Association of mortality and early tracheostomy in patients with COVID-19: a retrospective analysis

Flinspach, Armin Niklas; Booke, Hendrik; Zacharowski, Kai; Balaban, Ümniye; Herrmann, Eva; Adam, Elisabeth Hannah

doi:10.1038/s41598-022-19567-w

Cited by 6 publications

(6 citation statements)

References 49 publications

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“…We also found a lower incidence of tracheostomy in the second wave. This is in line with earlier research showing that early tracheostomy does not improve patient outcome [ 27 , 28 ]. This analysis showed a shorter duration of ventilation and a shorter length of hospital and ICU stay in survivors in the second wave.…”

Section: Discussionsupporting

confidence: 92%

Differences in Ventilation Management and Outcomes between the Two First Waves of the COVID-19 Pandemic—A Comparison between Two Nationwide Observational Studies in The Netherlands

Hol

Schultz

Martín‐Loeches

et al. 2023

JCM

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The aim of this analysis was to compare ventilation management and outcomes in invasively ventilated patients with acute hypoxemic respiratory failure due to coronavirus disease 2019 (COVID-19) between the first and second wave in the Netherlands. This is a post hoc analysis of two nationwide observational COVID-19 studies conducted in quick succession. The primary endpoint was ventilation management. Secondary endpoints were tracheostomy use, duration of ventilation, intensive care unit (ICU) and hospital length of stay (LOS), and mortality. We used propensity score matching to control for observed confounding factors. This analysis included 1122 patients from the first and 568 patients from the second wave. Patients in the second wave were sicker, had more comorbidities, and had worse oxygenation parameters. They were ventilated with lower positive end-expiratory pressure and higher fraction inspired oxygen, had a lower oxygen saturation, received neuromuscular blockade more often, and were less often tracheostomized. Duration of ventilation was shorter, but mortality rates were similar. After matching, the fraction of inspired oxygen was lower in the second wave. In patients with acute hypoxemic respiratory failure due to COVID-19, aspects of respiratory care and outcomes rapidly changed over the successive waves.

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Section: Discussionsupporting

confidence: 92%

Differences in Ventilation Management and Outcomes between the Two First Waves of the COVID-19 Pandemic—A Comparison between Two Nationwide Observational Studies in The Netherlands

Hol

Schultz

Martín‐Loeches

et al. 2023

JCM

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“…15 Flinspach et al published a study in September 2022 that included 117 patients from March 2020 to June 2021 and reported that early tracheostomy was associated with significant increase in mortality. 16 They also noted that the timing of tracheostomy became earlier as the pandemic progressed and more studies 12 confirmed the risk of viral transmission to HCW was less than previously thought and as resources became more easily available. A smaller study involving 47 patients by Battaglini et al in August 2022 reported that timing did not really affect patient outcomes.…”

Section: Discussionmentioning

confidence: 97%

Percutaneous tracheostomy in patients with COVID-19 infection and acute respiratory failure

Singh¹,

Sarwar²,

Hurtado³

et al. 2023

The Chronicles

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Background: Tracheostomy is often performed in patients who need prolonged intubation. COVID -19 brought unforeseen challenges, thus altering previously established norms. In this study, the outcomes of the patients undergoing tracheostomy for respiratory failure due to COVID -19 were studied. Methods: This is a single center retrospective observational cohort study of patients who underwent percutaneous tracheostomies between March 1, 2020, and September 30, 2021, due to respiratory failure secondary to COVID-19. Inclusion criteria included performance of percutaneous tracheostomies on patients with confirmed diagnosis of COVID-19. Exclusion criteria included patients undergoing surgical tracheostomies, extubation prior to the performance of a tracheotomy, and death prior to the performance of the tracheotomy. Results: The study included 49 patients after reviewing the records of 101 patients who underwent tracheostomies during the study period. The average age of the population was 59 ± 11years; 33 patients (67%) were men. The median Sequential Organ Failure Assessment (SOFA) score on admission was 2. The median duration of mechanical ventilation prior to tracheostomy was 18 days; the median positive end expiratory pressure was 10 cm H2O and the median fraction of inspired oxygen (FiO2) was 0.45. Two patients died during the procedure, one secondary to cardiac arrest and one secondary to bleeding. Eighteen patients (38%) died after the procedure during hospitalization; the median length of mechanical ventilation for all patients was 32.5 days. Eleven patients (22%) were eventually decannulated. Twenty patients (40%) were discharged to rehabilitation, and nine patients (18%) were discharged home. Eighteen patients (36%) were alive at the end of 90 days. Twelve patients (26%) were lost to follow up after discharge from the hospital. At the time of the tracheostomy, 16 patients (32%) had moderate ARDS as per the Berlin definition, and 12 (24%) had severe ARDS. Conclusion: Tracheostomy is an important therapeutic intervention in critically ill patients requiring mechanical ventilation. The COVID-19 pandemic raised important concerns and uncertainties about the management of these patients and the safety of healthcare workers. In this study, 29 patients (59%) undergoing tracheostomies recovered enough to be discharged to rehabilitation or to their homes. The risks to patients and to healthcare workers seem reasonable, but the optimal timing is uncertain and is best tailored to each patient based on his/her clinical status and prognosis. Keywords: COVID-19, tracheostomy, mechanical ventilation, acute respiratory failure

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“…Some studies revealed that early percutaneous dilatational tracheostomy was safe and could optimize clinical course of patients as well as distribution of critical care resources [ 45 – 50 ]. However, two recent studies investigating patients with COVID-19 reported an increased mortality in patients undergoing ET (< 10d after intubation; < 21d after intubation) [ 51 , 52 ]. In summary, whether patients with COVID-19 could get clinical benefits by performing early tracheostomy is still controversial, which need more investigations to figure out.…”

Section: Discussionmentioning

confidence: 99%

The impact of delayed tracheostomy on critically ill patients receiving mechanical ventilation: a retrospective cohort study in a chinese tertiary hospital

Zhao,

Zheng,

Xuan

et al. 2024

BMC Anesthesiol

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Objectives The timing of tracheostomy for critically ill patients on mechanical ventilation (MV) is a topic of controversy. Our objective was to determine the most suitable timing for tracheostomy in patients undergoing MV. Design Retrospective cohort study. Setting and participants One thousand eight hundred eighty-four hospitalisations received tracheostomy from January 2011 to December 2020 in a Chinese tertiary hospital. Methods Tracheostomy timing was divided into three groups: early tracheostomy (ET), intermediate tracheostomy (IMT), and late tracheostomy (LT), based on the duration from tracheal intubation to tracheostomy. We established two criteria to classify the timing of tracheostomy for data analysis: Criteria I (ET ≤ 5 days, 5 days < IMT ≤ 10 days, LT > 10 days) and Criteria II (ET ≤ 7 days, 7 days < IMT ≤ 14 days, LT > 14 days). Parameters such as length of ICU stay, length of hospital stay, and duration of MV were used to evaluate outcomes. Additionally, the outcomes were categorized as good prognosis, poor prognosis, and death based on the manner of hospital discharge. Student’s t-test, analysis of variance (ANOVA), Mann–Whitney U test, Kruskal–Wallis test, Chi-square test, and Fisher’s exact test were employed as appropriate to assess differences in demographic data and individual characteristics among the ET, IMT, and LT groups. Univariate Cox regression model and multivariable Cox proportional hazards regression model were utilized to determine whether delaying tracheostomy would increase the risk of death. Results In both of two criterion, patients with delayed tracheostomies had longer hospital stays (p < 0.001), ICU stays (p < 0.001), total time receiving MV (p < 0.001), time receiving MV before tracheostomy (p < 0.001), time receiving MV after tracheostomy (p < 0.001), and sedation durations. Similar results were also found in sub-population diagnosed as trauma, neurogenic or digestive disorders. Multinomial Logistic regression identified LT was independently associated with poor prognosis, whereas ET conferred no clinical benefits compared with IMT. Conclusions In a mixed ICU population, delayed tracheostomy prolonged ICU and hospital stays, sedation durations, and time receiving MV. Multinomial logistic regression analysis identified delayed tracheostomies as independently correlated with worse outcomes. Trial registration ChiCTR2100043905. Registered 05 March 2021.http://www.chictr.org.cn/listbycreater.aspx

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Association of mortality and early tracheostomy in patients with COVID-19: a retrospective analysis

Cited by 6 publications

References 49 publications

Differences in Ventilation Management and Outcomes between the Two First Waves of the COVID-19 Pandemic—A Comparison between Two Nationwide Observational Studies in The Netherlands

Differences in Ventilation Management and Outcomes between the Two First Waves of the COVID-19 Pandemic—A Comparison between Two Nationwide Observational Studies in The Netherlands

Percutaneous tracheostomy in patients with COVID-19 infection and acute respiratory failure

The impact of delayed tracheostomy on critically ill patients receiving mechanical ventilation: a retrospective cohort study in a chinese tertiary hospital

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