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Comparison of percutaneous dilatational tracheotomy versus open surgical technique in severe COVID-19: Complication rates, relative risks and benefits.

Authors
  • Botti, Cecilia1
  • Lusetti, Francesca2
  • Neri, Tommaso3
  • Peroni, Stefano3
  • Castellucci, Andrea2
  • Salsi, Pierpaolo3
  • Ghidini, Angelo2
  • 1 PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Reggio Emilia, Italy; Department of Surgery, Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123 Reggio Emilia, Italy. Electronic address: [email protected] , (Italy)
  • 2 Department of Surgery, Otolaryngology Unit, Azienda USL-IRCCS di Reggio Emilia, viale Risorgimento 80, 42123 Reggio Emilia, Italy. , (Italy)
  • 3 Intensive Care Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy. , (Italy)
Type
Published Article
Journal
Auris, nasus, larynx
Publication Date
Jun 01, 2021
Volume
48
Issue
3
Pages
511–517
Identifiers
DOI: 10.1016/j.anl.2020.10.014
PMID: 33143935
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Patients with acute respiratory failure due to COVID-19 have a high likelihood of needing prolonged intubation and may subsequently require tracheotomy. Usually, the choice of technique (percutaneous dilatational tracheotomy [PDT] versus open surgical tracheotomy [OST]) depends on the preference of surgeons and patient-related factors. In case of COVID-19, airborne spread of viral particles and limited time of apnea must be considered in the choice of the safest technique. The aim of this study is to compare the complication rates and offer an assessment of relative risks and benefits of PDT versus OST in patients with severe COVID-19. We performed a retrospective study considering 47 consecutive patients affected by severe acute respiratory distress syndrome due to SARS-CoV-2 infection, needing invasive mechanical ventilation and subsequent tracheostomy. This study was performed at the Intensive Care Unit of our tertiary referral center. Complication rates were analyzed. Seventeen patients underwent PDT and 30 patients were submitted to OST. Twenty-six patients (55.3%) had post-operative complications (local infection, hemorrhage, subcutaneous emphysema) with no significant difference between PDT and OST. PDT and OST are characterized by similar postoperative complication rates in severe COVID-19 patients. These findings suggest that OST might be preferred if expert ENT surgeons are available, as PDT could result in longer apnea and exposure to generated aerosol. However, authors recommend considering either OST or PDT at the discretion of the medical staff involved, according to the personal experience of the operators performing the procedure. Copyright © 2020. Published by Elsevier B.V.

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