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. 2021 Jul 28;10(15):3335.
doi: 10.3390/jcm10153335.

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

Nardi Tetaj  1 , Micaela Maritti  1 , Giulia Stazi  1 , Maria Cristina Marini  1 , Daniele Centanni  2 , Gabriele Garotto  1 , Ilaria Caravella  1 , Cristina Dantimi  1 , Matteo Fusetti  1 , Carmen Santagata  1 , Manuela Macchione  1 , Giada De Angelis  1 , Filippo Giansante  1 , Donatella Busso  1 , Rachele Di Lorenzo  1 , Silvana Scarcia  1 , Alessandro Carucci  1 , Ricardo Cabas  1 , Ilaria Gaviano  1 , Nicola Petrosillo  2 , Andrea Antinori  2 , Fabrizio Palmieri  2 , Gianpiero D'Offizi  2 , Stefania Ianniello  3 , Paolo Campioni  3 , Francesco Pugliese  4 , Francesco Vaia  5 , Emanuele Nicastri  2 , Giuseppe Ippolito  6 , Luisa Marchioni  1 , Icu Covid-Study Group
Affiliations

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

Nardi Tetaj et al. J Clin Med. .

Abstract

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 (p < 0.001). On day 7 after tracheostomy, early group patients required fewer intravenous anesthetic drugs and experienced an improvement of the ventilation parameters PaO2/FiO2 ratio, PEEP, and FiO2 (p < 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.

Keywords: COVID-19; ICU length of stay; ICU stay; early tracheostomy; healthcare workers; intensive care unit; late tracheostomy; mechanical ventilation; percutaneous tracheostomy.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flowchart of study selection. Abbreviations: ICU, intensive care unit; PDT, percutaneous dilatational tracheostomy; OTI, orotracheal intubation.
Figure 2
Figure 2
Frequency distribution of percutaneous dilatational tracheostomy (PDT) from orotracheal intubation (OTI).
Figure 3
Figure 3
Descriptive plots, means, and 95% confidence intervals of 110 ICU COVID-19 patients who underwent PDT using repeated measures ANOVA for the following variables: Propofol (a), Remifentanil (b), and Norepinephrine (c) administered by intravenous continuous infusion during the ICU stay. Legend: OTI, day of orotracheal intubation; PDT, day of percutaneous tracheostomy; 7° PDT, day 7 after tracheostomy.
Figure 4
Figure 4
Descriptive plots, means, and 95% confidence intervals of 110 ICU COVID-19 patients underwent PDT, for the following ventilation variables: FiO2 (%), fraction of inspired oxygen (a); PEEP (cmH2O), positive end-expiratory pressure (b); P/F ratio (mmHg), respiratory exchange ratio (c). Legend: OTI, the day of orotracheal intubation; PDT, the day of percutaneous tracheostomy; 7° PDT, day 7 after tracheostomy.
Figure 5
Figure 5
Boxplot of ICU length of stay (a) and days of mechanical ventilation (b) estimates, adjusted for confounding factors between the two groups (early group and late group). Legend: PDT, percutaneous dilatational tracheostomy; ICU LOS, Intensive Care Unit length of stay; early group, the group of patients who underwent PDT within the first 12 days of orotracheal intubation; late group, the group of patients who underwent PDT more than 12 days after orotracheal intubation.
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