Dovydas Melamed1, Edvardas Jukna2
1Vilnius City Clinical Hospital
Introduction. Usually, cases of acute respiratory failure due to COVID-19 require prolonged ventilation, an increase of reintubation cases, physicians often choose to use a tracheostomy for prolonged mechanical ventilation of a severely ill patients. This method reduces airway resistance and also improves control of airway secretion. Percutaneous and surgical tracheostomies can reduce complications that occur with a long duration of endotracheal intubation, causing laryngeal paralysis, stenosis, infections.
Aim. The aim of this article is to review the role of tracheostomy in a COVID-19 pandemic and to compare the advantages and disadvantages of percutaneous and surgical tracheostomies.
Method. This article examines 30 sources compiled from the PubMed database.
Overview. The most common reason to use a tracheostomy is prolonged mechanical ventilation of the patient. 14 to 21 days after intubation is the most commonly considered period for performing a tracheostomy. There are currently no general guidelines when it is appropriate to perform a tracheostomy, and most European countries follow the 14-day rule. The University of Pennsylvania conducted a study in several hospitals involving 53 patients with COVID-19. Intubation of the deceased before tracheostomy lasted an average of 22.7 days, and the median time from tracheostomy and death was 15.7 days. This study revealed the appropriateness of performing an early tracheostomy within a 21-day intubation period. Nowadays, percutaneous tracheostomy is the most commonly chosen procedure. However, certain patient-related factors such as goiter, obesity, subcutaneous emphysema, specific neck anatomy force doctors to choose surgical tracheostomy technique. Studies at the Tertiary Center in Reggio Emilia, Italy, and at the Adult Critical Care Network in South London have shown that there are no significant differences between percutaneous and surgical tracheostomy use.
Conclusions. Tracheostomy is often an unavoidable method to use in long-ventilated patients. Nowadays, percutaneous tracheostomy, as a newer and more advanced technique, is usually the method of first choice, but often the patient’s condition and anatomical features force the use of a more open, surgical tracheostomy. The results showed that the frequencies of the various complications were approximately the same, so there are no significant difference which method could be better to apply.
Keywords: tracheostomy, Covid-19, pandemic.