Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals

Staibano, Phillip; Levin, Marc; McHugh, Tobial; Gupta, Mukesh; Sommer, Doron D.

doi:10.1001/jamaoto.2021.0930

Cited by 24 publications

(45 citation statements)

References 111 publications

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“…This is the largest and most comprehensive meta-analysis to date examining tracheostomy timing in patients with COVID-19. Unlike a meta-analysis included studies published before March 4, 2021 [ 50 ], we observed a decrease in time to ventilation weaning when patients underwent ET. This is most likely attributable to the addition of several studies after March 4, 2021.…”

Section: Discussioncontrasting

confidence: 79%

Tracheostomy timing and clinical outcomes in ventilated COVID-19 patients: a systematic review and meta-analysis

Fang²,

Cheng

et al. 2022

Crit Care

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Background The association of tracheostomy timing and clinical outcomes in ventilated COVID-19 patients remains controversial. We performed a meta-analysis to evaluate the impact of early tracheostomy compared to late tracheostomy on COVID-19 patients’ outcomes. Methods We searched Medline, Embase, Cochrane, and Scopus database, along with medRxiv, bioRxiv, and Research Square, from December 1, 2019, to August 24, 2021. Early tracheostomy was defined as a tracheostomy conducted 14 days or less after initiation of invasive mechanical ventilation (IMV). Late tracheostomy was any time thereafter. Duration of IMV, duration of ICU stay, and overall mortality were the primary outcomes of the meta-analysis. Pooled odds ratios (OR) or the mean differences (MD) with 95%CIs were calculated using a random-effects model. Results Fourteen studies with a cumulative 2371 tracheostomized COVID-19 patients were included in this review. Early tracheostomy was associated with significant reductions in duration of IMV (2098 patients; MD − 9.08 days, 95% CI − 10.91 to − 7.26 days, p < 0.01) and duration of ICU stay (1224 patients; MD − 9.41 days, 95% CI − 12.36 to − 6.46 days, p < 0.01). Mortality was reported for 2343 patients and was comparable between groups (OR 1.09, 95% CI 0.79–1.51, p = 0.59). Conclusions The results of this meta-analysis suggest that, compared with late tracheostomy, early tracheostomy in COVID-19 patients was associated with shorter duration of IMV and ICU stay without modifying the mortality rate. These findings may have important implications to improve ICU availability during the COVID-19 pandemic. Trial registration The protocol was registered at INPLASY (INPLASY202180088).

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Section: Discussioncontrasting

confidence: 79%

Tracheostomy timing and clinical outcomes in ventilated COVID-19 patients: a systematic review and meta-analysis

Fang²,

Cheng

et al. 2022

Crit Care

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“…Recent systematic reviews have attempted to assess the utility of performing tracheotomy in the critically ill COVID-19 patient population [ 2 , 4 ]. While these suggest some potential benefits in terms of decreased ICU (intensive care unit) stay and overall mortality, the level of heterogeneity and possible selection bias leave interpretation of these results open.…”

Section: Utility Of Performing Tracheotomy In the Critical Care Covid-19 Populationmentioning

confidence: 99%

“… If a patient is COVID-19 positive and it has been less than 20 days since symptom onset or first positive RT-PCR, we recommend against performing a tracheotomy in this group of patients who are potentially still infectious [ 2 , 3 , 11 , 12 ]. This should only generally be considered in this situation if the endotracheal tube is proving insufficient to provide an adequate airway, or an emergent procedure is required [ 1 ].…”

Section: Changes To Previous Recommendationsmentioning

confidence: 99%

“… Regarding type of tracheotomy, either a percutaneous or open tracheotomy may be performed if clinically indicated. Based on recent evidence [ 2 ], outcomes and risk to the patient and healthcare workers appear to be similar for performance of both percutaneous tracheotomy and open tracheotomy [ 20 , 21 ]. …”

Section: Changes To Previous Recommendationsmentioning

confidence: 99%

“…In April 2020, the CSO-HNS (Canadian Society of Otolaryngology-Head & Neck Surgery) taskforce published recommendations on performance of tracheotomy during the COVID-19 pandemic [ 1 ]. Tracheotomy is considered an AGMP (aerosol generating medical procedure) with significant risks of viral transmission [ 2 – 4 ]. Since then, there has been a growing body of evidence that has helped guide management decisions, however, some issues such as mutant viral strains continue to evolve while others remain unclear.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Revised recommendations from the CSO-HNS taskforce on performance of tracheotomy during the COVID-19 pandemic – what a difference a year makes

Sommer

Côté

McHugh

et al. 2021

Journal of Otolaryngology - Head & Neck Surgery

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Background During the early part of the COVID-19 pandemic, the Canadian Society of Otolaryngology - Head & Neck Surgery (CSO-HNS) task force published recommendations on performance of tracheotomy. Since then, our understanding of the virus has evolved with ongoing intensive research efforts. New literature has helped us better understand various aspects including patient outcomes and health care worker (HCW) risks associated with tracheotomy during the COVID-19 pandemic. Accordingly, the task force has re-evaluated and revised some of the previous recommendations. Main body Based on recent evidence, a negative reverse transcription polymerase chain reaction (RT-PCR) COVID-19 swab status is no longer the main deciding factor in the timing of tracheotomy. Instead, tracheotomy may be considered as soon as COVID-19 swab positive patients are greater than 20 days beyond initial symptoms and 2 weeks of mechanical ventilation. Furthermore, both open and percutaneous surgical techniques may be considered with both techniques showing similar safety and outcome profiles. Additional recommendations with discussion of current evidence are presented. Conclusion These revised recommendations apply new evidence in optimizing patient and health care system outcomes as well as minimizing risks of COVID-19 transmission during aerosol-generating tracheotomy procedures. As previously noted, additional evidence may lead to further evolution of these and other similar recommendations. Graphical abstract

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A retrospective analysis of COVID‐19 tracheostomies: Early versus late tracheostomy

Bui

Kasabali

Dewan

2023

Laryngoscope Investig Oto

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ObjectivesTo assess the impact of early tracheostomy (ET) versus late tracheostomy (LT) placement on mortality and decannulation rates of COVID patients.MethodsA retrospective chart review was performed of all patients infected with COVID‐19 who underwent tracheostomy tube placement in an Ochsner‐affiliated hospital from March 2020 to May 2022. Patients were identified using the electronic medical record and data was collated using the “Epic SlicerDicer” tool. Descriptive statistics were gathered and compared between patients who underwent ET placement and those who underwent LT placement. Patient demographics, previous medical history, tracheostomy procedural details, arterial blood gases, complications, and outcomes including time to wean from the ventilator, and time to decannulation were recorded.ResultsTwo‐hundred nineteen patients were included in the study. There were no statistically significant differences in liberation from mechanical ventilation rates between early and LT (62% vs. 55%, p = .19), or in decannulation rates (40% vs. 32%, p = .14). The mean duration of time to liberation from mechanical ventilation for early trach was 13.88 versus 18.17 days for late trach, however, no statistically significant difference was found (p = .12). Similarly, mean duration of time to decannulation was 41.17 days for early versus 47.72 for late trach (p = .15).ConclusionContrary to some studies in the literature, the results presented here suggest ETs are not associated with hastened liberation from mechanical ventilation or increased decannulation rates. Further prospective studies may be warranted in assessing the impact of early versus LT in the COVID patient population.Level of EvidenceIII.

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Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals

Cited by 24 publications

References 111 publications

Tracheostomy timing and clinical outcomes in ventilated COVID-19 patients: a systematic review and meta-analysis

Tracheostomy timing and clinical outcomes in ventilated COVID-19 patients: a systematic review and meta-analysis

Revised recommendations from the CSO-HNS taskforce on performance of tracheotomy during the COVID-19 pandemic – what a difference a year makes

A retrospective analysis of COVID‐19 tracheostomies: Early versus late tracheostomy

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