Viral Infectivity in Patients Undergoing Tracheotomy With COVID‐19: A Preliminary Study

Abstract

Objective To establish the presence of live virus and its association with polymerase chain reaction (PCR) positivity and antibody status in patients with COVID-19 undergoing tracheotomy. Study Design Prospective observational study. Setting Single institution across 3 hospital sites during the first wave of the COVID-19 pandemic. Methods Patients who were intubated for respiratory wean tracheotomy underwent SARS-CoV-2 PCR nasal, throat, and endotracheal tube swabs at the time of the procedure. These were assessed via quantitative real-time reverse transcription PCR. The tracheal tissue excised during the tracheotomy was cultured for SARS-CoV-2 with Vero E6 and Caco2 cells. Serum was assessed for antibody titers against SARS-CoV-2 via neutralization assays. Results Thirty-seven patients were included in this study. The mean number of days intubated prior to undergoing surgical tracheotomy was 27.8. At the time of the surgical tracheotomy, PCR swab testing yielded 8 positive results, but none of the 35 individuals who underwent tissue culture were positive for SARS-CoV-2. All 18 patients who had serum sampling demonstrated neutralization antibodies, with a minimum titer of 1:80. Conclusion In our series, irrespective of positive PCR swab, the likelihood of infectivity during tracheotomy remains low given negative tracheal tissue cultures. While our results do not undermine national and international guidance on tracheotomy after day 10 of intubation, given the length of time to procedure in our data, infectivity at 10 days cannot be excluded. We do however suggest that a preoperative negative PCR swab not be a prerequisite and that antibody titer levels may serve as a useful adjunct for assessment of infectivity.

Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals

“…A study reporting on otolaryngologists who contracted COVID-19 noted that disease transmission can occur via tracheostomy . Another recent study demonstrated low rates of SARS-CoV-2 transmission within tracheostomy irrespective of polymerase chain reaction status . Overall, while tracheostomy has not been demonstrated to be a high-risk procedure for SARS-CoV-2 transmission, further studies are needed to establish the role of timing in viral transmission within HCPs .…”

“…Recent directions in determining the risk of infectivity in patients with COVID-19 have been moving toward relying on the duration since the first positive RT-PCR test result or first date of symptoms . A recent publication has suggested that antibody titers may also serve as a useful measure for assessing infectivity in the tracheostomy population . It remains unclear how the effects of vaccination and variant SARS-CoV-2 strains will affect these evolving considerations.…”