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

Critical Care Explorations
Abesh NiroulaDavid M Berkowitz

Abstract

To assess feasibility of modified protocol during percutaneous tracheostomy in coronavirus disease 2019 pandemic era. A retrospective review of cohort who underwent percutaneous tracheostomy with modified protocol. Medical, surgical, and neurologic ICUs. Patients admitted in medical, surgical, and neurologic units with prolonged need of mechanical ventilation or inability to liberate from the ventilator. 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. 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. Percutaneous tracheostomy performed with ap...Continue Reading

References

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Apr 23, 2020·JAMA : the Journal of the American Medical Association·Safiya RichardsonTheodoros P Zanos

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Citations

Feb 4, 2021·The New England Journal of Medicine·Brendan A McGrathMichael J Brenner
Feb 4, 2021·The New England Journal of Medicine·Pablo Álvarez-MaldonadoJosé L Sanjurjo-Martínez
Dec 15, 2020·The Journal of Surgical Research·Patrick MurphyDamaris Ortiz
Feb 4, 2021·The New England Journal of Medicine·Daniel A HashimotoHugh G Auchincloss
Jul 29, 2021·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Gunchan PaulM Ravi Krishna

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Methods Mentioned

BETA
sedation

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