Isolated cases of tracheomalacia with cuff leaking were reported.Ĭomplication rate was low hemorrhage was the notable major adverse outcome in 49 patients (2.6%). Only cuffed non-fenestrated tubes were used in all COVID-19 patients. Most of the endotracheal tubes were found partially or subtotally blocked with sticky secretions. Surgeons shared some technical modifications, such as a sub-isthmus tracheotomy approach or the use of electrocautery and harmonic scalpel, both used exclusively before opening the trachea. While almost all tracheotomies were regular procedures, four (0.2%) were vital emergency tracheostomies. Most procedures were performed at bed-side in the ICU. The median timing of tracheostomy was 12 days after intubation (range 4–42 days). Only 4.6% of COVID-19 patients (88 of 1890 patients) underwent tracheostomy at a very early stage within 7 days of intubation. Indication and timing of elective tracheostomy were usually established based on patient respiratory status by the ICU staff. Most tracheostomies ( n = 1461 81.3%) were open and the rest percutaneous ( n = 429 22.7%). The critical focus of our case study is the unprecedented amount of tracheostomies in Spain that may serve as a lesson for this and potential future pandemics.ĭistribution of tracheostomies in COVID-19 patients per hospital The rationale was to achieve fast weaning to enable incoming patients to take advantage of the released mechanical ventilation equipment.
Spanish otolaryngologists began tracheostomies very early in the pandemic, on March 11, 2020. The questions of an optimal strategy and outcomes in COVID-19 tracheostomies have not been answered yet. However, all recommendations are neither based on the experiences of patients infected by the SARS-CoV-2 nor in a pandemic situation with overcrowded ICUs lacking proper equipment for mechanical ventilation. In this pandemic scenario, with limited ICUs resources, tracheostomy seems to help COVID-19 patients to get off the mechanical ventilation, reducing the respiratory effort in patients with limited pulmonary reserves, shortening the dead space and enabling the suctioning of accumulated mucous.Ĭurrent protocols have recommended to delay tracheostomy for at least 14 days or longer or advocated to wait until a negative PCR. In Italy, 58% of 1591 COVID-19 patients were still in ICU 5 weeks after admission and mortality rates have been over 50% in large case series. Poor outcomes in critical patients infected with SARS-CoV-2 admitted to ICUs have been reported.