Outcomes of Combined Percutaneous Tracheostomy and Endoscopic Gastrostomy Tube Placement in COVID-19 Patients

Abstract Background:A significant number of patients with severe respiratory failure related to COVID-19 require prolonged mechanical ventilation. Minimal data exists regarding the timing, safety, and efficacy of combined bedside percutaneous tracheostomy and endoscopy gastrostomy tube placement in these patients. The safety for healthcare providers is also in question. This study’s objective was to evaluate the effectiveness and safety of combined bedside tracheostomy and gastrostomy tube placement in COVID-19 patients.Methods:This is a single arm, prospective cohort study in patients with COVID-19 and acute respiratory failure requiring prolonged mechanical ventilation who underwent bedside tracheostomy and percutaneous endoscopic gastrostomy tube placement. Detailed clinical and procedural data were collected. Descriptive statistics were employed and time to event curves were estimated and plotted using the Kaplan Meier method for clinically relevant pre-specified endpoints.Results:Fifty-eight patients were included. Nearly 90% of the patients received pronation therapy and 52% of patients underwent extracorporeal membrane oxygenation evaluation. The median total intensive care unit length of stay was 29 days (24.7-33.3) with a median of 10 days (6.3-13.7) post-procedure. Nearly 88% of patients were weaned from mechanical ventilation post-procedure at a median of 9 days (6-12); 94% of these were decannulated. Sixty-day mortality was 10.3%. Almost 90% of patients were discharged alive from the hospital. No transfer out of the intensive care unit was required and a median of 3 healthcare personnel per procedure were present.Conclusions:This study shows that survival of critically ill COVID-19 patients after tracheostomy and gastrostomy was nearly 90%. The time-to-event curves are encouraging regarding time to weaning, downsizing, decannulation and discharge. A combined procedure minimizes the risk of virus transmission to healthcare providers in addition to decreasing the number of anesthetic episodes, transfusions, and transfers patients must undergo.