• Kartik Prabhakaran, Ryan Malcom, James Choi, Alexandra Chudner, Augustine Moscatello, Peter Panzica, Rifat Latifi, and Peter Rhee.
• From the Department of Surgery (P.K., M.R., C.J., C.A., R.P.), Department of Otolaryngology (M.A.), and Department of Anesthesiology (P.P.), Westchester Medical Center New York Medical College, Valhalla, New York.
• J Trauma Acute Care Surg. 2020 Aug 1; 89 (2): 265-271.

BackgroundThe 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.MethodsThis 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.ResultsThere 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.ConclusionThis report describes a method of performing open tracheostomy with minimal aerosolization using readily available equipment and supplies in most hospitals.Level Of EvidenceTherapeutic/care management, Level V.

42 keywords...

hide…