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Novel Percutaneous Tracheostomy for Critically Ill Patients With COVID-19

The Annals of thoracic surgery, 2020-09, Vol.110 (3), p.1006-1011 [Peer Reviewed Journal]

2020 The Society of Thoracic Surgeons ;Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. ;2020 by The Society of Thoracic Surgeons Published by Elsevier. 2020 The Society of Thoracic Surgeons ;ISSN: 0003-4975 ;EISSN: 1552-6259 ;DOI: 10.1016/j.athoracsur.2020.04.010 ;PMID: 32339508

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  • Title:
    Novel Percutaneous Tracheostomy for Critically Ill Patients With COVID-19
  • Author: Angel, Luis ; Kon, Zachary N. ; Chang, Stephanie H. ; Rafeq, Samaan ; Palasamudram Shekar, Saketh ; Mitzman, Brian ; Amoroso, Nancy ; Goldenberg, Ronald ; Sureau, Kimberly ; Smith, Deane E. ; Cerfolio, Robert J.
  • Subjects: Betacoronavirus ; Coronavirus Infections - epidemiology ; COVID-19 ; Critical Illness - therapy ; Female ; Humans ; Male ; Middle Aged ; Original ; Pandemics ; Pneumonia, Viral - epidemiology ; Respiration, Artificial - methods ; SARS-CoV-2 ; Time Factors ; Tracheostomy - methods ; United States - epidemiology
  • Is Part Of: The Annals of thoracic surgery, 2020-09, Vol.110 (3), p.1006-1011
  • Description: Coronavirus 2019 (COVID-19) is a worldwide pandemic, with many patients requiring prolonged mechanical ventilation. Tracheostomy is not recommended by current guidelines as it is considered a superspreading event owing to aerosolization that unduly risks health care workers. Patients with severe COVID-19 who were on mechanical ventilation for 5 days or longer were evaluated for percutaneous dilational tracheostomy. We developed a novel percutaneous tracheostomy technique that placed the bronchoscope alongside the endotracheal tube, not inside it. That improved visualization during the procedure and continued standard mechanical ventilation after positioning the inflated endotracheal tube cuff in the distal trachea. This technique offers a significant mitigation for the risk of virus aerosolization during the procedure. From March 10 to April 15, 2020, 270 patients with COVID-19 required invasive mechanical ventilation at New York University Langone Health Manhattan’s campus; of those, 98 patients underwent percutaneous dilational tracheostomy. The mean time from intubation to the procedure was 10.6 ± 5 days. Currently, 32 patients (33%) do not require mechanical ventilatory support, 19 (19%) have their tracheostomy tube downsized, and 8 (8%) were decannulated. Forty patients (41%) remain on full ventilator support, and 19 (19%) are weaning from mechanical ventilation. Seven patients (7%) died as a result of respiratory and multiorgan failure. Tracheostomy-related bleeding was the most common complication (5 patients). None of health care providers has had symptoms or tested positive for COVID-19. Our percutaneous tracheostomy technique appears to be safe and effective for COVID-19 patients and safe for health care workers.
  • Publisher: Netherlands: Elsevier Inc
  • Language: English
  • Identifier: ISSN: 0003-4975
    EISSN: 1552-6259
    DOI: 10.1016/j.athoracsur.2020.04.010
    PMID: 32339508
  • Source: MEDLINE
    Alma/SFX Local Collection
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