Management of tracheostomy in COVID-19 patients: The Japanese experience

Yokokawa, Taizo; Ariizumi, Yosuke; Hiramatsu, Masayuki; Kato, Yukari; Endo, Kazuhira; Obata, Kazufumi; Kawashima, Kayoko; Sakata, Toshifumi; Hirano, Shigeru; Nakashima, Torahiko; Sekine, Tatsurou; Kiyuna, Asanori; Uemura, Saeko; Okubo, Keisuke; Sugimoto, Taro; Tateya, Ichiro; Fujimoto, Yasushi; Horii, Arata; Kimura, Yurika; Hyodo, Masamitsu; Homma, Akihiro

doi:10.1016/j.anl.2021.01.006

Cited by 19 publications

(11 citation statements)

References 19 publications

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“…In a multicenter prospective cohort study using propensity score matching that was conducted using data from 50 countries, among patients with acute respiratory distress syndrome, those who underwent tracheostomy reportedly had significantly lower 28-day hospital mortality rates than those who did not undergo tracheostomy [27] . Consequently, the potential improvement of outcomes caused by implementation of tracheostomy in COVID-19 patients has been investigated and described in several case series since the outbreak of the pandemic [ 16 , 17 , 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Earlier studies reported the risk for surgical providers to be directly exposed to the virus via aerosols during the procedure; therefore, international guidelines recommend delayed tracheostomy and extended MV with translaryngeal endotracheal intubation for at least 14 days or until a negative polymerase chain reaction result [12] , [13] , [14] . However, after a year into the COVID-19 pandemic, the risk of transmission of the virus to healthcare staff has been reported to be negligible with proper use of personal protective equipment [15] , [16] , [17] . Moreover, a safe tracheostomy procedure has been established [18] , and proactive and aggressive implementation of tracheostomy within 14 days after COVID-19 infection is again being considered [ 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association between tracheostomy and survival in patients with coronavirus disease 2019 who require prolonged mechanical ventilation for more than 14 days: A multicenter cohort study

Tanaka¹,

Uchiyama²,

Kitamura³

et al. 2023

Auris Nasus Larynx

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between tracheostomy and survival in patients with coronavirus disease 2019 who require prolonged mechanical ventilation for more than 14 days: A multicenter cohort study

Tanaka¹,

Uchiyama²,

Kitamura³

et al. 2023

Auris Nasus Larynx

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“…32,33 Therefore, numerous early guidelines and recommendations suggested that tracheostomy should be delayed beyond 21 days of IMV, and percutaneous tracheostomy is favored over open surgical tracheostomy. [34][35][36][37][38][39] However, for patients with unfavorable neck anatomy, open surgical tracheostomy is more practical despite the increased risk of aerosolized transmission upon opening of airway and known viability of SARS-CoV-2 to remain infectious in aerosols for hours and surfaces for days. [39][40][41] However, multiple observational studies have since been published to refute this hypothesis, demonstrating no risk of aerosolized transmission when adequate personal protective equipment (PPE) was used, regardless of tracheostomy technique.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Early Versus Late Tracheostomy in Coronavirus Disease 2019 Patients: A Systematic Review and Meta-Analysis

Chong

Tan

2022

J Intensive Care Med

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Background A significant proportion of Coronavirus Disease 2019 (COVID-19) patients require admission to the intensive care unit (ICU) and invasive mechanical ventilation (IMV). Tracheostomy is increasingly performed when a prolonged course of IMV is anticipated. Objectives To determine clinical and resource utilization benefits of early versus late tracheostomy among COVID-19 patients. Methods Pubmed, Cochrane Library, Scopus, and Embase were used to identify relevant studies comparing outcomes of COVID-19 patients undergoing early and late tracheostomy from January 1, 2020, to December 1, 2021. Results Twelve studies were selected, and 2222 critically ill COVID-19 patients hospitalized between January to December 2020 were included. Among the included patients, 34.5% and 65.5% underwent early and late tracheostomy, respectively. Among the included studies, 58.3% and 41.7% defined early tracheostomy using cutoffs of 14 and 10 days, respectively. All-cause in-hospital mortality was not different between the early and late tracheostomy groups (32.9% vs. 33.1%; OR = 1.00; P = 0.98). Sensitivity analysis demonstrated a similar mortality rate in studies using a cutoff of 10 days (34.6% vs. 35.5%; OR = 0.97; P = 0.89) or 14 days (31.2% vs. 27.7%; OR = 1.05; P = 0.78). The early tracheostomy group had shorter ICU length of stay (LOS) (mean: 23.18 vs. 30.51 days; P < 0.001) and IMV duration (mean: 20.49 vs. 28.94 days; P < 0.001) than the late tracheostomy group. The time from tracheostomy to decannulation was longer (mean: 23.36 vs. 16.24 days; P = 0.02) in the early tracheostomy group than in the late tracheostomy group, but the time from tracheostomy to IMV weaning was similar in both groups. Other clinical characteristics, including age, were similar in both groups. Conclusions Early tracheostomy reduced the ICU LOS and IMV duration among COVID-19 patients compared with late tracheostomy, but the mortality rate was similar in both groups. The findings have important implications for the treatment of COVID-19 patients, especially in a resource-limited setting.

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“…There have been a number of reports on the surgical methods, timing of tracheostomy, and its prognosis [ 3 – 5 ]. However, while evidence for surgical procedures and prevention of infection by medical staff has been established [ 2 – 6 ], the timing and indication of tracheostomy are controversial. Some reports have shown that patients who undergo earlier tracheostomy tend to achieve earlier ventilator liberation than others [ 3 ], and another report mentioned that tracheostomy should be performed approximately 7–14 days after intubation [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes after tracheostomy in patients with coronavirus disease 2019: a single-center experience in Japan

et al. 2022

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Purpose Many patients with coronavirus disease 2019 require mechanical ventilation and tracheostomy. However, the timing and indications for tracheostomy are controversial. This study assessed 11 patients with coronavirus disease 2019 who underwent tracheostomy with clinical information and retrospective analyses. Methods A single-center retrospective observational study was performed on patients with coronavirus disease 2019 who underwent tracheostomy between 2020 and 2021. Results Failure to wean was the most common indication for tracheostomy, followed by extracorporeal membrane oxygenation decannulation and the need for secretion management. After tracheostomy, six patients (54.5%) were liberated from the ventilator. The time from intubation to tracheostomy (21.1 ± 9.14 days) was correlated with the duration of ventilator dependency (36.83 ± 20.45 days, r 2 = 0.792, p = 0.018). The mean Acute Physiological and Chronic Health Evaluation II score was significantly lower in the ventilator-liberated group (23 ± 2.77) than in the non-ventilator-liberated group (31 ± 6.13, p = 0.0292). Furthermore, patients with Acute Physiological and Chronic Health Evaluation II scores of < 27 points achieved ventilator liberation and a long-term survival ( p = 0.0006). Conclusions This study describes the outcomes of a cohort of patients who underwent tracheostomy after intubation for coronavirus disease 2019. The Acute Physiological and Chronic Health Evaluation II score predicted whether or not the patient could achieve ventilator liberation.

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Management of tracheostomy in COVID-19 patients: The Japanese experience

Cited by 19 publications

References 19 publications

Association between tracheostomy and survival in patients with coronavirus disease 2019 who require prolonged mechanical ventilation for more than 14 days: A multicenter cohort study

Association between tracheostomy and survival in patients with coronavirus disease 2019 who require prolonged mechanical ventilation for more than 14 days: A multicenter cohort study

Clinical Outcomes of Early Versus Late Tracheostomy in Coronavirus Disease 2019 Patients: A Systematic Review and Meta-Analysis

Clinical outcomes after tracheostomy in patients with coronavirus disease 2019: a single-center experience in Japan

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