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Viral Infectivity in Patients Undergoing Tracheotomy With COVID-19: A Preliminary Study

OBJECTIVE: To establish the presence of live virus and its association with polymerase chain reaction (PCR) positivity and antibody status in patients with COVID-19 undergoing tracheotomy. STUDY DESIGN: Prospective observational study. SETTING: Single institution across 3 hospital sites during the f...

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Autores principales: George, Manish M., McIntyre, Charlotte J., Zhou, Jie, Kugathasan, Ruthiran, Amos, Dora C., Dillon, Ivan J., Barclay, Wendy S., Tolley, Neil S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008096/
https://www.ncbi.nlm.nih.gov/pubmed/33752547
http://dx.doi.org/10.1177/01945998211004255
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author George, Manish M.
McIntyre, Charlotte J.
Zhou, Jie
Kugathasan, Ruthiran
Amos, Dora C.
Dillon, Ivan J.
Barclay, Wendy S.
Tolley, Neil S.
author_facet George, Manish M.
McIntyre, Charlotte J.
Zhou, Jie
Kugathasan, Ruthiran
Amos, Dora C.
Dillon, Ivan J.
Barclay, Wendy S.
Tolley, Neil S.
author_sort George, Manish M.
collection PubMed
description OBJECTIVE: To establish the presence of live virus and its association with polymerase chain reaction (PCR) positivity and antibody status in patients with COVID-19 undergoing tracheotomy. STUDY DESIGN: Prospective observational study. SETTING: Single institution across 3 hospital sites during the first wave of the COVID-19 pandemic. METHODS: Patients who were intubated for respiratory wean tracheotomy underwent SARS-CoV-2 PCR nasal, throat, and endotracheal tube swabs at the time of the procedure. These were assessed via quantitative real-time reverse transcription PCR. The tracheal tissue excised during the tracheotomy was cultured for SARS-CoV-2 with Vero E6 and Caco2 cells. Serum was assessed for antibody titers against SARS-CoV-2 via neutralization assays. RESULTS: Thirty-seven patients were included in this study. The mean number of days intubated prior to undergoing surgical tracheotomy was 27.8. At the time of the surgical tracheotomy, PCR swab testing yielded 8 positive results, but none of the 35 individuals who underwent tissue culture were positive for SARS-CoV-2. All 18 patients who had serum sampling demonstrated neutralization antibodies, with a minimum titer of 1:80. CONCLUSION: In our series, irrespective of positive PCR swab, the likelihood of infectivity during tracheotomy remains low given negative tracheal tissue cultures. While our results do not undermine national and international guidance on tracheotomy after day 10 of intubation, given the length of time to procedure in our data, infectivity at 10 days cannot be excluded. We do however suggest that a preoperative negative PCR swab not be a prerequisite and that antibody titer levels may serve as a useful adjunct for assessment of infectivity.
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spelling pubmed-80080962021-03-30 Viral Infectivity in Patients Undergoing Tracheotomy With COVID-19: A Preliminary Study George, Manish M. McIntyre, Charlotte J. Zhou, Jie Kugathasan, Ruthiran Amos, Dora C. Dillon, Ivan J. Barclay, Wendy S. Tolley, Neil S. Otolaryngol Head Neck Surg General Otolaryngology OBJECTIVE: To establish the presence of live virus and its association with polymerase chain reaction (PCR) positivity and antibody status in patients with COVID-19 undergoing tracheotomy. STUDY DESIGN: Prospective observational study. SETTING: Single institution across 3 hospital sites during the first wave of the COVID-19 pandemic. METHODS: Patients who were intubated for respiratory wean tracheotomy underwent SARS-CoV-2 PCR nasal, throat, and endotracheal tube swabs at the time of the procedure. These were assessed via quantitative real-time reverse transcription PCR. The tracheal tissue excised during the tracheotomy was cultured for SARS-CoV-2 with Vero E6 and Caco2 cells. Serum was assessed for antibody titers against SARS-CoV-2 via neutralization assays. RESULTS: Thirty-seven patients were included in this study. The mean number of days intubated prior to undergoing surgical tracheotomy was 27.8. At the time of the surgical tracheotomy, PCR swab testing yielded 8 positive results, but none of the 35 individuals who underwent tissue culture were positive for SARS-CoV-2. All 18 patients who had serum sampling demonstrated neutralization antibodies, with a minimum titer of 1:80. CONCLUSION: In our series, irrespective of positive PCR swab, the likelihood of infectivity during tracheotomy remains low given negative tracheal tissue cultures. While our results do not undermine national and international guidance on tracheotomy after day 10 of intubation, given the length of time to procedure in our data, infectivity at 10 days cannot be excluded. We do however suggest that a preoperative negative PCR swab not be a prerequisite and that antibody titer levels may serve as a useful adjunct for assessment of infectivity. SAGE Publications 2021-03-23 2021-12 /pmc/articles/PMC8008096/ /pubmed/33752547 http://dx.doi.org/10.1177/01945998211004255 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle General Otolaryngology
George, Manish M.
McIntyre, Charlotte J.
Zhou, Jie
Kugathasan, Ruthiran
Amos, Dora C.
Dillon, Ivan J.
Barclay, Wendy S.
Tolley, Neil S.
Viral Infectivity in Patients Undergoing Tracheotomy With COVID-19: A Preliminary Study
title Viral Infectivity in Patients Undergoing Tracheotomy With COVID-19: A Preliminary Study
title_full Viral Infectivity in Patients Undergoing Tracheotomy With COVID-19: A Preliminary Study
title_fullStr Viral Infectivity in Patients Undergoing Tracheotomy With COVID-19: A Preliminary Study
title_full_unstemmed Viral Infectivity in Patients Undergoing Tracheotomy With COVID-19: A Preliminary Study
title_short Viral Infectivity in Patients Undergoing Tracheotomy With COVID-19: A Preliminary Study
title_sort viral infectivity in patients undergoing tracheotomy with covid-19: a preliminary study
topic General Otolaryngology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8008096/
https://www.ncbi.nlm.nih.gov/pubmed/33752547
http://dx.doi.org/10.1177/01945998211004255
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