Ultrasound-Guided Percutaneous Dilatational Tracheostomy for Critically Ill Patients With COVID-19

Background and Objectives The global coronavirus disease 2019 (COVID-19) pandemic has had a major impact on healthcare, especially in the area of critical care due to the longer period of mechanical ventilation. Ultrasound-guided percutaneous tracheostomy (US-PDT) is considered a safe alternative method.Materials and Method Patients with severe COVID-19 hospitalized in the intensive care unit (ICU) who were on mechanical ventilation for 5 days or longer were evaluated for percutaneous dilational tracheostomy. The procedure was performed with personal protective equipment with powered air purifying respirator (PAPR) in the ICU isolated by negative pressure. Parameters such as mortality, incidence of infection to medical staff, major and minor complications were observed.Results The average time taken for US-PDT was 6.4 minutes. Five patients (27.8%) showed oxygen saturation of less than 90% due to apnea during tracheotomy, but there was no case of severe hypoxemia that required discontinuation or re-intubation. There was no COVID-19 infection of medical staff related to the procedure. A total of 9 patients (50%) died from COVID-19 pneumonia, and 1 patient (5.6%) was decannulated. There was no death due to US-PDT and no serious complications such as pneumothorax or accidental decannulation were observed.Conclusion As patients eligible for tracheostomy increased significantly due to the COVID-19 epidemic, US-PDT can be considered to be a useful technique for COVID-19 patients who require long-term mechanical ventilation. This technique can lower the risk of transmission to medical staffs who are at the forefront of being exposed to the risk of infection when an epidemic breaks out.