Results
Since March 8th, 2020 to April 25th 2020 thirty Covid-19 patients were managed in the Covid intensive care units(ICU) of [Blinded for review]. Ten patients died, eleven patients were discharged and nine patients are being currently managed. Four (13%) tracheostomies were performed at bedside in our Covid ICUs. Demographic and clinical variables are reported in table 1.
All four patients needed prolonged mechanical ventilation, because of the acute respiratory failure, and had developed ventilator associated pneumonia (VAP) before performing tracheotomy. In three patients, gram-negative bacteria were isolated from the bronchial aspirates and one developed lung and paranasal fungal infection from zygomices. All patients underwent tracheotomy while recovering from septic shock and were still hemodynamically supported by a low dose of vasopressors.
After tracheotomy, one patient (PA) has been weaned from mechanical ventilation on day 28th, one (OI) died after 18 days of mechanical ventilation because of recurrent severe septic shock, associated with gram-negative infection with a progressive worsening of multi-organ functions. MG developed a severe invasive fungal infection, with isolation of a zygomices from the bronchial aspirate and he is still on mechanical ventilation. The last one (FI) resulted negative for SARS-nCoV2 on bronchoalveolar lavage after 22 days of mechanical ventilation, with a significant improvement of oxygenation (PaO2/FiO2>300) and he has been considered cured from COVID-19 and moved to a COVID-free ICU to complete the weaning from the ventilator.
“Surgical” endpoints are reported in table 2.