260: Percutaneous Dilational Tracheostomy During the COVID-19 Pandemic in New York City

INTRODUCTION: The COVID-19 pandemic overwhelmed New York City hospitals Shortages of ventilators and sedatives prompted tracheostomy earlier than recommended by professional societies The objective of this study was to determine the impact of percutaneous dilational tracheostomy (PDT) in COVID-19 patients on critical care capacity METHODS: This is a single-institution prospective case series of SARS-CoV-2 infected patients undergoing PDT from April 1-June 4, 2020 with follow-up through June 25, 2020 at a public tertiary care center Clinical data were obtained through medical record review Mechanically ventilated COVID-19 patients were screened for intervention based on the following criteria: ≥ 6 days of intubation with further need for mechanical ventilation, a fractional inspired oxygen concentration of ≤ 60%, positive end expiratory pressure ≤12, no significant organ dysfunction except acute kidney injury, and minimal pressor requirements The main outcomes measured were change in 48-hour periprocedural sedative/analgesia requirements, liberation from the ventilator, rate of transfer from the ICU, decannulation, PDT-related complications, and in-hospital survival RESULTS: Fifty-five patients met PDT criteria and underwent PDT a median of 13 days from intubation Patient characteristics are found in Table 1 Intravenous midazolam equivalents, fentanyl equivalents and cisatracurium equivalents were significantly reduced post- PDT (Table 2) Thirty-five patients were transferred from the ICU and liberated from the ventilator Median time from PDT to ventilator liberation and ICU discharge was 10 and 12 days respectively Decannulation occurred in 45 5% and 52 7% were discharged from acute inpatient care Median follow-up for the study was 62 days Four patients had bleeding complications postoperatively and 11 died during the study period Older age was associated with increased odds of complication (OR 1 12, 95% CI 1 04, 1 23) and death (OR=1 15, 95% CI 1 05, 1 30) CONCLUSIONS: Mechanically ventilated COVID-19 patients undergoing PDT using standard criteria improves ventilator and medication utilization in areas strained by the SARS-CoV-2 pandemic Long term outcomes after PDT in this population deserve further study