Healthcare Personnel Safety During Percutaneous Tracheostomy in Patients With COVID-19: Proof-of-Concept Study

• Published in: Journal of intensive care medicine Vol. 36; no. 5; pp. 612 - 616
• Main Authors: Sood, Rahul N., Dudiki, Natasha, Alape, Daniel, Maxfiel, Mark W.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-05-2021
• Subjects: COVID-19 - complications; COVID-19 - physiopathology; COVID-19 - prevention & control; Critical Pathways - organization & administration; Critical Pathways - trends; Female; Health Personnel; Humans; Infection Control - methods; Male; Middle Aged; Occupational Exposure - prevention & control; Patient Care Team - organization & administration; Personal Protective Equipment - standards; Proof of Concept Study; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; Safety Management; SARS-CoV-2 - isolation & purification; Tracheostomy - methods; Tracheostomy - trends; United States; United States; COVID-19; tracheostomy tube; safety
• ISSN: 0885-0666; 1525-1489
• DOI: 10.1177/0885066620980384

Background:
Covid-19 pandemic has resulted in the development of severe and persistent respiratory failure requiring long term ventilatory support. This necessitates the need for a reliable and easy to implement tracheostomy protocol given the concern for viral transmission risk to the involved healthcare personnel due to the aerosol generating nature of the procedure. We describe a protocol with unique and novel modifications to the Ciaglia dilatational percutaneous tracheostomy, effectively implemented during the Covid-19 pandemic at our institution.
Methods:
We describe the baseline characteristics of our initial 11 patients who underwent the procedure. Outlined are the healthcare personnel involved and the steps which are organized into 4 phases: planning, pre-procedure, intra-procedure and post-procedure. We have tracked procedural duration, provider safety as well as the development of new complications.
Results:
We describe use of this protocol for 11 bedside percutaneous tracheostomies performed on patients with COVID-19. The average total procedural duration as well as incision to tracheostomy tube placement times was 32.6 minutes and 5.8 minutes respectively. All 3 providers performing the tracheostomies remained asymptomatic with negative COVID-19 RT-PCR testing at 3 weeks.
Conclusions:
We report an efficacious and adaptable protocol for elective bedside percutaneous tracheostomies for patients with persistent ventilatory requirements due to COVID-19 with an intent to provide standardized and safe care for the patient and the involved healthcare personnel.