A Systematic Review on Tracheostomy in COVID-19 Patients: Current Guidelines and Safety Measures

Mandal, Ananya; Nandi, Sourabh; Chhebbi, Madiwalesh; Basu, Abhijit; Ray, M. D.

doi:10.1007/s12070-020-02152-w

Cited by 7 publications

(6 citation statements)

References 27 publications

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“…Various studies mention the complications associated with delaying tracheostomies[ 17 , 21 , 29 ]. Complications can be related to early or late procedure, severity of disease, comorbidities, type of tracheostomy performed, where the procedure was performed, and individual patient demographics.…”

Section: Discussionmentioning

confidence: 99%

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Timing of tracheostomy in mechanically ventilated COVID-19 patients

Amadi¹,

Trivedi²,

Ahmed³

2021

WJCCM

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According to the World Health Organization as of September 16, 2021, there have been over 226 million documented cases of coronavirus disease 2019 (COVID-19), which has resulted in more than 4.6 million deaths and approximately 14% develop a more severe disease that requires respiratory assistance such as intubation. Early tracheostomy is recommended for patients that are expected to be on prolonged mechanical ventilation; however, supporting data has not yet been provided for early tracheostomies in COVID-19 patients. The aim of this study was to explore established guidelines for performing tracheostomies in patients diagnosed with COVID-19. Factors considered were patient outcomes such as mortality, ventilator-associated pneumonia, intensive care unit length of stay, complications associated with procedures, and risks to healthcare providers that performed tracheostomies. Various observational studies, meta-analyses, and systematic reviews were collected through a PubMed Database search. Additional sources were found through Google. The search was refined to publications in English and between the years of 2003 and 2021. The keywords used were “Coronavirus” and/or “guidelines'' and/or “tracheostomy” and/or “intensive care”. Twenty-three studies were retained. Due to the complex presentation of the respiratory virus COVID-19, previously established guidelines for tracheostomies had to be reevaluated to determine if these guidelines were still applicable to these critically ill ventilated patients. More specifically, medical guidelines state benefits to early tracheostomies in critically ill ventilated non-COVID-19 patients. However, after having conducted this review, the assumptions about the benefits of early tracheostomies in critically ill ventilated patients may not be appropriate for COVID-19 patients.

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Section: Discussionmentioning

confidence: 99%

“…Mandal et al [ 17 ] performed a review of papers that took into consideration COVID-19 patients that required tracheostomies. This study examined guidelines for timing, staff safety, procedure, technique, and post-operative care.…”

Section: Clinical Presentationsmentioning

confidence: 99%

Timing of tracheostomy in mechanically ventilated COVID-19 patients

Amadi¹,

Trivedi²,

Ahmed³

2021

WJCCM

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“…The role of tracheotomy in affected patients is still hazy: few data are reported about the indications, timing, clinical results, and percentage of complications. However there are no current guidelines regarding the optimal time of tracheostomy in COVID-19 patients but most of the European countries following local policy of 14 days before performing tracheostomy [ 5 , 6 ]. The American Academy of Otolaryngology: Head and Neck Surgery has recommended a multidisciplinary approach in determining indications for tracheotomy in patients with COVID-19.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Tracheotomy for Covid-19 Pneumonia: Impacts on Survival and Prognostic Factors

Tuna

Birdane

2021

Indian J Otolaryngol Head Neck Surg

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The role of tracheotomy during the pandemic remains to be determined for severe COVID-19 pneumonia. We evaluated the effect of tracheotomy on prognostic markers and assessed 4 weeks survival in terms of clinical and biochemical characteristics of patients and time and type (open or percutaneous) of the operation. We performed a retrospective study considering ICU patients with COVID-19 pneumonia and tracheotomy, between May 30 and December 31, 2020. Four weeks survival postoperatively and alteration of biochemical markers were analyzed. 24 patients with COVID-19 pneumonia and tracheotomy, included in this study. Median age was 68.3 years (range 38–90) with male:female ratio 16:8. All the patients were diagnosed with COVID-19 pneumonia considering clinical symptoms and COVID-19 specific CT findings. RT-PCR test results were positive in 58.3%. Prognostic markers were found to be increased postoperatively with both types of surgery (75%). 1 week and 4 weeks survival after the operation was 66.7% and 45.8%, respectively. 4 weeks survival was decreased significantly with NLR ≥ 10 compared to NLR < 10 (15.3–81.8%). Nevertheless, 4 weeks survival differences between males and females (12.5% and 62.5%) and between age ≤ 50 and > 50 (100% and 35%) were also found to be statistically significant. Patients with younger age, male gender, and NLR < 10, were found to have longer survival after tracheotomy. Positive PCR results and preoperative critically increased biochemical markers were related to decreased survival. The number of comorbidities, time and type of surgery, and postoperative increment of prognostic markers seemed not to affect survival.

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“…Early tracheostomy is a definitive airway technique in the form of a tracheostomy performed within the first 10 days after intubation. The criteria are i) an endotracheal tube has been held for ≥14 days with a lot of bronchial secret production; ii) the decision is determined by two or more intensivists; iii) the surgeon who performs it agrees in determining the urgency of tracheostomy; iv) the patient gets mechanical ventilation with minimum requirement FiO2 ≤50% and PEEP ≤10; e) good prognosis (exclusion if the patient is >70 years old, with multiple organ failure, and does not have severe coagulopathy) [26], [27].…”

Section: Patient Number Three a 72-year-old Womanmentioning

confidence: 99%

Pneumothorax and pneumomediastinum among COVID-19 patients with mechanical ventilation: a case series

Luthfiana¹,

Faisal²,

Rosadi³

2023

IJPHS

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The incidence of pneumothorax is 10% of all COVID-19 patients and increases in patients who develop acute respiratory distress syndrome (ARDS) with mechanical ventilation, responsible for 24% of the population. As many as 60.7% of patients who have complications of pneumothorax or pneumomediastinum lead to mortality. This study was established to determine the potential of early tracheostomy in preventing the occurrence of pneumothorax and pneumomediastinum in COVID-19 and reducing mortality. This research was conducted as a descriptive study by case series of three COVID-19 patients in Jakarta, Indonesia in the span of 2021-2022. Tracheostomy performed within 10 days, did not develop a pneumothorax. Although, the patient did not have any comorbidities, age below 70 years, and coagulopathy problem, there was still a risk of recurrent pneumothorax post COVID-19 after tracheostomy. However, a tracheostomy is a procedure that poses an aerosol risk, so there is concern about the transmission of COVID-19 to medical personnel who perform it. Early tracheostomy has the potential to accelerate the resolution of COVID-19 disease in patients and has a positive impact on lung vitality. It is aimed to prevent hypoxic conditions and optimize the lung recruitment process. In addition, they did not experience complications from COVID-19 in the form of an air leak syndrome such as a pneumothorax or pneumomediastinum.

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A Systematic Review on Tracheostomy in COVID-19 Patients: Current Guidelines and Safety Measures

Cited by 7 publications

References 27 publications

Timing of tracheostomy in mechanically ventilated COVID-19 patients

Timing of tracheostomy in mechanically ventilated COVID-19 patients

The Efficacy of Tracheotomy for Covid-19 Pneumonia: Impacts on Survival and Prognostic Factors

Pneumothorax and pneumomediastinum among COVID-19 patients with mechanical ventilation: a case series

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