Bedside Tracheostomy on COVID-19 Patients in the Intensive Care Unit

Abstract

Introduction: Currently, coronavirus disease 2019 (COVID-19) infection is a global challenge to the medical community, often resulting in acute respiratory distress syndrome and respiratory failure needing mechanical ventilation. Tracheostomy is needed for prolonged ventilation as the severity of respiratory failure often escalates, needing extended ventilation in an intensive care unit (ICU). Objective: The objective of study was to evaluate clinical details of performing tracheostomy including patient profile, surgical steps, complications and precautions by health-care workers in the ICU of a specially assigned hospital for COVID-19 patients. Patients and Methods: This is a retrospective study of 22 COVID-19 patients who underwent bedside surgical tracheostomy in the ICU. Patient profile such as age, gender, comorbidities, complication of tracheostomy, ventilator withdrawal after tracheostomy and nosocomial infections of health-care workers related to tracheostomy were analysed. Results: In the study period of 6 months, there were 12,850 COVID-19 patients admitted to our COVID-designated hospital, of whom 2452 patients needed ICU care. A total of 610 patients needed ventilatory support, with 22 patients aged between 42 and 75 years (mean age of 64 years) undergoing a tracheostomy (16 males and 6 females). The median duration from the day of the orotracheal intubation to the day of tracheostomy was 13 days. Conclusion: Surgical tracheostomy on COVID-19 patients is a high-risk aerosol-generating procedure for health-care workers. It should be performed with close communication between otorhinolaryngologists, anaesthesiologists and intensivists, along with adequate personal protective equipment for smooth management of the airway.