Bedside Percutaneous Tracheostomy for Patients with COVID 19 with Endotracheal Obstruction

Abstract

Introduction-A significant number of intubated COVID-19 patients may develop worrisome hemorrhage related to trachea-bronchial mucosal and submucosal slough due to severe inflammation/necrosis related to COVID-19 pneumonia. The accumulation of debris in the endotracheal tube can progress to severe endotracheal tube obstruction ( ETO) necessitating high peak driving pressures with eventual loss of satisfactory ventilator volume delivery. Emergency endotracheal tube exchange under these circumstances can be an extremely high-risk undertaking both for the patient and caregivers. Method-Thirty mechanically ventilated COVID-19 patients deemed at high risk for ETO or who had already had a prior episodes of ETO were selected as candidates for bedside percutaneous tracheostomy. Those patients requiring high ventilator settings high ventilator ( i.e. FIO2 > 50 and PEEP more than 10 ) were also included in the study group. A disposable bronchoscope was utilized for direct visualization of appropriate tracheal puncture, guidewire passage, and final positioning of the tracheal tube. Results-All patients, including those individuals on high ventilator support attained the primary outcome of successful percutaneous tracheostomy without serous adverse events. Minor adverse events, such as brief periods of oxygen desaturation, were observed in 3 patients. Conclusion-Bedside percutaneous tracheostomy is a safe therapeutic option for patients with high risk for ETO due to trachea-bronchial mucosal and submucosal slough. Consideration for early, elective intervention may be justified due to high risks associated with urgent/emergency endotracheal tube exchange.