Percutaneous Tracheostomy With Apnea During Coronavirus Disease 2019 Era: A Protocol and Brief Report of Cases.

• Type of Material: Article
• Authors: Abesh Niroula, Emory University; Keriann Van Nostrand, Emory University; Onkar Khullar, Emory University; Seth Force, Emory University; Wissam Jaber, Emory University; Alejandro Sardi-Freitez, Emory University; David Berkowitz, Emory University
• Language: English
• Date: 2020-05
• Publisher: Society of Critical Care Medicine
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/CCE.0000000000000134
• Title of Journal or Parent Work: Critical Care Explorations
• Volume: 2
• Issue: 5
• Start Page: e0134
• End Page: e0134
• Grant/Funding Information: None declared
• Keywords: bedside; coronavirus disease 2019; percutaneous; tracheostomy; apnea
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Pathology; Health Sciences, Medicine and Surgery; Health Sciences, Immunology

Abstract

Objective: To assess feasibility of modified protocol during percutaneous tracheostomy in coronavirus disease 2019 pandemic era. Design: A retrospective review of cohort who underwent percutaneous tracheostomy with modified protocol. Settings: Medical, surgical, and neurologic ICUs. Subjects: Patients admitted in medical, surgical, and neurologic units with prolonged need of mechanical ventilation or inability to liberate from the ventilator. Interventions: A detailed protocol was written. Steps were defined to be performed before apnea and during apnea. A feasibility study of 28 patients was conducted. The key aerosol-generating portions of the procedure were performed with the ventilator switched to standby mode with the patient apneic. Measurements and Main Results: Data including patient demographics, primary diagnosis, age, body mass index, and duration of apnea time during the tracheostomy were collected. Average ventilator standby time (apnea) during the procedure was 238 seconds (3.96 min) with range 149 seconds (2.48 min) to 340 seconds (5.66 min). Single-use (disposable) bronchoscopes (Ambu A/S [Ballerup, Denmark] or Glidescope [Verathon, Inc., Bothell, WA]) were used during all procedures except in nine. No desaturation events occurred during any procedure. Conclusions: Percutaneous tracheostomy performed with apnea protocol may help minimize aerosolization, reducing risk of exposure of coronavirus disease 2019 to staff. It can be safely performed with portable bronchoscopes to limit staff and minimize the surfaces requiring disinfection post procedure.