Percutaneous Tracheostomy in Respiratory Failure Due to COVID-19

Area of Science:

• Critical Care Medicine
• Pulmonology
• Infectious Diseases

Background:

• Coronavirus disease 2019 (COVID-19) frequently causes hypoxemic respiratory failure, necessitating prolonged mechanical ventilation.
• Tracheostomy is typically considered for patients requiring mechanical ventilation for over two weeks.
• The safety and efficacy of tracheostomy in the context of COVID-19 remain incompletely defined.

Purpose of the Study:

• To describe the institutional experience with percutaneous tracheostomy in patients with COVID-19.
• To evaluate the safety and outcomes of percutaneous tracheostomy in this patient population.

Main Methods:

• A single-center, retrospective descriptive study was conducted.
• Data were collected on comorbidities and outcomes for patients with COVID-19 respiratory failure who underwent percutaneous tracheostomy between April 2020 and September 2020.
• A modified protocol with brief planned apnea was employed to minimize aerosolization during the procedure.

Main Results:

• Twenty-four patients underwent percutaneous tracheostomy; the average BMI was 33.0±10.0.
• At 30 days post-procedure, 71% retained the tracheostomy tube, and 58% remained ventilator-dependent.
• Three patients (13%) died within 30 days. By November 2020, 38% had died, and 29% were decannulated.
• No healthcare providers involved in the procedures contracted COVID-19.

Conclusions:

• Percutaneous tracheostomy is a safe bedside procedure for patients with prolonged COVID-19-related respiratory failure.
• The procedure is safe for both patients and healthcare providers when performed in an appropriate clinical setting.
• Morbid obesity did not impede the performance of percutaneous tracheostomy in this COVID-19 cohort.