Outcomes and Timing of Bedside Percutaneous Tracheostomy of COVID-19 Patients over a Year in the Intensive Care Unit

Background: The benefits and timing of percutaneous dilatational tracheostomy (PDT) in Intensive Care Unit (ICU) COVID-19 patients are still controversial. PDT is considered a high-risk procedure for the transmission of SARS-CoV-2 to healthcare workers (HCWs). The present study analyzed the optimal timing of PDT, the clinical outcomes of patients undergoing PDT, and the safety of HCWs performing PDT.

Methods: Of the 133 COVID-19 patients who underwent PDT in our ICU from 1 April 2020 to 31 March 2021, 13 patients were excluded, and 120 patients were enrolled. A trained medical team was dedicated to the PDT procedure. Demographic, clinical history, and outcome data were collected. Patients who underwent PDT were stratified into two groups: an early group (PDT ≤ 12 days after orotracheal intubation (OTI) and a late group (>12 days after OTI). An HCW surveillance program was also performed.

Results: The early group included 61 patients and the late group included 59 patients. The early group patients had a shorter ICU length of stay and fewer days of mechanical ventilation than the late group ( < 0.001). On day 7 after tracheostomy, early group patients required fewer intravenous anesthetic drugs and experienced an improvement of the ventilation parameters PaO/FiO ratio, PEEP, and FiO ( < 0.001). No difference in the case fatality ratio between the two groups was observed. No SARS-CoV-2 infections were reported in the HCWs performing the PDTs.

Conclusions: PDT was safe and effective for COVID-19 patients since it improved respiratory support parameters, reduced ICU length of stay and duration of mechanical ventilation, and optimized the weaning process. The procedure was safe for all HCWs involved in the dedicated medical team. The development of standardized early PDT protocols should be implemented, and PDT could be considered a first-line approach in ICU COVID-19 patients requiring prolonged mechanical ventilation.

Citing Articles

Tracheostomy Timing in Unselected Critically Ill Patients with Prolonged Intubation: A Prospective Cohort Study.

Tekin P, Bulut A J Clin Med. 2024; 13(10).

PMID: 38792271 PMC: 11121849. DOI: 10.3390/jcm13102729.

Early versus late tracheostomy in critically ill COVID-19 patients.

Szafran A, Dahms K, Ansems K, Skoetz N, Monsef I, Breuer T Cochrane Database Syst Rev. 2023; 11:CD015532.

PMID: 37982427 PMC: 10658650. DOI: 10.1002/14651858.CD015532.

Epidemiology of ventilator-associated pneumonia in ICU COVID-19 patients: an alarming high rate of multidrug-resistant bacteria.

Tetaj N, Capone A, Stazi G, Marini M, Garotto G, Busso D J Anesth Analg Crit Care. 2023; 2(1):36.

PMID: 37386603 PMC: 9389502. DOI: 10.1186/s44158-022-00065-4.

Laryngotracheal Complications after Intubation for COVID-19: A Multicenter Study.

Hernandez-Garcia E, Hernandez-Sandemetrio R, Quintana-Sanjuas A, Zapater-Latorre E, Gonzalez-Herranz R, Sanz L Life (Basel). 2023; 13(5).

PMID: 37240852 PMC: 10221865. DOI: 10.3390/life13051207.

Measurement of airborne particle emission during surgical and percutaneous dilatational tracheostomy COVID-19 adapted procedures in a swine model: Experimental report and review of literature.

Favier V, Lescroart M, Pequignot B, Grimmer L, Florentin A, Gallet P PLoS One. 2022; 17(11):e0278089.

PMID: 36417482 PMC: 9683587. DOI: 10.1371/journal.pone.0278089.

References

Botti C, Lusetti F, Peroni S, Neri T, Castellucci A, Salsi P . The Role of Tracheotomy and Timing of Weaning and Decannulation in Patients Affected by Severe COVID-19. Ear Nose Throat J. 2020; 100(2_suppl):116S-119S. PMC: 7548540. DOI: 10.1177/0145561320965196. View

Frova G, Quintel M . A new simple method for percutaneous tracheostomy: controlled rotating dilation. A preliminary report. Intensive Care Med. 2002; 28(3):299-303. DOI: 10.1007/s00134-002-1218-5. View

Durbin Jr C . Indications for and timing of tracheostomy. Respir Care. 2005; 50(4):483-7. View

Dullemond K, Renschler C, Trojanowski J, Scheuermeyer F, Stenstrom R, Griesdale D . Success and complications of endotracheal intubation in critical care settings under COVID-19 protocols. CJEM. 2021; 23(4):512-517. PMC: 7798372. DOI: 10.1007/s43678-020-00061-z. View

Privitera D, Angaroni L, Capsoni N, Forni E, Pierotti F, Vincenti F . Flowchart for non-invasive ventilation support in COVID-19 patients from a northern Italy Emergency Department. Intern Emerg Med. 2020; 15(5):767-771. PMC: 7238716. DOI: 10.1007/s11739-020-02370-8. View

Mehta C, Mehta Y . Percutaneous tracheostomy. Ann Card Anaesth. 2017; 20(Supplement):S19-S25. PMC: 5299824. DOI: 10.4103/0971-9784.197793. View

Cataldo M, Tetaj N, Selleri M, Marchioni L, Capone A, Caraffa E . Incidence of bacterial and fungal bloodstream infections in COVID-19 patients in intensive care: An alarming "collateral effect". J Glob Antimicrob Resist. 2020; 23:290-291. PMC: 7598418. DOI: 10.1016/j.jgar.2020.10.004. View

Trouillet J, Collange O, Belafia F, Blot F, Capellier G, Cesareo E . Tracheotomy in the intensive care unit: Guidelines from a French expert panel: The French Intensive Care Society and the French Society of Anaesthesia and Intensive Care Medicine. Anaesth Crit Care Pain Med. 2018; 37(3):281-294. DOI: 10.1016/j.accpm.2018.02.012. View

Smith M, Hibino M, Falcione B, Eichinger K, Patel R, Empey K . Immunosuppressive aspects of analgesics and sedatives used in mechanically ventilated patients: an underappreciated risk factor for the development of ventilator-associated pneumonia in critically ill patients. Ann Pharmacother. 2013; 48(1):77-85. PMC: 4052449. DOI: 10.1177/1060028013510698. View

10.

McGrath B, Ashby N, Birchall M, Dean P, Doherty C, Ferguson K . Multidisciplinary guidance for safe tracheostomy care during the COVID-19 pandemic: the NHS National Patient Safety Improvement Programme (NatPatSIP). Anaesthesia. 2020; 75(12):1659-1670. PMC: 7272992. DOI: 10.1111/anae.15120. View

11.

von Dossow V, Luetz A, Haas A, Sawitzki B, Wernecke K, Volk H . Effects of remifentanil and fentanyl on the cell-mediated immune response in patients undergoing elective coronary artery bypass graft surgery. J Int Med Res. 2008; 36(6):1235-47. DOI: 10.1177/147323000803600610. View

12.

Adly A, Youssef T, El-Begermy M, Younis H . Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review. Eur Arch Otorhinolaryngol. 2017; 275(3):679-690. DOI: 10.1007/s00405-017-4838-7. View

13.

Tran K, Cimon K, Severn M, Pessoa-Silva C, Conly J . Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012; 7(4):e35797. PMC: 3338532. DOI: 10.1371/journal.pone.0035797. View

14.

Byhahn C, Lischke V, Halbig S, Scheifler G, Westphal K . [Ciaglia blue rhino: a modified technique for percutaneous dilatation tracheostomy. Technique and early clinical results]. Anaesthesist. 2000; 49(3):202-6. DOI: 10.1007/s001010050815. View

15.

Trouillet J, Collange O, Belafia F, Blot F, Capellier G, Cesareo E . Tracheotomy in the intensive care unit: guidelines from a French expert panel. Ann Intensive Care. 2018; 8(1):37. PMC: 5854567. DOI: 10.1186/s13613-018-0381-y. View