Tracheotomy in Ventilated Patients With COVID-19

Chao, Tiffany N.; Braslow, Benjamin; Martin, Niels D.; Chalian, Ara A.; Atkins, Joshua H.; Haas, Andrew R.; Rassekh, Christopher H.

doi:10.1097/sla.0000000000003956

Cited by 92 publications

(134 citation statements)

References 17 publications

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“…Others argued that reducing sedation and partially returning the patient to spontaneous breathing could cause negative effects on oxygenation and respiratory pattern [29]. Furthermore, Chao et al [30] suggest to wait beyond 21 days for the viral load to decrease and to avoid unnecessary tracheostomies in particularly, critically ill patients. The American Academy of Otolaryngology-Head and Neck surgery suggests that tracheostomy should be performed after 14 days of endotracheal intubation, but there is no evidence as to the optimal timing of tracheostomy [31].…”

Section: Discussionmentioning

confidence: 99%

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

Volo¹,

Stritoni²,

Battel

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose The 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 the safety of healthcare workers. The aim of this study is to evaluate the efficacy and safety of tracheostomy placement in patients with COVID-19. Methods A retrospective cohort study on 23 COVID 19 patients, to analyse the timing of tracheostomy, the risk factors associated with in-hospital death and the infection of the involved health care workers. Early tracheostomy was defined as ≤ 10 days and late ones > 10 days. Results The 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, and 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. Conclusion We 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.

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Section: Discussionmentioning

confidence: 99%

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

Volo¹,

Stritoni²,

Battel

et al. 2020

Eur Arch Otorhinolaryngol

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“…We found two case series 42,55 and four editorials/technical communications/systematic reviews of the literature. 34,[79][80][81] Both case series discussed tracheostomy during the SARS-CoV epidemic of 2003. The systematic reviews included one from the SARS-CoV epidemic and three pertaining to the current COVID-19 pandemic.…”

Section: Role Of Preprocedural Covid-19 Testingmentioning

confidence: 99%

Use of Tracheostomy During the COVID-19 Pandemic

Lamb

Desai

Angel

et al. 2020

Chest

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BACKGROUND: The role of tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic remains unknown. The goal of this consensus statement is to examine the current evidence for performing tracheostomy in patients with respiratory failure from COVID-19 and offer guidance to physicians on the preparation, timing, and technique while minimizing the risk of infection to health care workers (HCWs). METHODS: A panel including intensivists and interventional pulmonologists from three professional societies representing 13 institutions with experience in managing patients with COVID-19 across a spectrum of health-care environments developed key clinical questions addressing specific topics on tracheostomy in COVID-19. A systematic review of the literature and an established modified Delphi consensus methodology were applied to provide a reliable evidence-based consensus statement and expert panel report. RESULTS: Eight key questions, corresponding to 14 decision points, were rated by the panel. The results were aggregated, resulting in eight main recommendations and five additional remarks intended to guide health-care providers in the decision-making process pertinent to tracheostomy in patients with COVID-19-related respiratory failure. CONCLUSION: This panel suggests performing tracheostomy in patients expected to require prolonged mechanical ventilation. A specific timing of tracheostomy cannot be recommended. There is no evidence for routine repeat reverse transcription polymerase chain reaction testing in patients with confirmed COVID-19 evaluated for tracheostomy. To reduce the risk of infection in HCWs, we recommend performing the procedure using techniques that minimize aerosolization while wearing enhanced personal protective equipment. The recommendations presented in this statement may change as more experience is gained during this pandemic.

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“…23 Five papers recommend delaying tracheostomy to 2-3 weeks after intubation. 18,20,26,29,30 The common reasoning is that this allows viral loads to decrease and minimizes the risk of transmission. The Surgical Infection Society Guidelines did not provide recommendations regarding tracheostomy timing but acknowledged the controversy and lack of clinical data to guide best practices.…”

Section: When To Perform Tracheostomy?mentioning

confidence: 99%

“…38 No transmission to health care workers was reported, which was largely attributed to the proper use of personal protective equipment; however, they speculated that PDT may present higher risk due to more extensive airway manipulation (eg, bronchoscopy and serial tracheal dilations), a viewpoint that is shared by the University of Pennsylvania Task Force and the Surgical Infection Society. 30,31 Bronchoscopy is known as an aerosol-generating procedure, and the pooled estimate from 2 studies of the odds ratios of aerosol transmission with bronchoscopy was 1.9. 16 However, proponents of PDT have pointed to decreased epithelial trauma and lower operative times as ways to minimize the likelihood of exposure.…”

Section: Where To Perform Tracheostomy and Techniquementioning

confidence: 99%

Controversies in Tracheostomy for Patients With COVID-19: The When, Where, and How

et al. 2020

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COVID-19 has impacted how we deliver care to patients, and much remains unknown regarding optimal management of respiratory failure in this patient population. There are significant controversies regarding tracheostomy in patients with COVID-19 related to timing, location of procedure, and technique. In this narrative review, we explore the recent literature, publicly available guidelines, protocols from different institutions, and clinical reports to provide critical insights on how to deliver the most benefit to our patients while safeguarding the health care force. Consensus can be reached that patients with COVID-19 should be managed in a negativepressure environment with proper personal protective equipment, and that performing tracheostomy is a complex decision that should be made through multidisciplinary discussions considering patient prognosis, institutional resources, staff experience, and risks to essential health care workers. A broad range of practices exist because there is no conclusive guidance regarding the optimal timing or technique for tracheostomy.

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Tracheotomy in Ventilated Patients With COVID-19

Cited by 92 publications

References 17 publications

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

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

Use of Tracheostomy During the COVID-19 Pandemic

Controversies in Tracheostomy for Patients With COVID-19: The When, Where, and How

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