PERCUTANEOUS TRACHEOTOMY IN ICU: OUR EXPERIENCE IN 2020-2021 (COVID-19 PANDEMIC).

INTRODUCTION Percutaneous tracheostomy (PT) is a surgical procedure for the placement of a tracheal tube through the anterior wall of the trachea. It is performed using a modified Seldinger technique between the second and third tracheal rings and guided under direct vision by the fiberoptic bronchoscope. It is a minimally invasive procedure with a low number of complications by experienced physicians. It is considered a safe alternative to surgical tracheostomies (ST), a more aggressive procedure. According to the internal protocols of the Anesthesia Intensive Care Unit (ICU) of the Valencia University General Hospital (CHGUV), PT are performed by anaesthesiologists, while ST are performed by otorhinolaryngologists. This study aims to confirm that PT is just as safe as ST, as well as that it presents the same or fewer immediate complications, understanding these as bleeding, loss of the airway due to the exit of the endotracheal tube, creation of a false pathway, injury to the posterior wall, injury to one or more tracheal rings, the appearance of subcutaneous emphysema and damage to the fiberoptic bronchoscope with the puncture needle. Due to the Covid-19 pandemic, patients with Covid-19 have been included. The modified protocol for this type of patient has been followed, following the consensus document of the Spanish Societies of Intensive Medicine (SEMICYUV), Otorhinolaryngology (SEORL-CCC), and Anesthesia (SEDAR). OBJECTIVE Review the total number of tracheotomies performed by anesthesiologists and otolaryngologists in the CHGUV ICU in 2020-2021, including patients with SARS-COV2 infection, as well as the total of immediate complications that occurred concerning the procedure. Confirm that PT is the technique of choice in critically ill patients due to its lower number and less severity of complications. MATERIAL AND METHODS Descriptive, observational, and retrospective study, in which each one of the tracheotomies performed in the CHGUV anesthesia ICU in 2020-2021, as well as their immediate complications, were collected. Patients with Covid-19 were included too. RESULTS A total of 294 tracheostomies were performed (20 were patients with SARS-COV2 infection). 294 were TP (12 with SARS-COV2) and 11 TQ (8 with SARS-COV2). Among the complications recorded, the most frequent was mild bleeding appearing in a total of 35 patients. Of these patients, only 30% belonged to the PD group. No cases required a surgical revision. In addition, within the ST, there was one case of accidental decannulation with loss of the airway. CONCLUSIONS Our study shows in general a low rate of early complications in tracheostomies, however, ST caused a higher incidence of immediate complications. Furthermore, PT has shown not only a lower incidence of complications but a lower severity of these too. The data from this study support the PT performed by experimented anesthesiologists as the technique of choice in critical patients compared to CT.