Tracheostomy protocols during <scp>COVID</scp>‐19 pandemic

Heyd, Cameron; Desiato, Vincent M.; Nguyen, Shaun A.; O’Rourke, Ashli; Clemmens, Clarice S.; Awad, Mahmoud; Worley, Mitchell L.; Day, Terry A.

doi:10.1002/hed.26192

Cited by 80 publications

(124 citation statements)

References 12 publications

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“… 1 The recent guidelines or expert recommendations for COVID-19 patients, however, have not given any particular recommendation on the choice of technique. 1 , 2 We took the best guidance available in the literature and developed a four-step protocol for PCT in COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

“…The tracheostomy consideration in COVID-19 patients should be conservative with generally higher threshold as compared to non-COVID patients. 2 The patient selection for PCT in COVID-19 should be based on clinically stability as it also reduces the risk of procedure complications and occupational transmission. We recommend the patient should be hemodynamically stable without any inotropes and stable ventilator parameters, i.e., FiO 2 ≤ 40% and PEEP ≤10 mm of Hg.…”

Section: Discussionmentioning

confidence: 99%

“…There are different modifications in the conventional PCT advised by authors and expert for COVID-19 patients. 1 , 2 , 7 These modifications primarily involve FOB placement either with small size endotracheal tube (ETT) in the trachea or using inline suction sheath with FOB. These modifications are on use of FOB in either different insertion sites or use of special devices to reduce production of aerosols.…”

Section: Discussionmentioning

confidence: 99%

“… 1 There are few expert consensus recommendations released by different group of experts in last few months on approaches and modification of procedures. 1 , 2 We developed a simplified protocol of PCT, which protects HCWs from nosocomial transmission and does not compromise the quality of care. We tested the protocol initially in a non-COVID patient followed by three COVID patients and found it easier and safe.…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous Tracheostomy in COVID-19 Patients: A Four-step Safe Protocol

Nasa¹,

Singh²,

Ali

et al. 2020

Indian Journal of Critical Care Medicine

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A bstract Background Coronavirus disease-2019 (COVID-19) pandemic has inundated healthcare systems globally especially resources in intensive care units (ICUs). Tracheostomy may be required in critically ill COVID-19 patients to facilitate weaning and to optimize resources like ventilator and ICU beds. Percutaneous tracheostomy (PCT) has become the standard of care globally in ICUs; however, it is considered a high-risk procedure in COVID-19 patients because of the inherent risk of aerosol generation. Materials and methods Patients with severe COVID-19 who were on mechanical ventilation because of respiratory failure for ≥10 days were evaluated for PCT. We developed a four-step approach from patient selection and timing, preparation, performance, and postprocedure for PCT in these patients. Results We evaluated our four-step protocol in four patients. One of them was non-COVID patient and rest three were COVID patients. The procedure was uneventful in all of the patients with median time of procedure and apnea is 10 minutes 30 seconds and 2 minutes 20 seconds, respectively. The tracheostomy was decannulated in two of these patients and one patient is still on ventilator. Conclusion We believe our four-step protocol for PCT in critically ill COVID-19 patient is simple, safe, and easily adapted in any setting with limited training and available resources. We recommend further studies to evaluate this approach in selected critically ill COVID-19 patients who need tracheostomy. How to cite this article Nasa P, Singh A, Ali A, Patidar S, Georgian A. Percutaneous Tracheostomy in COVID-19 Patients: A Four-step Safe Protocol. Indian J Crit Care Med 2020;24(9):832–834.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Percutaneous Tracheostomy in COVID-19 Patients: A Four-step Safe Protocol

Nasa¹,

Singh²,

Ali

et al. 2020

Indian Journal of Critical Care Medicine

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“…We went ahead with apnoiec tracheostomy for our patients. Variations in apneic tracheostomy included performing it under GA with complete muscle relaxant cover, proximal ET tube withdrawal followed by apnea induction prior to tracheotomy with or without progressing ET tube distally to reventilate, [ 7 , 8 ]or progressing the ET tube upto the carina before tracheotomy. Though each variation has its expected benefits, none is strongly recommended above the other.…”

Section: Discussionmentioning

confidence: 99%

Modifying Ways to Perform ICU Tracheostomies in COVID-19 Patients: Approach to a Safe and Secure Method

Bhavana

Ouseph

et al. 2020

Indian J Otolaryngol Head Neck Surg

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Early Outcomes From Early Tracheostomy for Patients With COVID-19

Kwak

Connors

Benedict

et al. 2021

JAMA Otolaryngol Head Neck Surg

111

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IMPORTANCE Decision-making in the timing of tracheostomy in patients with coronavirus disease 2019 has centered on the intersection of long-standing debates on the benefits of early vs late tracheostomy, assumptions about timelines of infectivity of the novel coronavirus, and concern over risk to surgeons performing tracheostomy. Multiple consensus guidelines recommend avoiding or delaying tracheostomy, without evidence to indicate anticipated improvement in outcomes as a result.OBJECTIVE To assess outcomes from early tracheostomy in the airway management of patients with COVID-19 requiring mechanical ventilation. DESIGN, SETTING, AND PARTICIPANTSA retrospective medical record review was completed of 148 patients with reverse transcriptase-polymerase chain reaction-confirmed COVID-19 requiring mechanical ventilation at a single tertiary-care medical center in New York City from March 1 to May 7, 2020. INTERVENTIONS Open or percutaneous tracheostomy.MAIN OUTCOMES AND MEASURES The primary outcomes were time from symptom onset to (1) endotracheal intubation, (2) tracheostomy; time from endotracheal intubation to tracheostomy; time from tracheostomy to (1) tracheostomy tube downsizing, (2) decannulation; total time on mechanical ventilation; and total length of stay. RESULTSParticipants included 148 patients, 120 men and 28 women, with an overall mean (SD) age of 58.1 (15.8) years. Mean (SD; median) time from symptom onset to intubation was 10.57 (6.58; 9) days; from symptom onset to tracheostomy, 22.76 (8.84; 21) days; and from endotracheal intubation to tracheostomy, 12.23 (6.82; 12) days. The mean (SD; median) time to discontinuation of mechanical ventilation was 33.49 (18.82; 27) days; from tracheostomy to first downsize, 23.02 (13.76; 19) days; and from tracheostomy to decannulation, 30.16 (16.00; 26) days. The mean (SD; median) length of stay for all patients was 51. 29 (23.66; 45) days. Timing of tracheostomy was significantly associated with length of stay: median length of stay was 40 days in those who underwent early tracheostomy (within 10 days of endotracheal intubation) and 49 days in those who underwent late tracheostomy (median difference, −8; 95% CI, −15 to −1). In a competing risks model with death as the competing risk, the late tracheostomy group was 16% less likely to discontinue mechanical ventilation (hazard ratio, 0.84; 95% CI, 0.55 to 1.28).CONCLUSIONS AND RELEVANCE This cohort study from the first 2 months of the pandemic in New York City provides an opportunity to reconsider guidelines for tracheostomy for patients with COVID-19. Findings demonstrated noninferiority of early tracheostomy and challenges recommendations to categorically delay or avoid tracheostomy in this patient population. When aligned with emerging evidence about the timeline of infectivity of the novel coronavirus, this approach may optimize outcomes from tracheostomy while keeping clinicians safe.

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Tracheostomy protocols during COVID‐19 pandemic

Cited by 80 publications

References 12 publications

Percutaneous Tracheostomy in COVID-19 Patients: A Four-step Safe Protocol

Percutaneous Tracheostomy in COVID-19 Patients: A Four-step Safe Protocol

Modifying Ways to Perform ICU Tracheostomies in COVID-19 Patients: Approach to a Safe and Secure Method

Early Outcomes From Early Tracheostomy for Patients With COVID-19

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