Abstract
Introduction The rapidly spreading Novel Coronavirus 2019 (COVID-19) appeared to be a highly transmissible pathogen in healthcare environments and had resulted in a significant number of patients with respiratory failure requiring tracheostomy, an aerosol-generating procedure that places healthcare workers at high risk of contracting the infection. Instead of deferring or delaying the procedure, we developed and implemented a novel percutaneous dilatational tracheostomy (PDT) protocol aimed at minimizing the risk of transmission while maintaining favorable procedural outcome. Patients and Methods. All patients who underwent PDT per novel protocol were included in the study. The key element of the protocol was the use of apnea during the critical part of the insertion and upon any opening of the ventilator circuit. This was coupled with the use of enhanced personnel protection equipment (PPE) with a powered air-purifying respirator (PAPR). The operators underwent antibody serology testing and were evaluated for COVID-19 symptoms two weeks from the last procedure included in the study. Results Between March 12th and June 30th, 2020, a total of 32 patients underwent PDT per novel protocol. The majority (80%) were positive for COVID-19 at the time of the procedure. The success rate was 94%. Only one patient developed minor self-limited bleeding. None of the proceduralists developed positive serology or any symptoms compatible with COVID-19 infection. Conclusion A novel protocol that uses periods of apnea during opening of the ventilator circuit along with PAPR-enhanced PPE for PDT on COVID-19 patients appears to be effective and safe for patients and healthcare providers.
Highlights
The rapidly spreading Novel Coronavirus 2019 (COVID-19) appeared to be a highly transmissible pathogen in healthcare environments and had resulted in a significant number of patients with respiratory failure requiring tracheostomy, an aerosol-generating procedure that places healthcare workers at high risk of contracting the infection
We collected data on all patients admitted to the intensive care unit (ICU) at Cooper University Hospital (CUH), from March 12th to June 30th, 2020, who had confirmed COVID-19 by nasal pharyngeal swab for reverse transcriptase polymerase chain reaction assay, who required mechanical ventilation for severe respiratory failure, and who underwent percutaneous dilatational tracheostomy (PDT) per novel protocol by the interventional pulmonary service
We describe in this retrospective study a novel protocol for percutaneous placement of tracheostomy in patients with
Summary
Since it was first identified in Wuhan City, Hubei Province, China, on December 30th, 2019, the Novel Coronavirus 2019 (COVID-19) has spread rapidly and widely resulting in a worldwide pandemic, affecting over 22 million persons worldwide and causing over 700 thousand deaths to date [1]. Pulmonary Medicine “avoid tracheotomy in COVID-19 positive or suspected patients” due to the risks to healthcare providers. They recommended that tracheostomies should not be performed before 2-3 weeks after intubation, preferably after negative COVID-19 testing, and favored open tracheostomy placement in these circumstances as opposed to percutaneous dilatational tracheostomy (PDT) [5, 6]. PDT is routinely performed in our medical ICU by the interventional pulmonary service. This emerging situation presented us with a new challenge of maintaining a balance between providing medical care to those in need while limiting disease spread and exposure to patients and staff. We report in this study the feasibility of this novel protocol and its safety for the patients and the providers
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