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Safety and Efficacy of a Novel Percutaneous Tracheostomy Protocol Adapted to Patients with COVID-19

Introduction and rationale: Many patients with COVID-19 admitted to the intensive care units require prolonged mechanical ventilation. Tracheostomy has been avoided due to increased risk of aerosolization especially during tracheal dilation resulting in increased risk for personnel infection. We describe our novel protocol to prevent exposure during percutaneous tracheostomy.Methods: Patients with COVID-19, on mechanical ventilation requiring prolonged mechanical ventilation were evaluated for bed-side percutaneous tracheostomy. The procedure was performed under bronchoscopic guidance and using a disposable bronchoscope. The scope was secured in position 1 cm from the end of the endotracheal tube with tape at the insertion site to allow the bronchoscopist to withdraw the ETT/bronchoscope en-bloc to the appropriate location in the trachea for adequate visualization during the procedure. Once the puncture point was identified, an expiratory pause was performed during which the trachea was punctured, a guide wire was placed, the anterior wall was dilated, and a tracheostomy was advanced and placed in the trachea. The time of the expiratory pause, any desaturation, complication and personnel conversion were measured.Results: A total of 18 percutaneous tracheostomies were performed. The total time of the expiratory pause, tracheal puncture to tracheostomy placement was thirty seconds to sixty seconds. There was no evidence of desaturation during the procedure, and there were no cases of staff conversion to positive COVID-19 status up to 14 days post procedure.Conclusions: we conclude that expiratory pause during percutaneous tracheostomy is safe, and importantly, may play significant role in decreasing aerosolization and staff exposure in patients with COVID-19 respiratory failure.