Objective: To identify factors predictive of 30-day mortality following tracheotomy in patients with COVID-19. Methods: A retrospective chart review of patients with COVID-19 who underwent tracheotomy at a tertiary medical center between March 2020 and October 2021 was conducted. Univariate and multivariable analyses of factors correlated with 30-day post-tracheotomy mortality were performed. The outcomes of tracheotomies performed in the operating room and at bedside were compared with t-tests and multivariable analysis. Results: One hundred-twenty patients met inclusion criteria, with 48 female patients (40%). Mean age was 59.8 [12.6] years, and the 30-day mortality rate was 18.3%. On univariate analysis, age (odds ratio (OR) = 1.06; P = .015), FiO2 at the time of tracheotomy (OR = 1.06; P < .001), and bedside tracheotomy (OR = 3.21; P = .019) were associated with increased risk of 30-day mortality. After including control variables, increased FiO2 continued to predict increased odds of 30-day mortality (OR = 1.08; P = .02); specifically, patients with FiO2 > 65% were significantly more likely to pass within 30 days than those with FiO2 ≤ 40% (OR = 28.24; P < .001). There was a significant difference in the 30-day mortality rate of bedside tracheotomies (31%) and OR tracheotomies (12%; P = .02), but this association was eliminated on multivariable analysis (OR = 0.95; P = .96). Conclusion: Intubated patients with COVID-19 undergoing tracheotomy with FiO2 > 65% have 25 times greater odds of 30-day mortality than those with FiO2 ≤ 40%. There were no differences in outcomes between bedside and OR tracheotomies.
Patient: Female, 19-year-old Final Diagnosis: Fractured tracheostomy tube Symptoms: Airway obstruction Medication:— Clinical Procedure: — Specialty: Otolaryngology Objective: Unusual clinical course Background: A wide variety of emergency scenarios associated with tracheostomy tubes have been reported in patients with complex airway disease. Fracture of a tracheostomy tube is a rare complication with a potential for catastrophic outcome. The aim of this case report is to present clinical features and management of airway compromise due to a fractured tracheostomy tube in a patient with subglottic and tracheal stenosis. Case Report: A 19-year-old woman with a history of chronic lung disease, developmental delay, subglottic stenosis, and tracheal stenosis presented to the Emergency Department after her mother noticed that the tracheostomy tube was broken at the junction of the cannula and neck plate. Upon arrival, the patient was stable and the stoma site had a pinpoint-size opening. A chest X-ray revealed a dislodged tracheostomy tube with the shaft’s convexity ventrally oriented in the trachea. The stoma was dilated to allow passage of a 2.5-mm flexible laryngo-scope into the trachea. The fractured tracheostomy tube lodged in the trachea distal to the stoma and proximal to the carina. The fractured tracheostomy tube migrated to the suprastomal site at the time of repeat tracheoscopy under general anesthesia. The fractured tracheostomy tube was removed transorally through the tracheal and subglottic stenosis with the use of optical forceps and rigid bronchoscope. Conclusions: Prompt recognition and management of a fractured tracheostomy tube is critical to prevent morbidity and mortality. Caregivers and healthcare providers must be prudent about proper tracheostomy tube care, potential manufacturing defects, and monitoring the condition of tracheostomy tubes.
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