Editor
Coronavirus disease 2019 (COVID-19) pandemic led to an unprecedented patient turnover and overuse of the limited resources1. This resulted in the re-definition of the method-of-choice in surgical procedures2.
Tracheostomy is commonly performed in patients requiring long-term mechanical ventilation. The percutaneous dilatational tracheostomy (PDT) is the technique of choice in the elective setting. The difficult identification of anatomical landmarks in patients with morbid obesity or those with a short, thick neck puts this population at increased risk of peri-procedural complications following PDT. Therefore, surgical tracheostomy (ST) is generally considered superior to PDT due to offering a better anatomical visualization3.
In 2015, we introduced the mini-surgical PDT (msPDT) as an alternative to the ST when PDT is contraindicated or difficult to perform4. We discontinued the use of bronchoscopy, the indispensable part of PDT techniques. The benefit of bronchoscopy has been debated5. It also may increase the risk of intra-procedural hypoxemia and transmission of COVID-194.
In msPDT, tracheal puncturing occurs upon appearance of tracheal rings after vertical and horizontal retraction of overlaying tissues. To prevent a posterior wall laceration, the catheter introducer needle is conducted at a 45 angle. Correct positioning of the needle's tip is confirmed by bubbles formation following aspiration of a pre-filled syringe4.
In a large randomized trial, we previously showed that msPDT is superior to the modified PDT and ST in terms of duration and complications2.
Being less time-consuming, it may put the practitioners not as much as PDT or ST at the risk of COVID-19.
Employment of msPDT instead of ST obviates the need for sector change from ICU to the operation theatre, which could contribute to COVID-19 propagation.
In addition to patient's safety, the safety of practitioners should also be taken into account in the risk–benefit evaluation of different tracheostomy techniques during viral pandemics.
References
- 1. Ives J, Huxtable R. Surgical Ethics During a Pandemic: Moving into the Unknown? Br J Surg 2020; 107: 1089–1090. [DOI] [PubMed] [Google Scholar]
- 2. Di Saverio S, Pata F, Khan M, Ietto G, Zani E, Carcano G. Convert to open: the new paradigm for surgery during COVID-19? Br J Surg 2020; 107: e194. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. De Leyn P, Bedert L, Delcroix M, Depuydt P, Lauwers G, Sokolov Yet al. Tracheotomy: clinical review and guidelines. Eur J Cardiothorac Surg 2007; 32: 412–421. [DOI] [PubMed] [Google Scholar]
- 4. Hashemian SM, Digaleh H; Massih Daneshvari Hospital Group . A Prospective Randomized Study Comparing Mini-surgical Percutaneous Dilatational Tracheostomy With Surgical and Classical Percutaneous Tracheostomy: A New Method Beyond Contraindications. 2016; 95: e208e. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Gadkaree SK, Schwartz D, Gerold K, Kim Y. Use of Bronchoscopy in Percutaneous Dilational Tracheostomy. JAMA Otolaryngol Head Neck Surg 2016; 142: 143–149. [DOI] [PubMed] [Google Scholar]