Abstract
The benefits of percutaneous dilational tracheostomy (PDT) placement have been well documented in patients requiring prolonged mechanical ventilation. However, the data regarding the benefit of PDT in coronavirus-2019 (COVID-19) patients are scarce. The objective of this study is to evaluate the outcomes of a cohort of 37 patients who underwent tracheostomy as part of their COVID-19 care. Retrospective data from a series for 37 patients undergoing tracheostomy was collected using chart review. Primary outcomes included 30 and 60 day mortality, weaning rate, and decannulation rate. Secondary outcomes collected included admission demographics, comorbidities, and procedural information. Thirty-seven (37) patients requiring prolonged mechanical ventilation due to COVID-19. Of these 37 patients, 35 were alive 60 days post-PDT placement, 33 have been weaned from mechanical ventilation and 18 have been decannulated. The low mortality and high decannulation rates in this cohort in is a promising development in the care of critically ill COVID-19 patients. Of note, all participating physicians underwent routine polymerase chain reaction (PCR) testing for infection with the severe acute respiratory syndrome coronavirus-2 virus and no physician contracted COVID-19 as a result of their involvement. Overall, this case series describes the modified PDT technique used by our team and discusses the feasibility and potential benefit to PDT placement in COVID-19 patients requiring long-term mechanical ventilation.
Highlights
Severe acute respiratory syndrome coronavirus-2 (SAR S-CoV-2) was first described in Wuhan, China as early as December, 2019 and has led to a pandemic that has infected more than 120 million people and has taken more than 2.6 million lives.[1]
A recent review suggests that up to 26% of patients hospitalized with coronavirus-2019 (COVID-19) will require admission to the intensive care unit (ICU), and that mortality in from COVID-19 once in the ICU may be as high as 31%
Initial recommendations from the American Academy of Otolaryngology for the timing of COVID-19 tracheostomy placement were to wait a minimum of 14 days after intubation in order to have a better idea of the individual patient prognosis.[5]
Summary
Severe acute respiratory syndrome coronavirus-2 (SAR S-CoV-2) was first described in Wuhan, China as early as December, 2019 and has led to a pandemic that has infected more than 120 million people and has taken more than 2.6 million lives.[1] A recent review suggests that up to 26% of patients hospitalized with coronavirus-2019 (COVID-19) will require admission to the intensive care unit (ICU), and that mortality in from COVID-19 once in the ICU may be as high as 31%.2. Management of severe disease secondary to COVID-19 infection is constantly changing, but often requires prolonged intubation due to acute respiratory failure, neuromuscular blockade, and prone positioning.[3] Percutaneous dilational tracheostomy (PDT) placement has been shown to facilitate mechanical ventilation weaning, minimize sedation requirement and improve tracheobronchial toileting in patients that require prolonged mechanical ventilation. Recommendations have been made that suggest tracheostomy may be indicated as soon as 7 days after intubation.[4]
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