 publications

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“…Regarding the choice between percutaneous or surgical tracheostomy, the whole otorhinolaryngological and anesthesiological community is perfectly aware of the pros and cons of both techniques and issues related to COVID-19 [ 18 – 21 ]. We opted to perform percutaneous tracheostomy with the “Ciaglia Blue Rhino” technique for most COVID-19 patients (91%), a procedure that generates minimal aerosolization; we reserve the surgical technique only for patients with certain characteristics such as difficult neck anatomy, goiter and coagulopathy, following an internal protocol similar to that published by Bassi and colleagues [ 22 ]. However, according to the current literature, there is no evidence that one technique generates more laryngotracheal sequelae than the other.…”

Section: Discussionmentioning

confidence: 99%

Incidence and types of laryngotracheal sequelae of prolonged invasive ventilation in COVID-19 patients

Fiacchini

Abel

Tricò

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose The COVID-19 outbreak has led to an increasing number of acute laryngotracheal complications in patients subjected to prolonged mechanical ventilation, but their incidence in the short and mid-term after ICU discharge is still unknown. The main objective of this study is to evaluate the incidence of these complications in a COVID-19 group of patients and to compare these aspects with non-COVID-19 matched controls. Methods In this cohort study, we retrospectively selected patients from November 1 to December 31, 2020, according to specific inclusion and exclusion criteria. The follow-up visits were planned after 6 months from discharge. All patients were subjected to an endoscopic evaluation and completed two questionnaires (VHI-10 score and MDADI score). Results Thirteen men and three women were enrolled in the COVID-19 group while nine men and seven women were included in the control group. The median age was 60 [56–66] years in the COVID-19 group and 64 [58–69] years in the control group. All the patients of the control group showed no laryngotracheal lesions, while five COVID-19 patients had different types of lesions, two located in the vocal folds and three in the trachea. No difference was identified between the two groups regarding the VHI-10 score, while the control group showed a significantly worse MDADI score. Conclusions COVID-19 patients subjected to prolonged invasive ventilation are more likely to develop a laryngotracheal complication in the short and medium term. A rigorous clinical follow-up to allow early identification and management of these complications should be set up after discharge.

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Section: Discussionmentioning

confidence: 99%

Incidence and types of laryngotracheal sequelae of prolonged invasive ventilation in COVID-19 patients

Fiacchini

Abel

Tricò

et al. 2022

Eur Arch Otorhinolaryngol

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“…How to perform and manage tracheostomy in coronavirus disease (COVID)-19 patients is interesting in terms of procedure, ICU organization and caregivers’ protection [ 13 ]. In our study, tracheostomy was performed in 16% of our patients.…”

Section: Discussionmentioning

confidence: 99%

Tracheostomy in COVID-19 acute respiratory distress syndrome patients and follow-up: A parisian bicentric retrospective cohort

et al. 2021

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Background Tracheostomy has been proposed as an option to help organize the healthcare system to face the unprecedented number of patients hospitalized for a COVID-19-related acute respiratory distress syndrome (ARDS) in intensive care units (ICU). It is, however, considered a particularly high-risk procedure for contamination. This paper aims to provide our experience in performing tracheostomies on COVID-19 critically ill patients during the pandemic and its long-term local complications. Methods We performed a retrospective analysis of prospectively collected data of patients tracheostomized for a COVID-19-related ARDS in two university hospitals in the Paris region between January 27th (date of first COVID-19 admission) and May 18th, 2020 (date of last tracheostomy performed). We focused on tracheostomy technique (percutaneous versus surgical), timing (early versus late) and late complications. Results Forty-eight tracheostomies were performed with an equal division between surgical and percutaneous techniques. There was no difference in patients’ characteristics between surgical and percutaneous groups. Tracheostomy was performed after a median of 17 [12–22] days of mechanical ventilation (MV), with 10 patients in the “early” group (≤ day 10) and 38 patients in the “late” group (> day 10). Survivors required MV for a median of 32 [22–41] days and were ultimately decannulated with a median of 21 [15–34] days spent on cannula. Patients in the early group had shorter ICU and hospital stays (respectively 15 [12–19] versus 35 [25–47] days; p = 0.002, and 21 [16–28] versus 54 [35–72] days; p = 0.002) and spent less time on MV (respectively 17 [14–20] and 35 [27–43] days; p<0.001). Interestingly, patients in the percutaneous group had shorter hospital and rehabilitation center stays (respectively 44 [34–81] versus 92 [61–118] days; p = 0.012, and 24 [11–38] versus 45 [22–71] days; p = 0.045). Of the 30 (67%) patients examined by a head and neck surgeon, 17 (57%) had complications with unilateral laryngeal palsy (n = 5) being the most prevalent. Conclusions Tracheostomy seems to be a safe procedure that could help ICU organization by delegating work to a separate team and favoring patient turnover by allowing faster transfer to step-down units. Following guidelines alone was found sufficient to prevent the risk of aerosolization and contamination of healthcare professionals.

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“…subjected to open surgical tracheostomy where a small anterior portion of one or two tracheal rings is removed ( Cheung and Napolitano, 2014 ; Brass et al, 2016 ) and submitted in 4% buffered formalin to the Surgical Pathology Department of our hospital. The decision to perform a percutaneous or an open surgical tracheostomy in COVID-19 patients was taken by the “tracheo-team” (two otolaryngologists and two anesthesiologists) according to internal guidelines derived from the most recent literature ( Bassi et al, 2020 ; Takhar et al, 2020 ).…”

Section: Methodsmentioning

confidence: 99%

Inflammatory Profiles of Tracheal Biopsies From SARS-CoV-2 Patients

et al. 2022

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PurposeAn increasing number of laryngotracheal complications in mechanically ventilated COVID-19 patients has been reported in the last few months. Many etiopathogenetic hypotheses were proposed but no clear explanation of these complications was identified. In this paper we evaluated the possibility that the tracheal mucosa could be a high viral replication site that could weaken the epithelium itself.MethodsSubjects for the COVID-19 group and the control group were selected retrospectively according to specific criteria. Patients’ basic and clinical data were recorded and analyzed. Tracheal samples of both groups were collected during surgical tracheostomies and then analyzed from a histological and genetic-transcriptional point of view.ResultsFour COVID-19 patients were enrolled in this study and compared with four non-COVID-19 patients. No laryngotracheal complications were identified in both groups. The SARS-CoV-2 was detected in one out of four COVID-19 samples. A subepithelial inflammatory lymphomonocyte infiltrate was observed in all patients but two cases of the COVID-19 group showed vasculitis of small subepithelial vessels associated with foci of coagulative necrosis. Two gene sets (HALLMARK_INFLAMMATORY_RESPONSE and HALLMARK_ESTROGEN_RESPONSE_LATE) were significantly deregulated in COVID-19 patients compared to the control group.ConclusionThe altered inflammatory response of the COVID-19 patients could be another possible explanation of the increasing number of laryngotracheal complications.

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Is Surgical Tracheostomy Better Than Percutaneous Tracheostomy in COVID-19–Positive Patients?

Cited by 17 publications

References 19 publications

Incidence and types of laryngotracheal sequelae of prolonged invasive ventilation in COVID-19 patients

Incidence and types of laryngotracheal sequelae of prolonged invasive ventilation in COVID-19 patients

Tracheostomy in COVID-19 acute respiratory distress syndrome patients and follow-up: A parisian bicentric retrospective cohort

Inflammatory Profiles of Tracheal Biopsies From SARS-CoV-2 Patients

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