Abstract
Background:
A significant number of patients with severe respiratory
failure related to COVID-19 require prolonged mechanical ventilation. Minimal
data exists regarding the timing, safety, and efficacy of combined bedside
percutaneous tracheostomy and endoscopy gastrostomy tube placement in these
patients. The safety for healthcare providers is also in question. This study's
objective was to evaluate the effectiveness and safety of combined bedside
tracheostomy and gastrostomy tube placement in COVID-19 patients.
Design
and Methods:
This is a single arm, prospective cohort study in
patients with COVID-19 and acute respiratory failure requiring prolonged
mechanical ventilation who underwent bedside tracheostomy and percutaneous
endoscopic gastrostomy placement. Detailed clinical and procedural data were
collected. Descriptive statistics were employed and time to event curves were
estimated and plotted using the Kaplan Meier method for clinically relevant
prespecified endpoints.
Results:
Among 58 patients, the median
total intensive care unit (ICU) length of stay was 29 days (24.7-33.3) with a
median of 10 days (6.3-13.7) postprocedure. Nearly 88% of patients were weaned
from mechanical ventilation postprocedure at a median of 9 days (6-12); 94% of
these were decannulated. Sixty-day mortality was 10.3%. Almost 90% of patients
were discharged alive from the hospital. All procedures were done at bedside
with no patient transfer required out of the ICU. A median of 3.0 healthcare
personnel total were present in the room per procedure.
Conclusion:
This study shows that survival of critically ill COVID-19 patients after
tracheostomy and gastrostomy was nearly 90%. The time-to-event curves are
encouraging regarding time to weaning, downsizing, decannulation, and discharge.
A combined procedure minimizes the risk of virus transmission to healthcare
providers in addition to decreasing the number of anesthetic episodes,
transfusions, and transfers patients must undergo. This approach should be
considered in critically ill COVID-19 patients requiring prolonged mechanical
ventilation.