Results
During the COVID-19 period between 1st March 2020 and
1st June 2020, 30 patients with COVID-19 underwent a
tracheostomy at our institution. 46.7% (n=14) underwent a bedside open
tracheostomy, 16.7% (n=5) underwent open tracheostomy in a theatre
setting, and 36.7% (n=11) underwent a percutaneous tracheostomy. Table
1 summarises the patient characteristics in further detail. The mean age
of patients undergoing bedside open tracheostomy was 60.5 years old
(48-69 years) where majority were male (n=10, 71.4%) and of Asian
ethnicity (n=9, 64.3%). The mean duration of mechanical intubation
prior to bedside open tracheostomy was 14.5 days. 71.4% (n=10) of
patients who had undergone bedside open tracheostomy were still alive
and had been successfully weaned from mechanical ventilation, with a
mean duration of 17 days from tracheostomy to successful decannulation.
In-hospital mortality was reported in 28.6% (n=4) in the bedside open
tracheostomy group, 20%(n=5) in open-theatre group, and 18.2% (n=11)
in percutaneous group. All deaths were attributed to COVID-19 related
complications. No significant tracheostomy related complications were
reported with bedside open tracheostomy method whilst 20% (n=1) and
9.1% (n=1) were reported in open-theatre and percutaneous approach
respectively. The average operating time (from skin incision to
insertion of tracheostomy tube) for bedside tracheostomy in COVID-19
patients was 9 minutes. There were no intra-operative complications
reported and minimal blood loss (<20 mls) were achieved in
open-bedside approach. In all cases, the operating surgeons used a
Half-Face Air Purifying Respirator, visor or goggles, fluid resistant
sterile theatre gown, double-gloving and head and shoe covering. There
were no healthcare personnel involved that reported acute respiratory
COVID-19 infection within two weeks of the procedure. All the Head and
Neck surgeons had a negative outcome for COVID-19 antibodies.