Percutaneous tracheostomy for long-term ventilated COVID-19-patients: rationale and first clinical-safe for all-experience

Wim Jonckheere; Michaël Mekeirele; Steven Hendrickx; Joop Jonckheer; Marc Diltoer; Idris Ghijselings; Matthias Raes; Domien Vanhonacker; Manu L.G. Malbrain; Ina Foulon; Frans Gordts; Daniel Jacobs-Tulleneers-Thevissen; Mark La Meir; Jan Nijs; Dirk Smets; Martijn Schoneveld; Ellen Van Eetvelde; Marian Vanhoeij; Katia Verbruggen; Guy Verfaillie; Paul Wischmeyer; Elisabeth De Waele

eISSN: 1731-2515
ISSN: 0209-1712

Anestezjologia Intensywna Terapia

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5/2020
vol. 52

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Artykuł oryginalny

Percutaneous tracheostomy for long-term ventilated COVID-19-patients: rationale and first clinical-safe for all-experience

Wim Jonckheere

¹

,

Michaël Mekeirele

²

,

Steven Hendrickx

^{2, 3}

,

Joop Jonckheer

²

,

Marc Diltoer

^{2, 4}

,

Idris Ghijselings

²

,

Matthias Raes

^{2, 3}

,

Domien Vanhonacker

^{2, 3}

,

Manu L.G. Malbrain

^{2, 4}

,

Ina Foulon

⁵

,

Frans Gordts

^{4, 5}

,

Daniel Jacobs-Tulleneers-Thevissen

^{1, 4}

,

Mark La Meir

^{4, 6}

,

Jan Nijs

⁶

,

Dirk Smets

^{1, 4}

,

Martijn Schoneveld

¹

,

Ellen Van Eetvelde

¹

,

Marian Vanhoeij

^{1, 4}

,

Katia Verbruggen

⁵

,

Guy Verfaillie

¹

,

Paul Wischmeyer

⁷

,

Elisabeth De Waele

^{2, 4, 8}

Department of Surgery, Universitair Ziekenhuis Brussel, Jette, Brussels, Belgium
Department of Intensive Care, Universitair Ziekenhuis Brussel, Jette, Brussels, Belgium
Department of Anesthesiology, Universitair Ziekenhuis Brussel, Jette, Brussels, Belgium
Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Jette, Brussels, Belgium
Department of Otorhinolaryngology, Universitair Ziekenhuis Brussel, Jette, Brussels, Belgium
Department of Cardiac Surgery, Universitair Ziekenhuis Brussel, Jette, Brussels, Belgium
Department of Anesthesiology and Surgery, Duke University School of Medicine, Durham, North Carolina, USA
Department of Nutrition, Universitair Ziekenhuis Brussel, Jette, Brussels, Belgium

Anestezjologia Intensywna Terapia
2020; 52, 5: 370–376

Data publikacji online: 2020/12/24

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Introduction
COVID-19 infection has resulted in thousands of critically ill patients admitted to ICUs and treated with mechanical ventilation. Percutaneous tracheostomy is a well-known technique utilised as a strategy to wean critically ill patients from mechanical ventilation. Worldwide differences exist in terms of methods, operators, and settings, and questions remain regarding timing and indications. If tracheostomy is to be performed in COVID-19 patients, a safe environment is needed for optimal care.

Material and methods
We present a guidewire dilating forceps tracheostomy procedure in COVID-19 patients that was optimised including apnoea-moments, protective clothing, checklists, and clear protocols. We performed a retrospective analysis of the outcome after tracheostomy in COVID-19 patients between March 2020 and May 2020.

Results
The follow-up of the first 16 patients, median age 62 years, revealed a median intubation time until tracheostomy of 18 days and median cannulation time of 20 days. The overall perioperative complication rate and complication rate while cannulated was 19%, mainly superficial bleeding. None of the healthcare providers involved in performing the procedure developed any symptoms of the disease.

Conclusions
This COVID-19-centred strategy based on flexibility, preparation, and cooperation between healthcare providers with different backgrounds facilitated percutaneous tracheostomy in COVID-19 patients without an increase in the overall complication rate or evidence of risk to healthcare providers. Our findings provide initial evidence that tracheostomy can be performed safely as a standard of care for COVID-19 patients requiring prolonged mechanical ventilation as was standard practice in ICU patients prior to the COVID-19 pandemic to promote ventilator weaning and patient recovery.