Safety and Feasibility of a Novel Protocol for Percutaneous Dilatational Tracheostomy in Patients with Respiratory Failure due to COVID-19 Infection: A Single Center Experience
Table 1
Novel PDT protocol.
(1) Equipment and medication checklist prior to entering room
Disposable bronchoscope function check
Tracheostomy kit verification
Sedative and neuromuscular blocker drawing
(2) Universal protocol and time out outside the room followed by donning of augmented PPE (N95 and PAPR)
(3) Apnea trial before start to mimic apnea
100% FIO2 and current PEEP
Place ventilator on standby for 60 seconds
Pass test if able to tolerate without desaturations
(4) Administer sedatives and paralytics to minimize cough and movement
(5) Short apnea to add adaptor to circuit and insert bronchoscope in the ETT
(6) Pull back ETT while keeping cuff inflated
(7) Local anesthesia, incision, and insertion of introducer needle and angiocatheter by most experienced operator
(8)Place ventilator on standby and complete dilation and insertion of tracheostomy tube
(9) Connect ventilator to tracheostomy, inflate tracheostomy cuff, and resume ventilation. Verify inspiratory and expiratory volumes
(10) Remove the ETT and bronchoscope en bloc from oropharynx directly in a bag
