Management of tracheostomy in COVID-19 patients: The Japanese experience

Taizo Yokokawa; Yosuke Ariizumi; Mariko Hiramatsu; Yujin Kato; Kazuhira Endo; Kazufumi Obata; Kayoko Kawashima; Toshifumi Sakata; Shigeru Hirano; Torahiko Nakashima; Tatsurou Sekine; Asanori Kiyuna; Saeko Uemura; Keisuke Okubo; Taro Sugimoto; Ichiro Tateya; Yasushi Fujimoto; Arata Horii; Yurika Kimura; Masamitsu Hyodo; Akihiro Homma

doi:10.1016/j.anl.2021.01.006

Management of tracheostomy in COVID-19 patients: The Japanese experience

Auris Nasus Larynx. 2021 Jun;48(3):525-529. doi: 10.1016/j.anl.2021.01.006. Epub 2021 Jan 9.

Authors

Taizo Yokokawa¹, Yosuke Ariizumi², Mariko Hiramatsu³, Yujin Kato⁴, Kazuhira Endo⁵, Kazufumi Obata⁶, Kayoko Kawashima⁷, Toshifumi Sakata⁸, Shigeru Hirano⁹, Torahiko Nakashima¹⁰, Tatsurou Sekine¹¹, Asanori Kiyuna¹², Saeko Uemura¹³, Keisuke Okubo¹⁴, Taro Sugimoto¹⁵, Ichiro Tateya¹⁶, Yasushi Fujimoto¹⁷, Arata Horii¹⁸, Yurika Kimura¹⁸, Masamitsu Hyodo¹⁸, Akihiro Homma¹⁹

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Sapporo 060-8638, Japan.
² Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
³ Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
⁴ Department of Otorhinolaryngology, The Jikei University School of Medicine, Tokyo, Japan.
⁵ Division of Otolaryngology - Head and Neck Surgery, Graduate School of Medicine, Kanazawa University, Kanazawa, Japan.
⁶ Department of Otolaryngology, Sapporo Medical University School of Medicine, Sapporo, Japan.
⁷ Department of Otorhinolaryngology, Osaka Habikino Medical Center, Osaka Prefectural Hospital Organization, Habikino, Japan.
⁸ Department of Otorhinolaryngology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
⁹ Department of Otolaryngology - Head & Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
¹⁰ Department of Otorhinolaryngology, Head &Neck Cancer Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
¹¹ Department of Otorhinolaryngology, Saitama Medical University, Saitama, Japan.
¹² Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
¹³ Department of Otolaryngology, School of Medicine, Jichi Medical University, Simotsuke, Japan.
¹⁴ Department of Otolaryngology, Sano Kosei General Hospital, Tochigi, Japan.
¹⁵ Department of Otolaryngology - Head and Neck Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
¹⁶ Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Fujita Health University, Toyoake, Japan.
¹⁷ Department of Otorhinolaryngology, Aichi Medical University, Nagakute, Japan; The academic committee of the Oto-Rhino-Laryngological Society of Japan.
¹⁸ The academic committee of the Oto-Rhino-Laryngological Society of Japan.
¹⁹ Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, North 15 West 7, Sapporo 060-8638, Japan. Electronic address: ak-homma@med.hokudai.ac.jp.

Abstract

Objective: Involvement in the tracheostomy procedure for COVID-19 patients can lead to a feeling of fear in medical staff. To address concerns over infection, we gathered and analyzed experiences with tracheostomy in the COVID-19 patient population from all over Japan.

Methods: The data for health-care workers involved in tracheostomies for COVID-19-infected patients were gathered from academic medical centers or their affiliated hospitals from all over Japan.

Results: Tracheostomies have been performed in 35 COVID-19 patients with a total of 91 surgeons, 49 anesthesiologists, and 49 surgical staff members involved. Twenty-eight (80%) patients underwent surgery more than 22 days after the development of COVID-19-related symptoms (11: 22-28 days and 17: ≥29 days). Thirty (85.7%) patients underwent surgery ≥ 15 days after intubation (14: 15-21 days, 6: 22-28 days, and 10: ≥29 days). Among the total of 189 health-care workers involved in the tracheostomy procedures, 25 used a powered air-purifying respirator (PAPR) and 164 used a N95 mask and eye protection. As a result, no transmission to staff occurred during the 2 weeks of follow-up after surgery.

Conclusion: No one involved in tracheostomy procedures were found to have been infected with COVID-19 in this Japanese study. The reason is thought to be that the timing of the surgery was quite late after the infections, and the surgery was performed using appropriate PPE and surgical procedure. The indications for and timing of tracheostomy for severe COVID-19 patients should be decided through multidisciplinary discussion.

Keywords: COVID-19; Personal protective equipment; Safety; Tracheostomy.

MeSH terms

COVID-19 / therapy*
Extracorporeal Membrane Oxygenation
Eye Protective Devices
Health Personnel
Humans
Infectious Disease Transmission, Patient-to-Professional / prevention & control*
Infectious Disease Transmission, Patient-to-Professional / statistics & numerical data
Japan
N95 Respirators
Patient Isolators
Personal Protective Equipment
Respiration, Artificial / methods
Respiratory Insufficiency / therapy*
Respiratory Protective Devices
SARS-CoV-2
Tracheostomy / methods*