Our Experience of Tracheostomy in COVID-19 Patients

Abstract

Tracheostomy in patients with COVID-19 requires significant decision making and procedural planning. Use of tracheostomy can facilitate weaning from ventilation and potentially increase the availability of much needed intensive care unit (ICU) beds, however this being a high aerosol generating procedure it does put the health care worker to risk of transmission. Here we present our experience and protocols for performing tracheostomy in COVID-19 positive patients. Eleven tracheostomies were performed in COIVD-19 patients over a period of 2 months (May-June 2020) at this tertiary care hospital dedicated to manage COVID patients. All patients underwent open surgical tracheostomy, the specific indication, preoperative protocols, surgical steps and precautions taken have been discussed. Tracheostomy was done not before 10 days after initiation of mechanical ventilation. Patient's cardiovascular vitals should show recovery with some spontaneous effort. There should be reduction in need for FiO 2 and ventilator requirements. Of total 11 tracheostomies performed only one patient had post procedure bleeding which was controlled conservatively. We have summarized our experience in performing tracheostomies in 11 such patients. Our guidelines and recommendations on tracheostomy during the COVID-19 pandemic are presented in this study. We suggest tracheostomies to be done after 10 days of intubation with precautions and given indications with the idea of early weaning off of patient from ventilator and more availability of ICU beds which is already overwhelmed by patient load.

Tracheostomy Practice in Mechanically Ventilated Patients With SARS-CoV-2 Induced Acute Respiratory Distress Syndrome: a Single-center Retrospective Study With Focus on Tracheomalacia

“…The most common comorbidities were hypertension (48%), diabetes mellitus (15%), and chronic obstructive pulmonary disease (12%). At ICU admission, median APACHE and SOFA scores were 23 [21][22][23][24][25][26][27] and 5 [3][4][5][6][7], respectively. List of abbreviations.…”

“…The median duration of antibiotic therapy was 6 [2][3][4][5][6][7][8][9][10][11][12][13][14][15] days. Overall, median ICU and hospital length of stay were 14 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] days and 26 days, respectively. Sixty patients (40%) died in the ICU, mortality increased according to disease severity at admission (25%, 40%, and 58%, p = 0.041, for mild, moderate, and severe ARDS, respectively).…”

“…Mortality in the ICU did not differ between tracheostomized patients and patients treated exclusively with endotracheal intubation (34% vs. 45%, p = 0.243). Patients in whom a tracheostomy was performed had a signi cantly longer duration of mechanical ventilation (25 vs. 8 [5][6][7][8][9][10][11][12] days, p < 0.001) and both ICU (27 vs. 9 [5][6][7][8][9][10][11][12][13][14] days, p < 0.001) and hospital (45 [27-58] vs. 17 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] days, p < 0.001) length of stay.…”

“…Tracheomalacia was diagnosed in 8 (5%) of studied patients. The diagnosis was performed 27 [21][22][23][24][25][26][27][28][29][30][31][32] days after endotracheal intubation. Compared to the remaining population (Table 2), more patients in whom tracheomalacia was diagnosed were female (75% vs. 20%, p = 0.002;…”

“…All patients diagnosed with tracheomalacia were treated with a tracheostomy for airway management (100% vs. 45%, p = 0.008). No difference was found regarding the use of the surgical approach (87.5% vs. 72.3% p = 0.671 with surgical approach), the timing of tracheostomy (11 [7][8][9][10][11][12][13][14] days vs. 11 [8][9][10][11][12][13][14][15][16][17] days, p = 0.371), and decannulation (35 days vs. 19 [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] p = 0.108) comparing patients that developed tracheomalacia with the remaining population. Conversely, the duration of mechanical ventilation (29 [22][23][24][25][26][27][28][29][30]…”