Ultrasound-guided percutaneous dilatation tracheostomy demonstrates efficacy and safety in patients with COVID-19: a retrospective cohort study

Coronavirus disease (COVID-19) can progress to acute respiratory distress syndrome, necessitating prolonged mechanical ventilation and tracheostomy. Despite the conventional use of bronchoscopy-guided techniques, ultrasound-guided percutaneous dilatation tracheostomy offers benefits during a global pandemic, primarily by minimizing aerosol formation and dissemination. This study aims to assess the outcomes of COVID-19 patients who underwent ultrasound-guided percutaneous dilatation tracheostomy with limited medical staff and to compare these outcomes with those of patients who received bronchoscopy-guided percutaneous dilatation tracheostomy prior to the pandemic. This retrospective cohort study included patients admitted to the specialized COVID-19 ICU Department in the Clinical Hospital Centre (CHC) Rijeka, Croatia, from March 28, 2020, to December 31, 2021. This study analyzed demographic data, the duration of mechanical ventilation before and after ultrasound-guided percutaneous dilatation tracheostomy, and whether the patients were successfully weaned off the ventilator. These results were compared to the matching outcomes and complications of bronchoscopy-guided tracheotomies in 2012 and 2013 in CHC Rijeka. A total of 825 patients were hospitalized due to COVID-19 respiratory failure, of which 603 patients required invasive mechanical ventilation, and subsequently 99 patients underwent ultrasound-guided percutaneous dilatation tracheostomy, and the majority were males ( n = 70, 70.7%). The overall median age was 67 years (range: 36–87 years). The weaning from mechanical ventilation in the COVID-19 population was successful in 54 patients (54.55%), without significant difference regarding gender, duration of mechanical ventilation, type of PDT, or infectious period, respectively. When comparing the patients who underwent ultrasound-guided PDT in the COVID-19 period to bronchoscopy-guided PDT in the pre-COVID-19 period (in years 2012 and 2013), there is a significant overall increase in performed tracheostomies in the COVID-19 period ( p < 0.01) in the later onset ( p < 0.0001), with significantly fewer weaned patients from mechanical ventilation ( p < 0.0001). However, no significant difference in the occurrence of complications has been observed among studied techniques. Our experience with ultrasound-guided percutaneous dilatation tracheostomy in COVID-19 patients has demonstrated its effectiveness, safety, and non-inferiority over bronchoscopy-guided techniques. This technique minimizes aerosol spread, improves ventilation management, and has comparable complication rates to the pre-COVID period. Additionally, this two-operator technique provided a tailored balance of safety for personnel and quality of care for COVID-19 patients. It has proved to be essential in both overwhelming pandemic conditions and situations with an overall medical staff shortage.