Subscribe to RSS
Percutaneous Tracheostomy in COVID-19 Critically Ill Patients: Experience from 30 Consecutive Procedures
Introduction Percutaneous tracheostomy (PT) in the intensive care unit (ICU) is a well-established practice that shows a reduced risk of wound infection compared with surgical tracheostomy, thus facilitating mechanical ventilation, nursing procedures, reduction in sedation and early mobilization.
Objective This is an observational case-control study that compares the results of PT in ICU patients with coronavirus disease 2019 (COVID-19) prospectively enrolled to a similar group of subjects, retrospectively recruited, without COVID-19.
Methods Ninety-eight consecutive COVID-19 patients admitted to the ICU at Pisa Azienda Ospedaliero Universitaria Pisana between March 11th and May 20th, 2020 were prospectively studied. Thirty of them underwent PT using different techniques. Another 30 non-COVID-19 ICU patients were used as a control-group. The main outcome was to evaluate the safety and feasibility of PT in COVID-19 patients. We measured the rate of complications.
Results Percutaneous tracheostomy was performed with different techniques in 30 of the 98 COVID-19 ICU patients admitted to the ICU. Tracheostomy was performed on day 10 (mean 10 ± 3.3) from the time of intubation. Major tracheal complications occurred in 5 patients during the procedure. In the control group of 30 ICU patients, no differences were found with regards to the timing of the tracheostomy, whereas a statistically significant difference was observed regarding complications with only one tracheal ring rupture reported.
Conclusion Percutaneous tracheostomy in COVID-19 patients showed a higher rate of complications compared with controls even though the same precautions and the same expertise were applied. Larger studies are needed to understand whether the coronavirus disease itself carries an increased risk of tracheal damage.
Received: 18 July 2020
Accepted: 08 August 2020
01 February 2021 (online)
© 2021. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil
- 1 Grasselli G, Zangrillo A, Zanella A. et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA 2020; 06
- 2 Chen J, Qi T, Liu L. et al. Clinical progression of patients with COVID-19 in Shanghai, China. J Infect 2020; 80 (05) e1-e6
- 3 Guan W-J, Ni Z-Y, Hu Y, Liang W-H, Ou C-Q, He J-X. et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020; 30; 382 (18) 1708-1720
- 4 Murthy S, Gomersall CD, Fowler RA. Care for Critically Ill Patients With COVID-19. JAMA 2020
- 5 Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S. et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med 2020 Mar 13
- 6 Yang X, Yu Y, Xu J. et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; 8 (05) 475-481
- 7 de Kleijn BJ, Wedman J, Zijlstra JG, Dikkers FG, van der Laan BFAM. Short- and long-term complications of surgical and percutaneous dilatation tracheotomies: a large single-centre retrospective cohort study. Eur Arch Otorhinolaryngol 2019; 276 (06) 1823-1828
- 8 Gupta S, Dixit S, Choudhry D. et al. Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations. Indian J Crit Care Med 2020; 24 (Suppl. 01) S31-S42
- 9 Modalsli L, Liknes K, Flaatten H. Outcomes after percutaneous dilatation tracheostomy: Patients view 6 years after the procedure. Acta Anaesthesiol Scand 2020; 64 (06) 798-802
- 10 Mehta Y, Mehta C. Percutaneous tracheostomy. Ann Card Anaesth 2017; 20 (01) 121
- 11 McGrath BA, Ashby N, Birchall M. et al. Multidisciplinary guidance for safe tracheostomy care during the COVID-19 pandemic: the NHS National Patient Safety Improvement Programme (NatPatSIP). Anaesthesia 2020
- 12 McGrath BA, Brenner MJ, Warrillow SJ. et al. Tracheostomy in the COVID-19 era: global and multidisciplinary guidance. Lancet Respir Med 2020; 8 (07) 717-725
- 13 Piccin O, Albertini R, Caliceti U. et al. Early experience in tracheostomy and tracheostomy tube management in Covid-19 patients. Am J Otolaryngol 2020; 41 (04) 102535
- 14 Turri-Zanoni M, Battaglia P, Czaczkes C, Pelosi P, Castelnuovo P, Cabrini L. Elective Tracheostomy During Mechanical Ventilation in Patients Affected by COVID-19: Preliminary Case Series From Lombardy, Italy. Otolaryngol Head Neck Surg 2020; 163 (01) 135-137
- 15 Angel L, Kon ZN, Chang SH. et al. Novel Percutaneous Tracheostomy for Critically Ill Patients With COVID-19. Ann Thorac Surg 2020; S0003-4975(20)30603-2
- 16 Kwan A, Fok WG, Law KI, Lam SH. Tracheostomy in a patient with severe acute respiratory syndrome. Br J Anaesth 2004; 92 (02) 280-282
- 17 Wei WI, Tuen HH, Ng RWM, Lam LK. Safe tracheostomy for patients with severe acute respiratory syndrome. Laryngoscope 2003; 113 (10) 1777-1779
- 18 Divisi D, Altamura G, Di Tommaso S. et al. Fantoni translaryngeal tracheostomy versus ciaglia blue rhino percutaneous tracheostomy: a retrospective comparison. Surg Today 2009; 39 (05) 387-392
- 19 Chee VWT, Khoo ML-C, Lee SF, Lai YC, Chin NM. Infection control measures for operative procedures in severe acute respiratory syndrome-related patients. Anesthesiology 2004; 100 (06) 1394-1398
- 20 Tien HC, Chughtai T, Jogeklar A, Cooper AB, Brenneman F. Elective and emergency surgery in patients with severe acute respiratory syndrome (SARS). Can J Surg 2005; 48 (01) 71-74
- 21 Tay JK, Khoo ML-C, Loh WS. Surgical Considerations for Tracheostomy During the COVID-19 Pandemic: Lessons Learned From the Severe Acute Respiratory Syndrome Outbreak. JAMA Otolaryngol Head Neck Surg 2020
- 22 Suzuki Y, Suzuki T, Yamamoto Y. et al. Evaluation of the Safety of Percutaneous Dilational Tracheostomy Compared with Surgical Tracheostomy in the Intensive Care Unit. Crit Care Res Pract 2019; 2019: 2054846
- 23 Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020; 18 (05) 1094-1099
- 24 Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J. et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020 Feb 7
- 25 Leung TF, Wong GWK, Hon KLE, Fok TF. Severe acute respiratory syndrome (SARS) in children: epidemiology, presentation and management. Paediatr Respir Rev 2003; 4 (04) 334-339
- 26 Khammas AH, Dawood MR. Timing of Tracheostomy in Intensive Care Unit Patients. Int Arch Otorhinolaryngol 2018; 22 (04) 437-442
- 27 Giannis D, Ziogas IA, Gianni P. Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. J Clin Virol 2020; 127: 104362
- 28 Salna M, Tipograf Y, Liou P. et al. Tracheostomy Is Safe During Extracorporeal Membrane Oxygenation Support. ASAIO J 2020; 66 (06) 652-656
- 29 McGrath BA, Wallace S, Goswamy J. Laryngeal oedema associated with COVID-19 complicating airway management. Anaesthesia 2020; 75 (07) 972
- 30 Lodigiani C, Iapichino G, Carenzo L. et al; Humanitas COVID-19 Task Force. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res 2020; 191: 9-14
- 31 Menter T, Haslbauer JD, Nienhold R. et al. Postmortem examination of COVID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction. Histopathology 2020