key: cord-0726298-scyacow0
authors: Canan, G.Ü.R.S.O.Y.; Turkey, Muğla
title: Pause Ventilation Tracheostomy
date: 2020-06-12
journal: Ann Thorac Surg
DOI: 10.1016/j.athoracsur.2020.05.021
sha: 96209098bea92cfd828f39b33896c0eede8c862b
doc_id: 726298
cord_uid: scyacow0

nan

To the Editor:

We excitedly read the article about the Novel Percutaneous Dilatational Tracheostomy (PDT) technique developed by Angel et al. In the COVID-19 pandemic, where the discussions of timing and technique (surgery or percutaneous) for tracheostomy continue, this novel technique has guided us all. However the fact that bronchoscopy is a procedure that requires experience and equipment may be considered as the limitation of this technique. In our country, there is no bronchoscopy of every intensive care unit. Therefore, alternative methods are needed for PDT in the COVID-19 pandemic.

For the PDT procedure without bronchoscopy, we used the method we defined as "pause ventilation tracheostomy". First of all, the operations to be performed during PDT were planned, the task of the personnel was defined and the necessary materials were prepared. In the intensive care unit, there were only 3 people in the patient room: 2 experienced people to perform the procedure and 1 person to manage the airway. A team outside the room was present throughout the procedure to assist in possible complication management and supply materials and medicines. They all had personal full personal protective equipment. Starting 5 minutes before the procedure, preoxygenation of the patient was achieved with 100% FIO2. Standard preparations for the PDT (shoulder roll placement, sedation, paralytics .. etc) after an anterior neck ultrasound was performed to identify site of insertion between the first and second tracheal rings. Endotracheal tube was placed below the vocal cords. The ETT cuff was checked to ensure no leak throughout the procedure. Lidocaine with epinephrine was used as local anesthetic prior to beginning any kind of instrumentation. Then we performed the PDT. Firstly, a superficial small skin incision was made and the pretracheal tissue was cleared with blunt dissection. Following entering the trachea with the needle, mechanical ventilation was stopped after an exhalation. Exhalation side with HEPA filter of breathing set was separated from the mechanical ventilator machine so that it was less than half of the expiratory time and ETT was clamped. Guidewire was placed and tracheal dilation was performed. Tracheostomy tube (TT) was placed. After filling of the TT cuff, mechanical ventilation was initiated. Paused ventilation lasted for about 41 seconds and the patient did not develop hypoxemia. After the procedure, PaO2 was evaluated as 168 mmHg and PaCO2 was 41 mmHg in arterial blood gasses. After the procedure, it was confirmed with USG that athelactasis did not develop. No symptoms related to SARS-CoV-2

Novel Percutaneous Tracheostomy for Critically Ill Patients with COVID-19

were observed in any healthcare providers after the procedure.