Role and significance of tracheotomy in intensive care units in coronavirus disease 2019-positive patients

Abstract

Introduction. The role of tracheotomy in the treatment of patients with prolonged intubation in intensive care units is known and confirmed. In light of the global pandemic of severe acute respiratory syndrome coronavirus-2 infection and consequent coronavirus disease 2019, we present our experiences with tracheotomy in infected patients. Material and Methods. A retrospective observational study of patients treated in intensive care units at the Clinical Hospital Center ?Dr. Dragisa Misovic Dedinje? was carried out in the period from March 21, 2020 to May 14, 2020. Results. A total of 970 coronavirus disease 2019-positive patients were treated and out of that number, 116 patients were treated in intensive care units (12%), of which 49 patients (42%) were on non-invasive mechanical ventilation and 67 patients (58%) on intensive mechanical ventilation. The average age of the patients was 59.3 years; the youngest patient was 46, and the oldest 73 years old. Tracheotomy was performed in 24 patients (21%), in 13 males (54.1%) and 11 females (45.9%). The mean time from intubation to tracheotomy was 11.6 days. Of the 24 tracheotomized patients, 12 had a successful decannulation (50%) and were discharged from intensive care units, 6 had a lethal outcome, and 6 patients were in treatment. Discussion. All the patients underwent tracheotomy in the hospital room, because we considered that any transfer and manipulation of these severe patients may lead to worsening of the generally serious condition. Although some guidelines recommend that it would be ideal to know the coronavirus disease 2019 status before any invasive procedure, we believe that this is not necessary, especially considering the clinical picture of patients during the pandemic, as well as computed tomography findings in the lungs. Conclusion. Tracheotomy has an important place in the treatment of patients with severe coronavirus disease 2019 infection since it provides easier maintenance of the airway, and in the recovery phase leads to easier transition of patients from mechanical ventilation to spontaneous breathing. The decision on the day when the tracheotomy will be performed is strictly individual and depends on the general condition of the patient, and the use of thermocautery does not affect the course of treatment and the final outcome.