TRACHEOSTOMY AND COVID-19 ARDS: ONE ACADEMIC CENTER'S EXPERIENCE

SESSION TITLE: Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: To evaluate the practice of creation of tracheostomies during the initial phases of the COVID-19 pandemic, with a focus on clinical outcomes and sedation parameters METHODS: We enrolled 45 consecutive COVID-19 positive adult patients whom a consult for tracheostomy was placed at Johns Hopkins Hospital between 4/16/2020 and 5/22/2020 A total of 38 tracheostomies were performed at the time of censoring Five of the patients were extubated before performance of tracheostomy and two were awaiting creation of tracheostomy Data was collected via manual extraction on clinical outcomes, sedative medication use for the 48 hours pre- and 48 hours post-tracheostomy RESULTS: Baseline characteristics of the 45 patients include a median age of 62, BMI of 30, with an even split of Male:Female (23:22) The median days of intubation before tracheostomy was 20 (range: 5-36), median days from consult for tracheostomy to performance of tracheostomy was 3 A multidisciplinary team across specialties performed the tracheostomy consults with Interventional Pulmonary performing 18, Otolaryngology 13, General Surgery 9, Thoracic Surgery 5 29 of the tracheostomies were performed percutaneously A bronchoalveolar lavage, tracheal aspirate, or sputum sample was obtained on the day of performance of the tracheostomy and 35 of the 38 were negative for COVID-19 The samples were sent a median of 23 5 days after the initial positive test Mortality on date of censoring was 7 (15 6%) including 5 (13 2%) of the patients with tracheostomy 10 (22 2%) had been discharged including 9 (23 7%) of the patients with tracheostomy Sedation and analgesia (total dose in 48 hours pre- (PR) and 48 hours post post-tracheostomy (PO)) expressed as median dosage for patients receiving that medication:- Dexmedetomidine (mcg/kg/hr): PR (18 patients): 28 7;PO (17 patients): 27 4- Midazolam (mg): PR (7 patients): 82 6;PO (8 patients): 55 5- Fentanyl (mcg): PR (21 patients): 450 0;PO (19 patients): 618 75- Propofol (mcg/kg/min): PR (8 patients): 1245 2;PO (5 Patients): 84 4 CONCLUSIONS: In the early-phase of the COVID-19 pandemic 38 patients with COVID-19 induced respiratory failure underwent successful tracheostomy The median length of intubation prior to tracheostomy was 20 days, longer than our historical average, likely related to initial concerns over performing this high-risk aerosolizing procedure The total dosage of each sedative medication decreased from the 48 hours pre- and post-tracheostomy, potentially related to endotracheal tube removal CLINICAL IMPLICATIONS: We were able to show that performance of tracheostomy during COVID-19 is safe and can be approached from multiple specialties Early tracheostomy should be considered in appropriate patients to reduce cumulative sedative medication dose, length of intubation, length of ICU stay, and cost of admission DISCLOSURES: No relevant relationships by Esther Ben Or, source=Web Response No relevant relationships by Nasir Bhatti, source=Web Response Consultant relationship with Veracyte, Inc Please note: $1001 - $5000 Added 04/01/2020 by David Feller-Kopman, source=Web Response, value=Consulting fee No relevant relationships by Elliott Haut, source=Web Response Receive Research Support relationship with Medtronic Please note: >$100000 Added 05/31/2020 by Alexander Hillel, source=Web Response, value=Grant/Research No relevant relationships by Chris Kapp, source=Web Response research, consultant relationship with Veran Please note: 2016-ongoing by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Research, Consultant relationship with Veracyte Please note: 2017- Present by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response President relationship with Association of Interventional Pulmonary Program Directors Please note: 2017-2019 by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Consu tant relationship with Veran Medical Please note: 2016-Present by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Consultant relationship with Veracyte Please note: 2018-Present by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Research relationship with Veracyte Please note: 2017-Present by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Research, Consultant relationship with Coridea Please note: 2017-Present by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Education relationship with Intuitive Please note: 3 days by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Consultant relationship with Veracyte Please note: 2018 to present by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Advisory Board relationship with Veracyte Please note: May 2019 (1 day) by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Focus Group relationship with Cook Medical Please note: May 2019 (1 day) by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Consultant relationship with Merit Medical Please note: 2019 Added 06/11/2020 by Hans Lee, source=Web Response, value=Honoraria Consultant relationship with Cook Medical Please note: 2019 Added 06/11/2020 by Hans Lee, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Veracyte Please note: Consulting fee Added 06/11/2020 by Hans Lee, source=Web Response, value=Honoraria No relevant relationships by Laeben Lester, source=Web Response No relevant relationships by Jacqueline Stokes, source=Web Response no disclosure submitted for Jeffrey Thiboutot;No relevant relationships by Lonny Yarmus, source=Web Response, value=Grant/Research Support Removed 05/31/2020 by Lonny Yarmus, source=Web Response No relevant relationships Added 04/27/2020 by Lonny Yarmus, source=Web Response, value=Grant/Research Support Removed 05/31/2020 by Lonny Yarmus, source=Web Response No relevant relationships Added 04/27/2020 by Lonny Yarmus, source=Web Response, value=Grant/Research Support Removed 05/31/2020 by Lonny Yarmus, source=Web Response No relevant relationships Added 04/27/2020 by Lonny Yarmus, source=Web Response, value=Grant/Research Support Removed 05/31/2020 by Lonny Yarmus, source=Web Response No relevant relationships Added 04/27/2020 by Lonny Yarmus, source=Web Response, value=Grant/Research Support Removed 05/31/2020 by Lonny Yarmus, source=Web Response No relevant relationships by Lonny Yarmus, source=Web Response Removed 04/27/2020 by Lonny Yarmus, source=Web Response No relevant relationships by Lonny Yarmus, source=Web Response Removed 04/27/2020 by Lonny Yarmus, source=Web Response No relevant relationships by Lonny Yarmus, source=Web Response Removed 04/27/2020 by Lonny Yarmus, source=Web Response No relevant relationships Added 04/27/2020 by Lonny Yarmus, source=Web Response, value=Grant/Research Support Removed 05/31/2020 by Lonny Yarmus, source=Web Response No relevant relationships by Lonny Yarmus, source=Web Response Removed 04/27/2020 by Lonny Yarmus, source=Web Response