Outcomes in Severe COVID-19 Patients Following Percutaneous Versus Open Surgical Tracheostomy: An Analysis of Clinical and Prognostic Indicators

Akbari, Ali; Shekouhi, Ramin; Khaloo, Vahid; Shamsi, Tahereh; Sohooli, Maryam; Hosseini, Seyed Vahid; Ghahramani, Leila

doi:10.7759/cureus.32487

Cited by 3 publications

(5 citation statements)

References 29 publications

(27 reference statements)

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“…Furthermore, the SOFA score was higher with statistically significant differences in patients taken to open tracheostomy. However, a retrospective observational study involving 72 patients reported a mortality rate of 92% in patients who underwent open tracheostomy compared to 65.9% in the percutaneous tracheostomy group in patients with Sars-Cov2 infection [ 12 ], suggesting that the technique employed may influence mortality, as evidenced in the results of this study.…”

Section: Discussionmentioning

confidence: 81%

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Open versus percutaneous tracheostomy in patients with COVID-19: retrospective cohort analysis

González-Muñoz,

Ramírez-Giraldo,

Peña Suárez

et al. 2023

BMC Pulm Med

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Background During the COVID-19 pandemic, a great number of patients required Mechanical Ventilation (MV). Tracheostomy is the preferred procedure when difficult weaning is presented. Surgical techniques available for performing tracheostomy are open and percutaneous, with contradictory reports on the right choice. This paper aims to describe the clinical results after performing a tracheostomy in patients with COVID-19, regarding both surgical techniques. Methods An observational, analytical study of a retrospective cohort was designed. All patients admitted to the Hospital Universitario Mayor Méderi, between March 2020 and April 2021 who presented COVID-19 requiring MV and who underwent tracheostomy were reviewed. Open versus percutaneous tracheostomy groups were compared and the primary outcome evaluated was in-hospital mortality. Results A total of 113 patients were included in the final analysis. The median age was 66.0 (IQR: 57.2 – 72.0) years old and 77 (68.14%) were male. Open tracheostomy was performed in 64.6% (n = 73) of the patients and percutaneous tracheostomy in 35.4% (n = 40) with an in-hospital mortality of 65.7% (n = 48) and 25% (n = 10), respectively (p < 0.001). In a multivariate analysis, open tracheostomy technique [OR 9.45 (95% CI 3.20–27.92)], older age [OR 1.05 (95% CI 1.01–1.09)] and APACHE II score [OR 1.10 (95% CI 1.02–1.19)] were identified as independent risk factors for in-hospital mortality. Late tracheostomy (after 14 days) [OR 0.31 (95% CI 0.09–1.02)] and tracheostomy day PaO2/FiO2 [OR 1.10 (95% CI 1.02–1.19)] were not associated to in-hospital mortality. Conclusions Percutaneous tracheostomy was independently associated with lower in-hospital mortality and should be considered the first option to perform this type of surgery in patients with COVID-19 in extended MV or difficulty weaning.

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Section: Discussionmentioning

confidence: 81%

“…Surgical techniques for tracheostomy are open and percutaneous, with contradictory reports about the preferred choice [ 12 – 14 ]. This paper aims to describe the clinical results and complications after tracheostomy in patients with COVID-19, according to both surgical techniques.…”

Section: Introductionmentioning

confidence: 99%

Open versus percutaneous tracheostomy in patients with COVID-19: retrospective cohort analysis

González-Muñoz,

Ramírez-Giraldo,

Peña Suárez

et al. 2023

BMC Pulm Med

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“…Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), caused by the novel coronavirus, has rapidly caused a global health crisis. Coronavirus disease 2019 (COVID-19) clinical manifestations range from asymptomatic individuals to respiratory arrest needing mechanical ventilation, with a significant death and morbidity rate, especially in the elderly [1]. In the pathophysiology of COVID-19 infection, the angiotensinconverting-enzyme receptor 2 (ACE2) plays a critical role [2].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 Induces Body Composition and Metabolic Alterations

Yazdanpanah¹,

Mardani²,

Osati³

et al. 2023

Cureus

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BackgroundIndividuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are highly susceptible to disease-related metabolic dysregulation given the hyperinflammatory immune response of coronavirus disease 2019 . These changes are remarkably involved in multiple steps in adipogenesis and lipolysis. This study aimed to elaborate on the significant relations of COVID-19 infection with body fat distribution, changes in serum insulin, and homeostasis model assessment-estimated insulin resistance (HOMA-IR) levels before and after the infection. MethodsIn this follow-up study, from July 2021 to September 2021, persons referred to a university-affiliated Nutrition Counselling Clinic were randomly selected for the study samples. Validated food frequency (FFQ) and physical activity questionnaires were completed. Body composition was assessed in this investigation. On the second visit, those who reported mild to moderate COVID-19 infection (without hospitalization) were selected as the case group and the asymptomatic individuals as the control group. All measurements were re-measured in the second visit. ResultsIn a total of 441 patients, the mean age was 38.82±4.63 years. There were 224 (50.79%) male subjects, and 217 (49.20%) were females. There was a statistically significant difference in the longitudinal change in total fat percentage between subjects with and without COVID-19. Also, the difference in HOMA-IR before and after COVID-19 in case groups (both males and females) was statistically significant (P-value < 0.001). Moreover, serum insulin levels were significantly increased in all cases (P-value < 0.001), while remaining stable in control groups. When compared to their initial visit, COVID-19 patients' total fat percentage rose significantly (almost 2%) following a hypocaloric diet. Participants who were not infected with COVID-19 had a lower total fat percentage than those who were. Serum insulin and HOMA-IR levels increased significantly after infection compared to the primary measurements. ConclusionIndividuals with COVID-19 infection may require tailored medical nutrition therapy to improve short and long-term COVID-19 outcomes such as muscle loss and fat accommodation.

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“…The novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) has further dramatically impacted all areas of healthcare, and it is especially evident across critical care settings with a significant increase in the incidence of tracheostomy (Akbari et al, 2022;Singh et al, 2022;Vuu et al, 2022;Williams & McGrath, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…The novel severe acute respiratory syndrome coronavirus (SARS‐CoV‐2) has further dramatically impacted all areas of healthcare, and it is especially evident across critical care settings with a significant increase in the incidence of tracheostomy (Akbari et al, 2022; Singh et al, 2022; Vuu et al, 2022; Williams & McGrath, 2021). Unfortunately, the emergence of the virus has created a high‐risk tracheostomy patient care environment where healthcare providers are at an elevated risk for viral infections through droplets and aerosolized secretions (McGrath, Brenner, et al, 2020;Meister et al, 2021; Pandian et al, 2020; Zaga et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of interprofessional tracheostomy teams: A systematic review

Ninan

Grubb

Brenner

et al. 2023

Journal of Clinical Nursing

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Aim(s)To systematically locate, evaluate and synthesize evidence regarding effectiveness of interprofessional tracheostomy teams in increasing speaking valve use and decreasing time to speech and decannulation, adverse events, lengths of stay (intensive care unit (ICU) and hospital) and mortality. In addition, to evaluate facilitators and barriers to implementing an interprofessional tracheostomy team in hospital settings.DesignSystematic review using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) and Johns Hopkins Nursing Evidence‐Based Practice Model's guidance.MethodsOur clinical question: Do interprofessional tracheostomy teams increase speaking valve use and decrease time to speech and decannulation, adverse events, lengths of stay and mortality? Primary studies involving adult patients with a tracheostomy were included. Eligible studies were systematically reviewed by two reviewers and verified by another two reviewers.Data SourcesMEDLINE, CINAHL and EMBASE.ResultsFourteen studies met eligibility criteria; primarily pre‐post intervention cohort studies. Percent increase in speaking valve use ranged 14%–275%; percent reduction in median days to speech ranged 33%–73% and median days to decannulation ranged 26%–32%; percent reduction in rate of adverse events ranged 32%–88%; percent reduction in median hospital length of stay days ranged 18–40 days; no significant change in overall ICU length of stay and mortality rates. Facilitators include team education, coverage, rounds, standardization, communication, lead personnel and automation, patient tracking; barrier is financial.ConclusionPatients with tracheostomy who received care from a dedicated interprofessional team showed improvements in several clinical outcomes.Implications for Patient CareAdditional high‐quality evidence from rigorous, well‐controlled and adequately powered studies are necessary, as are implementation strategies to promote broader adoption of interprofessional tracheostomy team strategies. Interprofessional tracheostomy teams are associated with improved safety and quality of care.ImpactEvidence from review provides rationale for broader implementation of interprofessional tracheostomy teams.Reporting MethodPRISMA and Synthesis Without Meta‐analysis (SWiM).Patient/Public ContributionNone.

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Outcomes in Severe COVID-19 Patients Following Percutaneous Versus Open Surgical Tracheostomy: An Analysis of Clinical and Prognostic Indicators

Cited by 3 publications

References 29 publications

Open versus percutaneous tracheostomy in patients with COVID-19: retrospective cohort analysis

Open versus percutaneous tracheostomy in patients with COVID-19: retrospective cohort analysis

COVID-19 Induces Body Composition and Metabolic Alterations

Effectiveness of interprofessional tracheostomy teams: A systematic review

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