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Percutaneous tracheostomy in COVID-19 patients: a new apneic approach

BACKGROUND: Percutaneous dilation tracheostomy is an aerosol-generating procedure carrying a documented infectious risk during respiratory virus pandemics. For this reason, during the COVID-19 outbreak, surgical tracheostomy was preferred to the percutaneous one, despite the technique related compli...

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Autores principales: Moizo, Elena, Zangrillo, Alberto, Colombo, Sergio, Leggieri, Carlo, Mucci, Milena, Beccaria, Paolo, Pasculli, Nicola, Borghi, Giovanni, Plumari, Valentina Paola, La Bruna, Alessia, Dossi, Roberto, Baiardo Redaelli, Martina, Tornaghi, Anna, Lombardi, Gaetano, Landoni, Giovanni, Dell’Acqua, Antonio, Guzzo, Francesca, Monti, Giacomo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313898/
https://www.ncbi.nlm.nih.gov/pubmed/34329661
http://dx.doi.org/10.1016/j.bjane.2021.07.013
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author Moizo, Elena
Zangrillo, Alberto
Colombo, Sergio
Leggieri, Carlo
Mucci, Milena
Beccaria, Paolo
Pasculli, Nicola
Borghi, Giovanni
Plumari, Valentina Paola
La Bruna, Alessia
Dossi, Roberto
Baiardo Redaelli, Martina
Tornaghi, Anna
Lombardi, Gaetano
Landoni, Giovanni
Dell’Acqua, Antonio
Guzzo, Francesca
Monti, Giacomo
author_facet Moizo, Elena
Zangrillo, Alberto
Colombo, Sergio
Leggieri, Carlo
Mucci, Milena
Beccaria, Paolo
Pasculli, Nicola
Borghi, Giovanni
Plumari, Valentina Paola
La Bruna, Alessia
Dossi, Roberto
Baiardo Redaelli, Martina
Tornaghi, Anna
Lombardi, Gaetano
Landoni, Giovanni
Dell’Acqua, Antonio
Guzzo, Francesca
Monti, Giacomo
author_sort Moizo, Elena
collection PubMed
description BACKGROUND: Percutaneous dilation tracheostomy is an aerosol-generating procedure carrying a documented infectious risk during respiratory virus pandemics. For this reason, during the COVID-19 outbreak, surgical tracheostomy was preferred to the percutaneous one, despite the technique related complications increased risk. METHODS: We describe a new sequence for percutaneous dilation tracheostomy procedure that could be considered safe both for patients and healthcare personnel. A fiberscope was connected to a video unit to allow bronchoscopy. Guidewire positioning was performed as usual. While the established standard procedure continues with the creation of the stoma without any change in mechanical ventilation, we retracted the bronchoscope until immediately after the access valve in the mount tube, allowing normal ventilation. After 3 minutes of ventilation with 100% oxygen, mechanical ventilation was stopped without disconnecting the circuit. During apnea, the stoma was created by dilating the trachea and the tracheostomy cannula was inserted. Ventilation was then resumed. We evaluated the safeness of the procedure by recording any severe desaturation and by performing serological tests to all personnel. RESULTS: Thirty-six patients (38%) of 96 underwent tracheostomy; 22 (23%) percutaneous dilation tracheostomies with the new approach were performed without any desaturation. All personnel (150 operators) were evaluated for serological testing: 9 (6%) had positive serology but none of them had participated in tracheostomy procedures. CONCLUSION: This newly described percutaneous dilation tracheostomy technique was not related to severe desaturation events and we did not observe any positive serological test in health workers who performed the tracheostomies.
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spelling pubmed-83138982021-07-27 Percutaneous tracheostomy in COVID-19 patients: a new apneic approach Moizo, Elena Zangrillo, Alberto Colombo, Sergio Leggieri, Carlo Mucci, Milena Beccaria, Paolo Pasculli, Nicola Borghi, Giovanni Plumari, Valentina Paola La Bruna, Alessia Dossi, Roberto Baiardo Redaelli, Martina Tornaghi, Anna Lombardi, Gaetano Landoni, Giovanni Dell’Acqua, Antonio Guzzo, Francesca Monti, Giacomo Braz J Anesthesiol Original Investigation BACKGROUND: Percutaneous dilation tracheostomy is an aerosol-generating procedure carrying a documented infectious risk during respiratory virus pandemics. For this reason, during the COVID-19 outbreak, surgical tracheostomy was preferred to the percutaneous one, despite the technique related complications increased risk. METHODS: We describe a new sequence for percutaneous dilation tracheostomy procedure that could be considered safe both for patients and healthcare personnel. A fiberscope was connected to a video unit to allow bronchoscopy. Guidewire positioning was performed as usual. While the established standard procedure continues with the creation of the stoma without any change in mechanical ventilation, we retracted the bronchoscope until immediately after the access valve in the mount tube, allowing normal ventilation. After 3 minutes of ventilation with 100% oxygen, mechanical ventilation was stopped without disconnecting the circuit. During apnea, the stoma was created by dilating the trachea and the tracheostomy cannula was inserted. Ventilation was then resumed. We evaluated the safeness of the procedure by recording any severe desaturation and by performing serological tests to all personnel. RESULTS: Thirty-six patients (38%) of 96 underwent tracheostomy; 22 (23%) percutaneous dilation tracheostomies with the new approach were performed without any desaturation. All personnel (150 operators) were evaluated for serological testing: 9 (6%) had positive serology but none of them had participated in tracheostomy procedures. CONCLUSION: This newly described percutaneous dilation tracheostomy technique was not related to severe desaturation events and we did not observe any positive serological test in health workers who performed the tracheostomies. Elsevier 2021-07-27 /pmc/articles/PMC8313898/ /pubmed/34329661 http://dx.doi.org/10.1016/j.bjane.2021.07.013 Text en © 2021 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Investigation
Moizo, Elena
Zangrillo, Alberto
Colombo, Sergio
Leggieri, Carlo
Mucci, Milena
Beccaria, Paolo
Pasculli, Nicola
Borghi, Giovanni
Plumari, Valentina Paola
La Bruna, Alessia
Dossi, Roberto
Baiardo Redaelli, Martina
Tornaghi, Anna
Lombardi, Gaetano
Landoni, Giovanni
Dell’Acqua, Antonio
Guzzo, Francesca
Monti, Giacomo
Percutaneous tracheostomy in COVID-19 patients: a new apneic approach
title Percutaneous tracheostomy in COVID-19 patients: a new apneic approach
title_full Percutaneous tracheostomy in COVID-19 patients: a new apneic approach
title_fullStr Percutaneous tracheostomy in COVID-19 patients: a new apneic approach
title_full_unstemmed Percutaneous tracheostomy in COVID-19 patients: a new apneic approach
title_short Percutaneous tracheostomy in COVID-19 patients: a new apneic approach
title_sort percutaneous tracheostomy in covid-19 patients: a new apneic approach
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313898/
https://www.ncbi.nlm.nih.gov/pubmed/34329661
http://dx.doi.org/10.1016/j.bjane.2021.07.013
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