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

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

doi:10.3390/jcm10153335

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

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

Authors

Nardi Tetaj¹, Micaela Maritti¹, Giulia Stazi¹, Maria Cristina Marini¹, Daniele Centanni², Gabriele Garotto¹, Ilaria Caravella¹, Cristina Dantimi¹, Matteo Fusetti¹, Carmen Santagata¹, Manuela Macchione¹, Giada De Angelis¹, Filippo Giansante¹, Donatella Busso¹, Rachele Di Lorenzo¹, Silvana Scarcia¹, Alessandro Carucci¹, Ricardo Cabas¹, Ilaria Gaviano¹, Nicola Petrosillo², Andrea Antinori², Fabrizio Palmieri², Gianpiero D'Offizi², Stefania Ianniello³, Paolo Campioni³, Francesco Pugliese⁴, Francesco Vaia⁵, Emanuele Nicastri², Giuseppe Ippolito⁶, Luisa Marchioni¹, Icu Covid-Study Group

Affiliations

¹ UOC Resuscitation, Intensive and Sub-Intensive Care, National Institute for Infectious Diseases IRCCS, Lazzaro Spallanzani, 00149 Rome, Italy.
² Clinical and Research Department of Infectious Diseases, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy.
³ Department of Radiology and Diagnostic Imaging, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy.
⁴ Department of Anesthesia and Critical Care Medicine, Sapienza University of Rome, 00161 Rome, Italy.
⁵ Health Direction, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy.
⁶ Scientific Direction, National Institute for Infectious Diseases IRCCS Lazzaro Spallanzani, 00149 Rome, Italy.

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.