The benefits of percutaneous dilational tracheostomy (PDT) placement have been well documented in patients requiring prolonged mechanical ventilation. However, the data regarding the benefit of PDT in coronavirus-2019 (COVID-19) patients are scarce. The objective of this study is to evaluate the outcomes of a cohort of 37 patients who underwent tracheostomy as part of their COVID-19 care. Retrospective data from a series for 37 patients undergoing tracheostomy was collected using chart review. Primary outcomes included 30 and 60 day mortality, weaning rate, and decannulation rate. Secondary outcomes collected included admission demographics, comorbidities, and procedural information. Thirty-seven (37) patients requiring prolonged mechanical ventilation due to COVID-19. Of these 37 patients, 35 were alive 60 days post-PDT placement, 33 have been weaned from mechanical ventilation and 18 have been decannulated. The low mortality and high decannulation rates in this cohort in is a promising development in the care of critically ill COVID-19 patients. Of note, all participating physicians underwent routine polymerase chain reaction (PCR) testing for infection with the severe acute respiratory syndrome coronavirus-2 virus and no physician contracted COVID-19 as a result of their involvement. Overall, this case series describes the modified PDT technique used by our team and discusses the feasibility and potential benefit to PDT placement in COVID-19 patients requiring long-term mechanical ventilation.

BACKGROUND: Covid-19 pandemic has resulted in the development of severe and persistent respiratory failure requiring long term ventilatory support. This necessitates the need for a reliable and easy to implement tracheostomy protocol given the concern for viral transmission risk to the involved healthcare personnel due to the aerosol generating nature of the procedure. We describe a protocol with unique and novel modifications to the Ciaglia dilatational percutaneous tracheostomy, effectively implemented during the Covid-19 pandemic at our institution. METHODS: We describe the baseline characteristics of our initial 11 patients who underwent the procedure. Outlined are the healthcare personnel involved and the steps which are organized into 4 phases: planning, pre-procedure, intra-procedure and post-procedure. We have tracked procedural duration, provider safety as well as the development of new complications. RESULTS: We describe use of this protocol for 11 bedside percutaneous tracheostomies performed on patients with COVID-19. The average total procedural duration as well as incision to tracheostomy tube placement times was 32.6 minutes and 5.8 minutes respectively. All 3 providers performing the tracheostomies remained asymptomatic with negative COVID-19 RT-PCR testing at 3 weeks. CONCLUSIONS: We report an efficacious and adaptable protocol for elective bedside percutaneous tracheostomies for patients with persistent ventilatory requirements due to COVID-19 with an intent to provide standardized and safe care for the patient and the involved healthcare personnel.