Safely performing percutaneous dilatational tracheostomies on COVID‐19 patients in the intensive care unit: A standardized approach

Tenório, Lucas Ribeiro; Nakai, Marianne Yumi; Artese Araújo, Giancarlo; Menezes, Marcelo Benedito; Bertelli, Antônio Augusto Tupinambá; Romeo, Dominic; Rajasekaran, Karthik; Gonçalves, Antonio José

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and the resulting coronavirus disease 2019 (COVID‐19) have afflicted hundreds of millions of people in a worldwide pandemic. During this pandemic, otolaryngologists have sought to better understand risk factors associated with COVID‐19 contamination during surgical procedures involving the airways such as tracheostomies. OBJECTIVE: This study provides a standardized technique of performing an ultrasound (US)‐guided percutaneous dilatational tracheostomy (PDT) on COVID‐19 patients in the intensive care unit (ICU). It also outlines safety strategies for health care providers that includes proper use of personal protective equipment (PPE) and regular testing of otolaryngologists for COVID‐19 contamination. METHODS: This study analyzed data from 44 PDT procedures performed on COVID‐19 patients in the ICU of hospitals in Sao Paulo and Santos, Brazil. The PDT procedures were conducted between April 2020 and August 2020, which coincided with a peak of the COVID‐19 pandemic in São Paulo, Brazil. Surgeons were tested for COVID‐19 using a two‐stage serological enzyme‐linked immunosorbent assay specific for SARS‐CoV‐2 antigens. CONCLUSION: This study describes a safe standardized technique of US‐guided PDT for COVID‐19 patients in the ICU using a method that also decreases the risk of surgeon contamination.