Viral Infectivity in Patients Undergoing Tracheotomy With COVID-19: A Preliminary Study.
Otolaryngol Head Neck Surg
; 165(6): 819-826, 2021 12.
Article
in English
| MEDLINE | ID: covidwho-1147429
ABSTRACT
OBJECTIVE:
To establish the presence of live virus and its association with polymerase chain reaction (PCR) positivity and antibody status in patients with COVID-19 undergoing tracheotomy. STUDYDESIGN:
Prospective observational study.SETTING:
Single institution across 3 hospital sites during the first wave of the COVID-19 pandemic.METHODS:
Patients who were intubated for respiratory wean tracheotomy underwent SARS-CoV-2 PCR nasal, throat, and endotracheal tube swabs at the time of the procedure. These were assessed via quantitative real-time reverse transcription PCR. The tracheal tissue excised during the tracheotomy was cultured for SARS-CoV-2 with Vero E6 and Caco2 cells. Serum was assessed for antibody titers against SARS-CoV-2 via neutralization assays.RESULTS:
Thirty-seven patients were included in this study. The mean number of days intubated prior to undergoing surgical tracheotomy was 27.8. At the time of the surgical tracheotomy, PCR swab testing yielded 8 positive results, but none of the 35 individuals who underwent tissue culture were positive for SARS-CoV-2. All 18 patients who had serum sampling demonstrated neutralization antibodies, with a minimum titer of 180.CONCLUSION:
In our series, irrespective of positive PCR swab, the likelihood of infectivity during tracheotomy remains low given negative tracheal tissue cultures. While our results do not undermine national and international guidance on tracheotomy after day 10 of intubation, given the length of time to procedure in our data, infectivity at 10 days cannot be excluded. We do however suggest that a preoperative negative PCR swab not be a prerequisite and that antibody titer levels may serve as a useful adjunct for assessment of infectivity.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Pneumonia, Viral
/
Tracheotomy
/
SARS-CoV-2
/
COVID-19
Type of study:
Cohort study
/
Observational study
/
Prognostic study
Limits:
Animals
/
Female
/
Humans
/
Male
/
Middle aged
Language:
English
Journal:
Otolaryngol Head Neck Surg
Journal subject:
Otolaryngology
Year:
2021
Document Type:
Article
Affiliation country:
01945998211004255
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