ACQUIRED TRACHEOMALACIA REQUIRING URGENT TRACHEOSTOMY EXCHANGE IN PATIENTS WITH COVID-19

Objectives: COVID-19 has become a frequent cause of respiratory failure requiring tracheostomy. With prolonged intubation and high dose corticosteroid use, patients with COVID-19 are at risk for tracheomalacia. Prolonged ventilation can result in a poor seal of the tracheostomy cuff to the trachea. When tracheomalacia occurs, a ventilator cannot deliver adequate tidal volumes, and an urgent tube exchange is required to maintain oxygenation and ventilation. Tracheostomy for prolonged ventilation patients with COVID-19 was often delayed due to high viral loads and persistent high ventilatory requirements. We sought to describe our single center experience with COVID-19 patients requiring tracheostomy.

Methods: We performed a single-center, retrospective review of a procedural database from June 2020 – October 2021. We identified patients with COVID-19 diagnosis who underwent percutaneous tracheostomy for prolonged mechanical ventilation. We collected demographic and procedural data. Descriptive statistics were performed.

Results: 45 patients were identified. Mean age was 55 years; 33% were female. 37 patients (82.2%) survived their index hospitalization. Tracheostomy was performed after a mean of 16 days of mechanical ventilation. 10 patients (22.2%) required urgent exchange to an extended length tracheostomy tube at 7.2 days mean time after initial tracheostomy tube was placed. Two patients (4.4%) went on to require tracheal resection for tracheal stenosis.

Conclusion: There is a high rate of potentially life-threatening tracheal complications of prolonged mechanical ventilation in patients with COVID-19. Placement of an extended length tracheostomy tube can reduce cuff leak in ventilated patients, and use of the extended length tracheostomy tube at initial tracheostomy placement may reduce the need for urgent tracheostomy exchange.