Open Tracheostomy for COVID-19-Positive Patients: A Method to Minimize Aerosolization and Reduce Risk of Exposure

Authors

Kartik Prabhakaran, New York Medical CollegeFollow
Ryan Malcom
James ChoiFollow
Alexandra Chudner, New York Medical College
Augustine Moscatello, New York Medical CollegeFollow
Peter Panzica, New York Medical CollegeFollow
Rifat Latifi, New York Medical CollegeFollow
Peter Rhee

DOI

10.1097/TA.0000000000002780

Journal Title

Journal of Trauma and Acute Care Surgery

First Page

265

Last Page

271

Document Type

Article

Publication Date

8-1-2020

Department

Surgery

Second Department

Otolaryngology

Third Department

Anesthesiology

Abstract

BACKGROUND: The COVID-19 virus is highly contagious, and thus there is a potential of infecting operating staff when operating on these patients. This case series describes a method of performing open tracheostomy for COVID-19 patients while minimizing potential aerosolization of the virus using typically available equipment and supplies.

METHODS: This is a case series of 18 patients who were COVID-19-positive and underwent open tracheostomy in the operating room under a negative pressure plastic hood created using readily available equipment and supplies. Patients had to be intubated for at least 14 days, be convalescing from their cytokine storm, and deemed to survive for at least 14 more days. Other indications for tracheostomy were altered mental status, severe deconditioning, respiratory failure and failed extubation attempts.

RESULTS: There were 14 men and 4 women with severe SARS-CoV2 infection requiring long-term intubation since March 23 or later. The mean age was 61.7 years, body mass index was 32.6, and the pretracheostomy ventilator day was 20.4 days. The indications for tracheostomy were altered mental status, severe deconditioning and continued respiratory with hypoxia. Failed extubation attempt rate was 16.7% and hemodialysis rate was 38.9%. All patients were hemodynamically stable, without any evidence of accelerating cytokine storm. To date there was one minor bleeding due to postoperative therapeutic anticoagulation.

CONCLUSION: This report describes a method of performing open tracheostomy with minimal aerosolization using readily available equipment and supplies in most hospitals.

LEVEL OF EVIDENCE: Therapeutic/care management, Level V.

Recommended Citation

Prabhakaran, K., Malcom, R., Choi, J., Chudner, A., Moscatello, A., Panzica, P., Latifi, R., & Rhee, P. (2020). Open Tracheostomy for COVID-19-Positive Patients: A Method to Minimize Aerosolization and Reduce Risk of Exposure. Journal of Trauma and Acute Care Surgery, 89 (2), 265-271. https://doi.org/10.1097/TA.0000000000002780