Surgical tracheotomy vs percutaneous dilatation tracheotomy in
COVID-19 patients (Table 4)
PDT is preferred over surgical ST for COVID-19 patients due to lower
transmission risks from a shorter procedure, reduced number of HCW being
exposed during the procedure, decreased spillage of patient fluids, and
reduced risk of aerosol generation.
In the era of SARS/COVID-19, the operating theatre (OT) is the ideal
setting for ST. However, transfer to OT may increase transmission to
HCWs. Exposure of an infectious patient throughout the hospital would
also place transport staff at risk of infection. While ST can also be
performed in the intensive care unit (ICU), the smaller ICU rooms may
restrict movement of surgeons. Patient positioning on a pneumatic ICU
bed is difficult because patient anatomy sinks away from surgeon with
any manipulation. Beyond that, ICU beds are usually wider than usual OT
tables, making it ergonomically difficult for the surgeon to reach the
patient. Hence, performing ST in an ICU room is technically more
challenging than in the OT. On the other hand, PDT can be performed
conveniently at the patient bedside. This reduces the number of HCWs
exposed to the infectious patient, as there is no contact with any
transport or additional OT staff.
ST is also a longer procedure than PDT, resulting in a longer period of
time HCWs are in close contact with the patient. ST will also lead to
greater spillage of blood and secretions than PDT, hence resulting in a
higher transmission risk. (9) However, it should be noted that PDT
typically requires real time bronchoscopy followed by bronchoscopic
confirmation of puncture into trachea, as well as ETT withdrawal prior
to puncture. These may result in an aerosol leak and possible mode of
transmission of the virus to HCWs.
Therefore, PDT has been recommended over ST if there are no
contraindications (such as goiter, poorly palpable laryngeal landmarks),
or if an emergency tracheotomy needs to be done. (10)