Experience of percutaneous tracheostomy in critically ill COVID-19 patients

Abstract

Background: Coronavirus disease 2019 (COVID-19) is a highly contagious disease that causes respiratory failure. Tracheostomy is an essential procedure in critically ill COVID-19 patients; however, it is an aerosol-generating technique and thus carries the risk of infection transmission. We report our experience with percutaneous tracheostomy and its safety in a real medical setting.

Methods: During the COVID-19 outbreak, 13 critically ill patients were admitted to the intensive care unit (ICU) at Daegu Catholic University Medical Center between February 24 and April 30, 2020. Seven of these patients underwent percutaneous tracheostomy using Ciaglia Blue Rhino. The medical environment, percutaneous tracheostomy method, and COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR) results were retrospectively reviewed. After treatment, the COVID-19 infection status of healthcare personnel was investigated by RT-PCR.

Results: The ICU contained negative pressure cohort areas and isolation rooms, and healthcare personnel wore a powered air-purifying respirator system. We performed seven cases of percutaneous tracheostomy in the same way as in patients without COVID-19. Five patients (71.4%) tested positive for COVID-19 by RT-PCR at the time of tracheostomy. The median cycle threshold value for the RNA-dependent RNA polymerase was 30.60 (interquartile range [IQR], 25.50-36.56) in the upper respiratory tract and 35.04 (IQR, 28.40-36.74) in the lower respiratory tract. All healthcare personnel tested negative for COVID-19 by RT-PCR.

Conclusions: Percutaneous tracheostomy was performed with conventional methods in the negative pressure cohort area. It was safe to perform percutaneous tracheostomy in an environment of COVID-19 infection.

Keywords: COVID-19; SARS-CoV-2; reverse transcriptase polymerase chain reaction; tracheostomy.

Figure 1.

Schematic view of the temporary negative pressure isolation intensive care unit. The unit consisted of nine beds; three beds were in negative pressure isolation rooms with one anteroom, and six beds were in cohort areas that used a common space and a mobile negative air machine to create negative pressure. The entire unit was sealed by erecting a temporary wall to maintain proper negative pressure, and all spaces were subjected to pressure monitoring.

Figure 2.

A photograph of healthcare personnel performing percutaneous tracheostomy. Healthcare personnel wore a 3M Jupiter powered air-purifying respirator system, a 3M Versaflo high durability hood with integrated head suspension, eye protection, a fluid-repellent disposable surgical gown, a cap, boots, double gloves, and an N95 mask.