Per-cutaneous dilatation tracheostomy (PCTD) in COVID-19 patients and peri-tracheostomy care: A case series and guidelines

COVID 19 patients with severe respiratory failure may require prolonged mechanical ventilation. Placement of a tracheostomy tube often becomes necessary for such patients. The steps of tracheostomy procedure and post tracheostomy care of these patients can be classified as aerosol generating. We wis...

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Bibliographic Details
Published in:Pakistan journal of medical sciences 2020-12, Vol.36 (7), p.1714-1718
Main Authors: Khan, Ehtesham, Lal, Shankar, Hashmi, Junaid, Thomas, Jubil, Malik, Muhammad Anwar
Format: Article
Language:English
Subjects:
Aerosols
Anesthesia
Bronchoscopy
Clinical Case Series
Coronaviruses
COVID-19
Disease transmission
Health aspects
Infections
Intensive care
Intubation
Ostomy
Patients
Personal protective equipment
Respiratory failure
Severe acute respiratory syndrome coronavirus 2
Tracheostomy
Tracheotomy
Ventilators
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Summary:COVID 19 patients with severe respiratory failure may require prolonged mechanical ventilation. Placement of a tracheostomy tube often becomes necessary for such patients. The steps of tracheostomy procedure and post tracheostomy care of these patients can be classified as aerosol generating. We wish to highlight our modified technique to address these issues. We performed percutaneous dilation tracheostomy in three clinically challenging COVID-19 patients in our ICU and developed guidelines aiming to minimise aerosolisation during and after the tracheostomy procedure to safeguard healthcare workers. Percutaneous tracheostomy was performed by a team of three experienced anaesthetists and an ICU nurse. The decision of surgical or percutaneous tracheostomy should be dependent on the experience of the tracheostomy performer, health-care worker safety, resource availability, and patient-centred care. We believe our modified strategic approach of brief bronchoscopy, minimum PEEP and gas flows and step-wise planned approach for PCDT offers an extra level of safety to healthcare workers.
ISSN:1682-024X
1681-715X
DOI:10.12669/pjms.36.7.3518