J Korean Med Sci.  2020 Jul;35(28):e263. 10.3346/jkms.2020.35.e263.

A Case Report of Tracheostomy for a Patient with COVID-19: How to Minimize Medical Staff and Patient Risks

• Youn SH
• Baek SY
• Yoon J
• Hong SS
• Kim Y

• KMID: 2504369
• DOI: http://doi.org/10.3346/jkms.2020.35.e263

Abstract

Coronavirus disease was first reported in December 2019, and the World Health Organization declared it as a pandemic on March 11, 2020. The virus is known to attack various vital organs, including the respiratory system. Patients sometimes require positive pressure ventilation and tracheostomy. Because tracheostomy is a droplet-spreading procedure, medical staff should protect themselves against the risk of transmission of this contagious viral disease. In our case, we performed tracheostomy for a 70-year-old man with coronavirus disease 2019 (COVID-19) who had required more oxygen with gradual weakness of respiratory muscle to maintain his arterial oxygen saturation. We focused on the risks of the medical staffs and patients, and minimized them at the same time using temporary balloon over-inflation, pre-operative adjustment of endotracheal tube position, and attachment of a transparent film dressing to the surgical field without stopping the ventilator while following routine safety measures. Fourteen days after the tracheostomy, all participating medical staff members were healthy and asymptomatic. The patient was discharged 105 days after the COVID-19 diagnosis.

Keyword

COVID-19; Sputum; Tracheostomy; Transmission

Figure

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  Fig. 1 Before surgery, chest radiography was used to adjust the position of the place where the balloon was supposed to be between the level of the second tracheal ring and the carina. (A) Before adjustment tube (B) after adjustment tube.

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  Fig. 2 Around tracheal manipulation. (A) Balloon is below the tracheal incision without air leakage through its side. (B) Through transparent membrane, tube withdrawal can be seen without pause of ventilator and spreading droplets.

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  Fig. 3 Procedures to protect patient (left), medical staff (right), and both (middle).FiO2 = fraction of inspired oxygen, PAPR = powered air-purifying respirator, PPE = personal protective equipment.

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