• Elena Moizo, Alberto Zangrillo, Sergio Colombo, Carlo Leggieri, Milena Mucci, Paolo Beccaria, Nicola Pasculli, Giovanni Borghi, Valentina Paola Plumari, Alessia La Bruna, Roberto Dossi, Martina Baiardo Redaelli, Anna Tornaghi, Gaetano Lombardi, Giovanni Landoni, Antonio Dell'Acqua, Francesca Guzzo, and Giacomo Monti.
• IRCCS San Raffaele Scientific Institute, Department of Anesthesia and Intensive Care, Milan, Italy. Electronic address: moizo.elena@hsr.it.
• Braz J Anesthesiol. 2021 Jul 27.

BackgroundPercutaneous dilation tracheostomy is an aerosol-generating procedure carrying a documented infectious risk during respiratory virus pandemics. For this reason, during the COVID-19 outbreak, surgical tracheostomy was preferred to the percutaneous one, despite the technique related complications increased risk.MethodsWe describe a new sequence for percutaneous dilation tracheostomy procedure that could be considered safe both for patients and healthcare personnel. A fiberscope was connected to a video unit to allow bronchoscopy. Guidewire positioning was performed as usual. While the established standard procedure continues with the creation of the stoma without any change in mechanical ventilation, we retracted the bronchoscope until immediately after the access valve in the mount tube, allowing normal ventilation. After 3 minutes of ventilation with 100% oxygen, mechanical ventilation was stopped without disconnecting the circuit. During apnea, the stoma was created by dilating the trachea and the tracheostomy cannula was inserted. Ventilation was then resumed. We evaluated the safeness of the procedure by recording any severe desaturation and by performing serological tests to all personnel.ResultsThirty-six patients (38%) of 96 underwent tracheostomy; 22 (23%) percutaneous dilation tracheostomies with the new approach were performed without any desaturation. All personnel (150 operators) were evaluated for serological testing: 9 (6%) had positive serology but none of them had participated in tracheostomy procedures.ConclusionThis newly described percutaneous dilation tracheostomy technique was not related to severe desaturation events and we did not observe any positive serological test in health workers who performed the tracheostomies.Copyright © 2021 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

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