Elective tracheostomy in COVID-19 patients: A retrospective case series

ABSTRACT

The COVID-19 outbreak represents a global health threat due to the unprecedented number of patients admitted to intensive care units and the overwhelming need for mechanical ventilation. Performing a tracheostomy in COVID-19 patients poses unique risks and demands for safety precautions. We report a case series of 10 patients with COVID-19 who underwent elective open tracheostomies to provide access for prolonged mechanical ventilation. At the time of tracheostomy, they had required a mean mechanical ventilation period of 18.6 days (range, 13-23 days) and exhibited a mean PaO2/FiO2 ratio of 242.8 (range, 165-321). All patients still tested positive for SARS-CoV-2 at the time of tracheostomy. In all cases, total intravenous anesthesia was used and deep neuromuscular paralysis was guaranteed. Pre-oxygenation was performed before the beginning of the procedure and before tracheal incision. Ventilation was ceased whilst the window in the trachea was being performed. A cuffed non-fenestrated tracheostomy tube was inserted and the cuff was inflated before resuming ventilation. All team members wore adequate personal protective equipment (PPE). Only one patient developed postoperative complications (pneumothorax and postoperative continuous bleeding) and no viral transmission to health care workers was documented. Our experience supports the safety of tracheostomy in COVID-19 patients, provided that meticulous planning and strict safety recommendations are followed.