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Experience of percutaneous tracheostomy in critically ill COVID-19 patients

Acute and Critical Care 2020년 35권 4호 p.263 ~ 270
김은진, 유은형, 정치영, 김경찬,
소속 상세정보
김은진 ( Kim Eun-Jin ) - Daegu Catholic University School of Medicine Daegu Catholic University Medical Center Department of Internal Medicine
유은형 ( Yoo Eun-Hyung ) - Daegu Catholic University School of Medicine Daegu Catholic University Medical Center Department of Laboratory Medicine
정치영 ( Jung Chi-Young ) - Daegu Catholic University School of Medicine Daegu Catholic University Medical Center Department of Internal Medicine
김경찬 ( Kim Kyung-Chan ) - Daegu Catholic University School of Medicine Daegu Catholic University Medical Center Department of Internal Medicine

Abstract


Background: Coronavirus disease 2019 (COVID-19) is a highly contagious disease that causes respiratory failure. Tracheostomy is an essential procedure in critically ill COVID-19 patients; however, it is an aerosol-generating technique and thus carries the risk of infection transmission. We report our experience with percutaneous tracheostomy and its safety in a real medical setting.

Methods: During the COVID-19 outbreak, 13 critically ill patients were admitted to the intensive care unit (ICU) at Daegu Catholic University Medical Center between February 24 and April 30, 2020. Seven of these patients underwent percutaneous tracheostomy using Ciaglia Blue Rhino. The medical environment, percutaneous tracheostomy method, and COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR) results were retrospectively reviewed. After treatment, the COVID-19 infection status of healthcare personnel was investigated by RT-PCR.

Results: The ICU contained negative pressure cohort areas and isolation rooms, and healthcare personnel wore a powered air-purifying respirator system. We performed seven cases of percutaneous tracheostomy in the same way as in patients without COVID-19. Five patients (71.4%) tested positive for COVID-19 by RT-PCR at the time of tracheostomy. The median cycle threshold value for the RNA-dependent RNA polymerase was 30.60 (interquartile range [IQR], 25.50?36.56) in the upper respiratory tract and 35.04 (IQR, 28.40?36.74) in the lower respiratory tract. All healthcare personnel tested negative for COVID-19 by RT-PCR.

Conclusions: Percutaneous tracheostomy was performed with conventional methods in the negative pressure cohort area. It was safe to perform percutaneous tracheostomy in an environment of COVID-19 infection.

키워드

COVID-19; reverse transcriptase polymerase chain reaction; SARS-CoV-2; tracheostomy

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