Abstract
Background & Objective:COVID 19 patients with severe respiratory failure may require prolonged mechanical ventilation. Placement of a tracheostomy tube often becomes necessary for such patients. The steps of tracheostomy procedure and post tracheostomy care of these patients can be classified as aerosol generating. We wish to highlight our modified technique to address these issues.Methodology:We performed percutaneous dilation tracheostomy in three clinically challenging COVID-19 patients in our ICU and developed guidelines aiming to minimise aerosolisation during and after the tracheostomy procedure to safeguard healthcare workers.Results:Percutaneous tracheostomy was performed by a team of three experienced anaesthetists and an ICU nurse.Conclusion:The decision of surgical or percutaneous tracheostomy should be dependent on the experience of the tracheostomy performer, health-care worker safety, resource availability, and patient-centred care. We believe our modified strategic approach of brief bronchoscopy, minimum PEEP and gas flows and step-wise planned approach for PCDT offers an extra level of safety to healthcare workers.
Highlights
COVID-19 patients with severe respiratory failure may require prolonged mechanical ventilation
Placement of a tracheostomy tube often becomes necessary for such patients.The actual tracheostomy procedure as well as post tracheostomy care of these patients involves multiple steps which can be classified as Aerosol Generating
Cases description: All tracheostomies were percutaneous because PCDT carries lesser risk of aerosolization, bleeding and require no or minimum use of diathermy as compared to surgical tracheostomy
Summary
Per-cutaneous dilatation tracheostomy (PCTD) in COVID-19 patients and peri-tracheostomy care:. Ehtesham Khan[1], Shankar Lal[2], Junaid Hashmi[3], Jubil Thomas[4], Muhammad Anwar Malik[5]
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