Percutaneous Tracheostomy in COVID-19 Patients: A Four-step Safe Protocol

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Surgical Procedures

Background:

• The COVID-19 pandemic has strained global healthcare systems, particularly intensive care units (ICUs).
• Tracheostomy is crucial for weaning and resource optimization in severe COVID-19 patients requiring mechanical ventilation.
• Percutaneous tracheostomy (PCT) is standard in ICUs but poses aerosolization risks in COVID-19 patients.

Purpose of the Study:

• To develop and evaluate a safe, four-step protocol for performing percutaneous tracheostomy (PCT) in critically ill COVID-19 patients.
• To address the challenges of aerosol generation and resource management associated with tracheostomy in the context of the COVID-19 pandemic.

Main Methods:

• A four-step protocol was developed, encompassing patient selection, preparation, procedure performance, and post-procedure care for PCT.
• The protocol was evaluated in four patients, including three with severe COVID-19 requiring mechanical ventilation for over 10 days.

Main Results:

• The four-step PCT protocol was successfully implemented in all evaluated patients, with no complications.
• Median procedure time was 10 minutes 30 seconds, and median apnea time was 2 minutes 20 seconds.
• Two patients were decannulated post-procedure, and one remained on ventilation.

Conclusions:

• The developed four-step protocol for PCT in critically ill COVID-19 patients is simple, safe, and adaptable.
• This protocol can be implemented in resource-limited settings with minimal training.
• Further studies are recommended to validate this approach in selected COVID-19 patients requiring tracheostomy.