(1051) Use of a Bougie to Prevent Hypoxemia and Loss of Airway During Percutaneous Tracheostomy in the ICU

Introduction: Percutaneous tracheostomy is recommended in critically ill patients who require prolonged mechanical ventilation (MV) to facilitate the weaning process. It presents many beneficial effects such as improved pulmonary and thoracic mechanics, minimized need for sedatives and improved communication with staff and family members. However, it may be associated with complications such as hypoxemia, airway loss, bleeding, and pneumothorax. Patients with SARS-CoV-2 infection have a deficient oxygen reserve and do not tolerate periods of derecruitment and desaturation with a high mortality rate ranging from 40% to 67%. This study aims to identify and describe the clinical outcomes of patients with MV undergoing a percutaneous tracheostomy technique using a bougie.

Methods: A descriptive cross-sectional study based on a cohort of adult patients with molecular diagnosis of SARS-CoV-2, undergoing MV and indicated for percutaneous tracheostomy. The patients were admitted to the Intensive Care Unit between April 1, 2020, and June 30, 2021. Demographic, intervention, and outcome variables were collected.

Results: This study included 93 patients with a mean age of 53.6 years, mostly males (66.7%). The predominant comorbidity was obesity (47.5%), followed by hypertension (42.5%). The median time to tracheostomy was 12 days (IQR 8 - 23). Regarding respiratory mechanics, the mean PaO2/FiO2 ratio before the procedure was 142. 62% of the patients had at least one failed extubation attempt before the procedure. Complications related to the procedure occurred in 14 patients, with 7 of them (7.5%) experiencing bleeding within the first 48 hours following the procedure, likely due to the use of anticoagulants. Two patients required surgical management. There were no episodes of hypoxemia or airway loss. The overall mortality rate was 33.3%, and it was associated with pulmonary, infectious, and neurological complications related to COVID-19.

Conclusions: The use of a bougie during percutaneous tracheostomy provides significant benefits for patients with COVID-19 by reducing complications related to airway loss and hypoxemia. Additionally, it facilitates early initiation of rehabilitation, contributing to a faster recovery. Future studies should focus on evaluating the optimal timing for tracheostomy in these patients.