Safety and Prognosis in Percutaneous vs Surgical Tracheostomy in 27 Patients With COVID‐19

Riestra-Ayora, Juan; Yanes-Díaz, Joaquín; Peñuelas, Óscar; Molina-Quiros, Cristina; Sanz-Fernández, Ricardo; Martín-Sanz, Eduardo

doi:10.1177/0194599820931801

Cited by 34 publications

(38 citation statements)

References 9 publications

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“…Additionally, one study reported that none of the blood samples from COVID-19 patients tested positive for RNA from SARS-CoV-2, suggesting that the virus may not be present within the smoke produced by electrocautery [24]. Consistent with our study, 10 surgical tracheostomies for COVID-19 patients were preformed using an electrocautery device without any cases of transmission in a recent study [25]. Therefore, we consider the clinical benefits of electrocautery, including reduced operation time, surgical view, and easy bleeding control, to exceed the risk of potential viral transmission.…”

Section: Discussionsupporting

confidence: 88%

Safe surgical tracheostomy during the COVID-19 pandemic: A protocol based on experiences with Middle East Respiratory Syndrome and COVID-19 outbreaks in South Korea

et al. 2020

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Background: A subset of patients with COVID-19 require intensive respiratory care and tracheostomy. Several guidelines on tracheostomy procedures and care of tracheostomized patients have been introduced. In addition to these guidelines, further details of the procedure and perioperative care would be helpful. The purpose of this study is to describe our experience and tracheostomy protocol for patients with MERS or COVID-19. Materials and Methods: Thirteen patients with MERS were admitted to the ICU, 9 (69.2%) of whom underwent surgical tracheostomy. During the COVID-19 outbreak, surgical tracheostomy was performed in one of seven patients with COVID-19. We reviewed related documents and collected information through interviews with healthcare workers who had participated in designing a tracheostomy protocol. Results: Compared with previous guidelines, our protocol consisted of enhanced PPE, simplified procedures (no limitation in the use of electrocautery and wound suction, no stay suture, and delayed cannula change) and a validated screening strategy for healthcare workers. Our protocol allowed for all associated healthcare workers to continue their routine clinical work and daily life. It guaranteed safe return to general patient care without any related complications or nosocomial transmission during the MERS and COVID-19 outbreaks. Conclusion: Our protocol and experience with tracheostomies for MERS and COVID-19 may be helpful to other healthcare workers in building an institutional protocol optimized for their own COVID-19 situation.

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Section: Discussionsupporting

confidence: 88%

Safe surgical tracheostomy during the COVID-19 pandemic: A protocol based on experiences with Middle East Respiratory Syndrome and COVID-19 outbreaks in South Korea

et al. 2020

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“…However, none of the trials or observational studies that led to the development of these guidelines was in the context of COVID-19. Our lower mortality rate of 5.6% ( n = 4) at ≤14 days compares favourably relative to the rate of 41% reported at ≤7 days by Riestra-Ayora et al 20 .…”

Section: Discussionsupporting

confidence: 69%

Challenges of tracheostomy in COVID-19 patients in a tertiary centre in inner city London

Yeung

Hopkins

Auzinger

et al. 2020

International Journal of Oral and Maxillofacial Surgery

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The rapid global spread of SARS-CoV-2, the causative agent of COVID-19, has dominated healthcare services, with exponential numbers requiring mechanical ventilation in the intensive care unit (ICU). Tracheostomy facilitates respiratory and sedative weaning but risks potential viral transmission. This study reviewed the tracheostomy provision, techniques, and outcomes for a single-centre prospective cohort during the resource-pressured COVID-19 period. Seventy-two of 176 patients underwent tracheostomy at a median 17 days: 44 surgical (open), 28 percutaneous. Their median age was 58 years, the male to female ratio was 2.4:1, 75.1% were of BAME backgrounds, 76% had a BMI ≥ 25 kg/m 2 , and 65% had ≥2 major co-morbidities. Seventy-nine percent of patients were weaned from sedation at a median 2 days, 61% were weaned from mechanical ventilation at a median 10 days, 39% were discharged from the ICU at a median 11.5 days, and 19.4% were discharged home at a median 24 days. All patients survived the procedure. The mortality rate was 9.7% at a median 12 days. No clinician reported COVID-19 symptoms within 14 days of the procedure. The role of tracheostomy in COVID-19 is currently unclear. Delivery of tracheostomy by maxillofacial surgeons relieved the workload pressure from ICU clinicians. The choice of technique was influenced by the patient and resource factors, resulting in a mixed cohort of open and percutaneous tracheostomy in COVID-19 patients. Preliminary data suggest that open tracheostomy is as favourable as percutaneous tracheostomy for COVID-19 patients, and is safe for clinicians.

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“…Even when operating on COVID-19-positive patients, it appears that infection of the surgical team can be avoided with proper PPE and protocols. 3 We look forward to continued investigation of risk factors and efforts to minimize risks during endonasal surgery and thank the authors of the aforementioned study for their efforts and model that can be used to study these risks.…”

mentioning

confidence: 99%

Endonasal drilling may be employed safely in the COVID‐19 era

Snyderman

Gardner

2020

Int Forum Allergy Rhinol

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Safety and Prognosis in Percutaneous vs Surgical Tracheostomy in 27 Patients With COVID‐19

Cited by 34 publications

References 9 publications

Safe surgical tracheostomy during the COVID-19 pandemic: A protocol based on experiences with Middle East Respiratory Syndrome and COVID-19 outbreaks in South Korea

Safe surgical tracheostomy during the COVID-19 pandemic: A protocol based on experiences with Middle East Respiratory Syndrome and COVID-19 outbreaks in South Korea

Challenges of tracheostomy in COVID-19 patients in a tertiary centre in inner city London

Endonasal drilling may be employed safely in the COVID‐19 era

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