Abstract
BackgroundWe studied the safety of percutaneous dilatational tracheostomy (PCDT) in severe acute respiratory syndrome novel coronavirus 2 (SARS-nCoV2).Patients and MethodsFrom 01 March 20 to 30 November 2020, 1635 required hospital admission of which 145 (9%) required intensive (ICU) care. The primary outcomes are mortality and secondary outcomes were duration of invasive mechanical ventilation (IMV), length of stay (LOS) in ICU and hospital, and days required for decannulation.ResultsOut of the 145 (9%), 107 (73.7%) were males (mean 61.4 years, median body mass index (BMI) of 28.2 kg/m2), and 38 (26.2%) were females (mean 58.10 years, median BMI of 31.2 kg/m2). In the cohort of 80 (55.17%) requiring IMV, 19 (23.7%) died within 72 hours and were not included in the study, 37 (group “NT”) and 24 (group “T”) had a median duration of ventilation of 9 d (IQR, 6-11) and 12 d (IQR, 11-17.25) respectively. Patients in group “T” underwent PCDT based on clinical criteria (fraction of inspired oxygen (FiO2) of ≤ 50% with positive end-expiratory pressure (PEEP) of ≤ 10 cms of H2O with stable hemodynamics), and 16 (66.7%) had survived. The reverse transcription-polymerase chain reaction (RT-PCR) does not need to be negative, and none of the health care workers (HCW’s) were infected. The Cox-hazard ratio [HR] is 0.19, 95% confidence interval [CI] (0.09, 0.41) with a P-value of <0.001, 83 (57.2%) were discharged with a mortality of 42.8%.ConclusionsPCDT is safe and effective in patients anticipated in need of prolonged mechanical ventilation.
Highlights
During the period from 01 March to 30 November 2020, the SARS-nCoV2 pandemic patients admitted to the intensive care unit were studied
Expert consensus recommends that CoVID-19 patients, anticipated to have prolonged mechanical ventilation with minimal ventilatory settings, i.e., FiO2 ≤ 50% and positive-end expiratory pressure (PEEP) ≤ 10, should undergo tracheostomy to reduce the duration of mechanical ventilation and ICU length of stay (LOS) [3,4,5]
We feel that patients requiring prolonged mechanical ventilation with stable hemodynamics and improving ventilatory settings with FiO2 ≤ 50% and PEEP ≤ 10 should be considered for a bedside percutaneous tracheostomy to reduce the incidence of nosocomial infections and duration of mechanical ventilation
Summary
During the period from 01 March to 30 November 2020, the SARS-nCoV2 pandemic patients admitted to the intensive care unit were studied. (2021) 3:2082–2087 aerosol-generating procedure (AGP), could not be done in patients requiring prolonged ventilation due to fear of the spread of infection to health care workers (HCW’s) [2]. In the latter part of the pandemic, there was greater confidence in personal protective measures, and with an increased surge in the number of cases, and acute shortage of ICU beds, patients anticipated to have prolonged ventilation with improving ventilatory settings (FiO2 ≤ 50% and PEEP ≤ 10 cms of H2O with stable hemodynamics) were considered for percutaneous tracheostomy (~7 days) to reduce the ICU LOS and morbidity. The primary outcomes are mortality and secondary outcomes were duration of invasive mechanical ventilation (IMV), length of stay (LOS) in ICU and hospital, and days required for decannulation
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