Assessment of the harms and potential benefits of tracheostomy in COVID-19 patients: Narrative review of outcomes and recommendations

Omari, Ahmad Al; Al-Ashqar, Ra'ed; Alrhman, Rasha Alabd; Nuseir, Amjad; Allan, Hadeel; Alzoubi, Firas

doi:10.1016/j.amjoto.2021.102972

Cited by 11 publications

(14 citation statements)

References 42 publications

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“…7 However, recommendations have been made that suggest tracheostomy may be indicated as soon as 7 days after intubation. 4 Aerosol-generating procedures such as tracheostomy placement are high risk procedures for infection of droplettransmitted viruses to health care providers. 8 Nevertheless, the original Angel et al cohort of 98 COVID-19 patients that underwent PDT demonstrated feasibility and safety of a modified technique that placed bronchoscope alongside the endotracheal tube (ETT) in order to minimalize aerosolization.…”

Section: Introductionmentioning

confidence: 99%

“…However, the timing for tracheostomy placement and weaning protocols have not been widely agreed upon or extensively documented. 4 Initial recommendations from the American Academy of Otolaryngology for the timing of COVID-19 tracheostomy placement were to wait a minimum of 14 days after intubation in order to have a better idea of the individual patient prognosis. 5 Other studies have suggested that the window for a safe tracheostomy is anywhere from 10 to 21 days after intubation.…”

Section: Introductionmentioning

confidence: 99%

“… 7 However, recommendations have been made that suggest tracheostomy may be indicated as soon as 7 days after intubation. 4 …”

Section: Introductionmentioning

confidence: 99%

“… 9 Many other studies have also demonstrated the safety and efficacy of the modified PDT technique, but data on patient weaning, decannulation, and mortality is limited, with few studies reporting follow-up duration beyond 30 days. 4 In addition, mortality rates after tracheostomy are also highly variable, with some centers reporting rates as low as 5%, and others as high as 60%. 4 More data regarding weaning, decannulation, and mortality along with longer-term follow-up of COVID-19 patients that underwent tracheostomy is necessary in order to optimize patient care for those hospitalized with COVID-19 complications.…”

Section: Introductionmentioning

confidence: 99%

“… 4 In addition, mortality rates after tracheostomy are also highly variable, with some centers reporting rates as low as 5%, and others as high as 60%. 4 More data regarding weaning, decannulation, and mortality along with longer-term follow-up of COVID-19 patients that underwent tracheostomy is necessary in order to optimize patient care for those hospitalized with COVID-19 complications. In this article, we describe a novel modified technique of the Ciaglia dilatational percutaneous tracheostomy, 30 and 60 day mortality, weaning data, and decannulation rates.…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 Tracheostomy: Experience in a University Hospital With Intermediate Follow-up

Sood

Palleiko

Alape-Moya

et al. 2021

J Intensive Care Med

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The benefits of percutaneous dilational tracheostomy (PDT) placement have been well documented in patients requiring prolonged mechanical ventilation. However, the data regarding the benefit of PDT in coronavirus-2019 (COVID-19) patients are scarce. The objective of this study is to evaluate the outcomes of a cohort of 37 patients who underwent tracheostomy as part of their COVID-19 care. Retrospective data from a series for 37 patients undergoing tracheostomy was collected using chart review. Primary outcomes included 30 and 60 day mortality, weaning rate, and decannulation rate. Secondary outcomes collected included admission demographics, comorbidities, and procedural information. Thirty-seven (37) patients requiring prolonged mechanical ventilation due to COVID-19. Of these 37 patients, 35 were alive 60 days post-PDT placement, 33 have been weaned from mechanical ventilation and 18 have been decannulated. The low mortality and high decannulation rates in this cohort in is a promising development in the care of critically ill COVID-19 patients. Of note, all participating physicians underwent routine polymerase chain reaction (PCR) testing for infection with the severe acute respiratory syndrome coronavirus-2 virus and no physician contracted COVID-19 as a result of their involvement. Overall, this case series describes the modified PDT technique used by our team and discusses the feasibility and potential benefit to PDT placement in COVID-19 patients requiring long-term mechanical ventilation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“… 7 However, recommendations have been made that suggest tracheostomy may be indicated as soon as 7 days after intubation. 4 …”

Section: Introductionmentioning

confidence: 99%