Abstract
BackgroundOne of the main symptoms of severe infection with the new coronavirus‑2 (SARS-CoV-2) is hypoxemic respiratory failure because of viral pneumonia with the need for mechanical ventilation. Prolonged mechanical ventilation may require a tracheostomy, but the increased risk for contamination is a matter of considerable debate.ObjectiveEvaluation of safety and effects of surgical tracheostomy on ventilation parameters and outcome in patients with COVID-19.Study designRetrospective observational study between March 27 and May 18, 2020, in a single-center coronavirus disease-designated ICU at a tertiary care German hospital.PatientsPatients with COVID-19 were treated with open surgical tracheostomy due to severe hypoxemic respiratory failure requiring mechanical ventilation.MeasurementsClinical and ventilation data were obtained from medical records in a retrospective manner.ResultsA total of 18 patients with confirmed SARS-CoV‑2 infection and surgical tracheostomy were analyzed. The age range was 42–87 years. All patients received open tracheostomy between 2–16 days after admission. Ventilation after tracheostomy was less invasive (reduction in PEAK and positive end-expiratory pressure [PEEP]) and lung compliance increased over time after tracheostomy. Also, sedative drugs could be reduced, and patients had a reduced need of norepinephrine to maintain hemodynamic stability. Six of 18 patients died. All surgical staff were equipped with N99-masks and facial shields or with powered air-purifying respirators (PAPR).ConclusionOur data suggest that open surgical tracheostomy can be performed without severe complications in patients with COVID-19. Tracheostomy may reduce invasiveness of mechanical ventilation and the need for sedative drugs and norepinehprine. Recommendations for personal protective equipment (PPE) for surgical staff should be followed when PPE is available to avoid contamination of the personnel.
Highlights
It is presumed that the transmission of the new coronavirus-2 (SARS-CoV-2) from animal to human occurred at the Huanan Seafood Market in Wuhan in December 2019
Other patients develop a severe course of corona virus disease (COVID-19) with viral pneumonia and acute respiratory failure, which was described to occur in 17% of patients in a larger cohort in Germany [16]
From March 27 and May 18, 2020, open surgical tracheostomy was performed on COVID-19 patients (n = 18) because of acute respiratory failure, but without severe multiorgan failure (MOF) at a tertiary care university hospital in Germany
Summary
It is presumed that the transmission of the new coronavirus-2 (SARS-CoV-2) from animal to human occurred at the Huanan Seafood Market in Wuhan in December 2019. The risk factors for the development of severe infection are reported to be advanced age, male sex and metabolic syndrome, which includes hypertension, high body mass index (BMI) and diabetes [33, 36]. These patients frequently develop hypoxemia because of severe acute respiratory failure, which requires intensive care with mechanical ventilation [13]. One of the main symptoms of severe infection with the new coronavirus-2 (SARS-CoV-2) is hypoxemic respiratory failure because of viral pneumonia with the need for mechanical ventilation. Patients with COVID-19 were treated with open surgical tracheostomy due to severe hypoxemic respiratory failure requiring mechanical ventilation. Recommendations for personal protective equipment (PPE) for surgical staff should be followed when PPE is available to avoid contamination of the personnel
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