ABSTRACT
SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: To evaluate the safety and efficacy of percutaneous tracheostomy in patients with severe acute respiratory syndrome coronavirus (SARS-CoV-2) requiring prolonged intubation. METHODS: We retrospectively reviewed patients with confirmed SARS-CoV-2 infection between April 1st, 2020 to July 20, 2020 at Mount Sinai Medical Center who required endotracheal intubation. We identified 10 patients who underwent percutaneous tracheostomy due to prolonged intubation. The following baseline data was collected: age, sex, BMI, SARS-CoV-2 status, mechanical ventilation requirements and treatments administered. RESULTS: We reviewed over 200 patients admitted to ICU with SARS-COV2. Ten patients underwent percutaneous tracheostomy. The mean age was 64.2 ± 12.4, 90% were male, with mean BMI of 29 ± 5.3. Six patients underwent bedside tracheostomy, in an airborne isolation room and 4 patients underwent the procedure in an operating room (OR). Prior to tracheostomy, the mean days on ventilator were 26.5 ± 8.3 with 90% on deep sedation and/or paralysis. Four patients were positive for SARS-CoV-2 infection on the day of the procedure. Eight patients were treated with Hydroxychloroquine and Azithromycin, 90% treated with convalescent plasma, and 70% with IL-6 inhibitors. One returned to OR for excessive bleeding and one patient required a tracheostomy exchange. Currently, 5 patients (50%) have recovered to long-term facilities. Three patients were successfully decannulated, 2 patients remain hospitalized and 2 patients succumbed due to multiorgan failure. No staff involved in procedures developed SARS-CoV-2 infection. CONCLUSIONS: Percutaneous tracheostomy in SARS-CoV-2 critically ill patients is feasible, safe and can facilitate the weaning process from the ventilator. Adequate selection and appropriate timing are of utmost importance to obtain positive outcomes. Unfortunately, a vast number of patients suffering respiratory failure secondary to SARS-CoV-2 are not suitable candidates. Although, a small sample size, this cohort suggests that in adequately selected patients' early tracheostomy can facilitate recovery from respiratory failure due to SARS-CoV-2. CLINICAL IMPLICATIONS: In adequately selected patients, early tracheostomy may assist the weaning process of patients unable to come off the ventilator, facilitating mobilization and hasten recoveries. DISCLOSURES: No relevant relationships by Angel Porras, source=Web Response no disclosure on file for Fernando Safdie;No relevant relationships by Anita Singh, source=Web Response No relevant relationships by Francico Ujueta, source=Web Response