Faculty Collaboration Database

Short-term Outcomes for Patients and Providers After Elective Tracheostomy in COVID-19-Positive Patients. J Surg Res 2021 Apr;260:38-45

Date

12/15/2020

Pubmed ID

33316758

Pubmed Central ID

PMC7587136

DOI

10.1016/j.jss.2020.10.013

Scopus ID

2-s2.0-85097474995 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

BACKGROUND: Urgent guidance is needed on the safety for providers of percutaneous tracheostomy in patients diagnosed with COVID-19. The objective of the study was to demonstrate that percutaneous dilational tracheostomy (PDT) with a period of apnea in patients requiring prolonged mechanical ventilation due to COVID-19 is safe and can be performed for the usual indications in the intensive care unit.

METHODS: This study involves an observational case series at a single-center medical intensive care unit at a level-1 trauma center in patients diagnosed with COVID-19 who were assessed for tracheostomy. Success of a modified technique included direct visualization of tracheal access by bronchoscopy and a blind dilation and tracheostomy insertion during a period of patient apnea to reduce aerosolization. Secondary outcomes include transmission rate of COVID-19 to providers and patient complications.

RESULTS: From April 6th, 2020 to July 21st, 2020, 2030 patients were admitted to the hospital with COVID-19, 615 required intensive care unit care (30.3%), and 254 patients required mechanical ventilation (12.5%). The mortality rate for patients requiring mechanical ventilation was 29%. Eighteen patients were assessed for PDT, and 11 (61%) underwent the procedure. The majority had failed extubation at least once (72.7%), and the median duration of intubation before tracheostomy was 15 d (interquartile range 13-24). The median positive end-expiratory pressure at time of tracheostomy was 10.8. The median partial pressure of oxygen (PaO2)/FiO2 ratio on the day of tracheostomy was 142.8 (interquartile range 104.5-224.4). Two patients had bleeding complications. At 1-week follow-up, eight patients still required ventilator support (73%). At the most recent follow-up, eight patients (73%) have been liberated from the ventilator, one patient (9%) died as a result of respiratory/multiorgan failure, and two were discharged on the ventilator (18%). Average follow-up was 20 d. None of the surgeons performing PDT have symptoms of or have tested positive for COVID-19.

CONCLUSIONS: and relevance: PDT for patients with COVID-19 is safe for health care workers and patients despite higher positive end-expiratory pressure requirements and should be performed for the same indications as other causes of respiratory failure.

Author List

Murphy P, Holler E, Lindroth H, Laughlin M, Simons CJ, Streib EW, Boustani M, Ortiz D

Author

Patrick Murphy MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Airway Extubation
Bronchoscopy
Female
Follow-Up Studies
Hospital Mortality
Humans
Infectious Disease Transmission, Patient-to-Professional
Intensive Care Units
Male
Middle Aged
Postoperative Complications
Respiration, Artificial
Retrospective Studies
Severity of Illness Index
Time Factors
Tracheostomy
Treatment Outcome