03:52 - Source: CNN
This man made a 'miracle' recovery from Covid-19

Editor’s Note: Susannah Hills is a pediatric airway surgeon at the New York Presbyterian Hospital and the Columbia University Medical Center. She also serves as assistant professor of otolaryngology-head and neck surgery at the Columbia University College of Physicians and Surgeons. The views expressed in this commentary are her own. Read more opinion on CNN.

CNN  — 

I hardly recognized her as she sat in the hospital chair, smiling, talking, and eating her dinner from a tray. Then I noticed her long, brown braids and the pink manicure, now chipping, and I remembered her clearly.

Dr. Susannah Hills

I met Valerie (not her real name) two weeks ago when she was sedated, unresponsive, in one of our makeshift intensive care unit beds set up where an operating table once was. As an ENT airway surgeon at Columbia University, I was there with our team to perform her tracheostomy – a procedure where a breathing tube is placed in a patient’s neck and the one in their mouth is removed, paving the way for the patient to be more comfortable, wake up and, gradually, get off the ventilator.

Years of research in intensive care units have taught us doctors that performing a tracheostomy helps patients get off life support and out of the ICU quicker, and also decreases the death rate if done appropriately.

Patients are put on the ventilator in a time of desperation. While it’s too soon to comment on the impact amid the Covid-19 outbreak, tracheostomy, a procedure we’re doing more and more for patients who survive long enough to withstand surgery, is a sign of hope.

Valerie had looked much older back then, asleep, with the breathing tube coming out the side of her mouth. The only clues to her identity were the long braids and her hot pink nails. Now, she has the tracheostomy tube we placed in her neck with a cap, because she doesn’t need it to help her breathe any more. I’ll come back to remove that breathing tube in just a few days.

She is one of our first patients to get her tracheostomy tube removed. Many, many more are still in ICU, trying to get off the ventilator.

In the past month, 150 tracheostomies have been done in our hospital for Covid-19 patients –nearly twice as many as we would normally do in an entire year. Our data shows that about 40% of these patients have already come off the ventilator. We expect there will be many more in the coming weeks.

As we come down from the peak of new Covid-19 cases here in New York City, airway surgeons like me are hitting our own surge of patients – and tracheostomies. And with the surge, new questions have come up. How will we have the workforce and resources to perform all of these procedures? And, how will we take care of what may be hundreds of patients afterwards?

Our operating rooms have turned into ICUs. Many of our surgeons, anesthesiologists and residents have been reassigned to care for patients in ICU. Each patient requires special care to make sure their tracheostomy tube does not become blocked and obstruct their breathing. There can also be other complications, like bleeding and skin wounds.

In normal times, these patients would be in units with skilled nurses used to taking care of patients. Nowadays, the level of experience and comfort of providers taking care of these airway patients varies and the number of tracheostomy patients is 10 times our normal volume.

The Covid-19 pandemic is teaching us that we have limits and we can’t do this alone.

This is why we have come together from across my hospital system to form a tracheostomy care team specifically for the dozens – possibly hundreds – of patients we will need to care for in the coming weeks. The team includes airway surgeons, thoracic surgeons, critical care surgeons, anesthesiologists, intensive care doctors, speech and language pathologists, and respiratory therapists.

We have also been speaking with colleagues across the country and in different parts of the world, learning from each other’s experiences and sharing practices that seem to work. Email reports of early experiences with Covid-19 from hospitals in China, Iran and Italy were widely circulated among hospitals around the globe. Virtual lectures from surgeons at the various epicenters of the virus were also shared. In fact, Vanderbilt University hosted a video lecture presented by Italian ENT surgeon Dr. Daniele Marchioni that was attended by over 200 airway surgeons in the US. And weekly Zoom meetings are bringing providers here in the states together to share information and insight.

We’re all from different specialties, and we are not necessarily used to working together, or doing things the same way. In particular, we surgeons are known to stick to our practice patterns. But these times call for cohesion more than ever.

In our hospital, we have put our individual preferences aside, created guidelines and standardized practices that make the team function. For example, on a typical day amid this outbreak, the rotating surgical and anesthesia teams go from patient to patient –sometimes as many as seven or eight – surgically entering the airway and placing the tracheostomy tube at their bedside.

The other surgical team members, along with physician assistants and residents, go from bed to bed, checking on the patients that already underwent surgery, making sure their tubes are secure and that they have the supplies they need nearby.

Now, we are finally seeing patients who are well enough to get their tracheostomy tubes removed. In the afternoons, we have “decannulation rounds,” where we check to see who is ready to have their breathing tube removed. We put a cap on the tracheostomy tubes of those who are ready, and if this goes well, we remove the tube completely.

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    We are coming through this pandemic as a team, working together across the hospital system, across the country and across the world. The bridges we are building will last long after we defeat the virus.

    After weeks of onslaught of relentless coronavirus illness and patients circling in downward spirals, we are seeing our sickest patients come out the other side. Like Valerie, it feels like we can all start to breathe again, at least just a little.