Tracheostomy in a patient with COVID-19
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An 81-year-old man had slight fever, fatigue and dry cough for 5 days and was admitted to hospital. He had hairy cell leukemia since 1993, Hodgkin lymphoma since 2002 and cervical kyphosis. His chest radiograph showed both-side, lower zone patchy consolidation. The polymerase chain reaction test for SARS-CoV-2 was positive. He received intensive drug treatment, including chloroquine phosphate, lopinavir, ritonavir, antibiotics, and respiratory care. His respiratory condition deteriorated, and he underwent tracheal intubation. On the 14th day after intubation, an open tracheostomy was carried out because of the prolonged tracheal intubation and unsuccessful extubation attempts.

The patient's condition was optimized before transfer from the intensive care unit (ICU) to the operating theater. Before incising the trachea, the cuff of the endotracheal tube was deflated, the tube was advanced forward 3 cm to prevent aerosol generation if the cuff would be ruptured and the cuff is re-inflated, thus establishing a closed circuit. After preoxygenation, the ventilator was turned off, the incision was made above the level of the tube cuff and rescue sutures around the third tracheal ring were inserted. The anesthesiologist deflated cuff and pulled out the intubation tube up to the level of the cricoid cartilage. No 8.5 cuffed non-fenestrated tracheostomy tube with an attached syringe to cuff was introduced, the cuff was inflated, the tube was connected to a ventilator and mechanical ventilation was restarted. The tracheostomy tube was fixed to the neck skin to avoid accidental extraction.

The endotracheal tube was removed from the mouth under a large piece of clear plastic in which it was immediately wrapped and disposed of in a plastic bag. After the operation, the patient was reconnected to the portable monitor and ventilator and transferred back to the ICU by a separate transport team. The patient's condition did not improve despite intensive treatments, and he died 10 days after surgery. All members of the surgical team remained well at 2 weeks after the procedures

Source: https://academic.oup.com/jscr/article/2020/6/rjaa194/5859612
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