Outcomes and Timing of Bedside Percutaneous Tracheostomy of COVID-19 Patients over a Year in the Intensive Care Unit.

Nardi Tetaj,Ilaria Gaviano,Andrea Antinori,Giuseppe Ippolito,Luisa Marchioni,Micaela Maritti,Ricardo Cabas,Ilaria Caravella,Gabriele Garotto,Paolo Campioni,Nicola Petrosillo,Daniele Centanni,Silvana Scarcia,Giada De Angelis,Carmen Santagata,Filippo Giansante,Giulia Stazi,Matteo Fusetti,Emanuele Nicastri,Stefania Ianniello,Donatella Busso,Manuela Macchione,Francesco Vaia,Rachele Di Lorenzo,Fabrizio Palmieri,Alessandro Carucci,Cristina Dantimi,Francesco Pugliese,Gianpiero D’Offizi,Maria Cristina Marini

doi:10.3390/jcm10153335

Abstract

Background: The benefits and timing of percutaneous dilatational tracheostomy (PDT) in Intensive Care Unit (ICU) COVID-19 patients are still controversial. PDT is considered a high-risk procedure for the transmission of SARS-CoV-2 to healthcare workers (HCWs). The present study analyzed the optimal timing of PDT, the clinical outcomes of patients undergoing PDT, and the safety of HCWs performing PDT. Methods: Of the 133 COVID-19 patients who underwent PDT in our ICU from 1 April 2020 to 31 March 2021, 13 patients were excluded, and 120 patients were enrolled. A trained medical team was dedicated to the PDT procedure. Demographic, clinical history, and outcome data were collected. Patients who underwent PDT were stratified into two groups: an early group (PDT ≤ 12 days after orotracheal intubation (OTI) and a late group (>12 days after OTI). An HCW surveillance program was also performed. Results: The early group included 61 patients and the late group included 59 patients. The early group patients had a shorter ICU length of stay and fewer days of mechanical ventilation than the late group (p < 0.001). On day 7 after tracheostomy, early group patients required fewer intravenous anesthetic drugs and experienced an improvement of the ventilation parameters PaO2/FiO2 ratio, PEEP, and FiO2 (p < 0.001). No difference in the case fatality ratio between the two groups was observed. No SARS-CoV-2 infections were reported in the HCWs performing the PDTs. Conclusions: PDT was safe and effective for COVID-19 patients since it improved respiratory support parameters, reduced ICU length of stay and duration of mechanical ventilation, and optimized the weaning process. The procedure was safe for all HCWs involved in the dedicated medical team. The development of standardized early PDT protocols should be implemented, and PDT could be considered a first-line approach in ICU COVID-19 patients requiring prolonged mechanical ventilation.

Highlights

2480 COVID-19 patients were hospitalized at our center; 451 (18.2%) of them were admitted to our IntensiveCare Unit (ICU), 342 (76%) patients underwent orotracheal intubation (OTI), and of these, 133 patients (38.9%) underwent bedside percutaneous dilatational tracheostomy (PDT)
PDT procedures had a beneficial impact on COVID ICU patients in terms of ICU
The present study showed that early group patients (PDT ≤ 12 days after OTI) had a shorter ICU length of stay (LOS) and were more prone to be ventilator-free

Summary

Introduction

Orotracheal intubation (OTI) and mechanical ventilation can be used in patients with more severe cases affected by acute respiratory distress syndrome (ARDS) in the Intensive. Tracheostomy has many beneficial effects, such as improving pulmonary mechanics; reducing laryngeal or tracheal nociceptive stimuli; facilitating the weaning process; and decreasing the requirement for sedatives, neuromuscular blocker agents, analgesics, and inotropic therapy. It reduces dead space and airway resistance, helps maintain easier oral hygiene, promotes oral nutrition, and improves communication [5,6]. The benefits and timing of percutaneous dilatational tracheostomy (PDT) in Intensive Care Unit (ICU) COVID-19 patients are still controversial.

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