Percutaneous and Open Tracheostomy in Patients With <scp>COVID</scp>‐19: The Weill Cornell Experience in New York City

Long, Stacey R.; Feit, Noah Z.; Chern, Alexander; Cooley, Victoria; Hill, Shanna S.; Rajwani, Kapil; Schenck, Edward J.; Stiles, Brendon M.; Tassler, Andrew B.

doi:10.1002/lary.29669

Cited by 13 publications

(32 citation statements)

References 42 publications

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“…On the other hand, the literature is concordant in finding no major differences in outcomes between surgical and percutaneous tracheostomy when performed in COVID-19 patients, as also confirmed by our series 23 . Naturally, as a rule of thumb, the major concern in tracheostomy preparation should always be to allow a safe tracheal opening, without damaging the surrounding laryngotracheal framework.…”

Section: Discussionsupporting

confidence: 88%

Post-COVID-19 airway stenosis treated by tracheal resection and anastomosis: a bicentric experience

Piazza

Lancini

Filauro

et al. 2022

Acta Otorhinolaryngol Ital

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SUMMARY Objective The COVID-19 pandemic was an extraordinary challenge for the global healthcare system not only for the number of patients affected by pulmonary disease, but also for the incidence of long-term sequalae. In this regard, laryngo-tracheal stenosis (LTS) represents one of the most common complications of invasive ventilation. Methods A case series of patients who underwent tracheal resection and anastomosis (TRA) for post-COVID-19 LTS was collected from June 2020 to September 2021. Results Among 14 patients included, 50% had diabetes and 64.3% were obese. During intensive care unit stay, mean duration of orotracheal intubation (OTI) was 15.2 days and 10 patients (71.4%) underwent tracheostomy, which was maintained in 7 for an average of 31 days. According to the European Laryngological Society classification, 13 patients (92.9%) had a grade IIIa LTS and one a grade IIIa+. All patients underwent Type A TRA, according to the authors’ classification. No major perioperative complications were reported and at the last follow-up all patients were asymptomatic. Conclusions With the appropriate indications, TRA represents an effective treatment in post-COVID-19 LTS patients. Short OTI times and careful tracheostomy are required in order to reduce the incidence of airway injury.

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Section: Discussionsupporting

confidence: 88%

Post-COVID-19 airway stenosis treated by tracheal resection and anastomosis: a bicentric experience

Piazza

Lancini

Filauro

et al. 2022

Acta Otorhinolaryngol Ital

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“…Of the TRCs, 105 (69.1%) were requests for new tracheostomy and 47 (30.9%) were consults for tracheostomy-related issues, including size adjustments, bleeding, concern for peristomal infection or granulation, and concern for tracheitis. As documented separately, both open and percutaneous tracheostomies were performed at our institution, in traditional ICUs, operating rooms or operating rooms converted to ICUs, after a median intubation time of 24 days [ 13 ].…”

Section: Resultsmentioning

confidence: 99%

“…4 B). Our department’s experience with tracheostomies during the COVID-19 pandemic has been previously documented in detail [ 4 , 13 ].…”

Section: Resultsmentioning

confidence: 99%

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Essential inpatient otolaryngology: what COVID-19 has revealed

Shomorony

Chern

Long

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose To identify areas of critical otolaryngology contributions to inpatient care resistant to disruption by the COVID-19 pandemic. Methods Medical records of 614 otolaryngology consults seen between January and June of 2019 and 602 seen between January and June of 2020 were reviewed. Extracted data included patient demographics, SARS-CoV-2 status, medical comorbidities, consult location, consult category, reason for consult, procedures performed, and overall outcome. Prevalence of data items was compared using t tests and Chi-squared tests. ResultsThe number of monthly consults to the otolaryngology service remained approximately stable after the onset of the COVID-19 pandemic. However, there was a substantial increase in ICU consults and a decrease in ER and floor consults. The proportion of otology, rhinology, and head and neck consults decreased while that of airway consults-most of which were tracheostomy-related-greatly increased. While the top ten reasons for consult remained essentially the same, they dramatically increased as a percentage of consults during COVID-19 (55-92%), whereas there was a dramatic decrease in the proportion of less frequent consults. Conclusion The changes in otolaryngology consultation patterns seen after the onset of the pandemic are multifactorial, but may be attributed to novel pathologies, attitudes, and policies. Nonetheless, these patterns reveal that a set of core otolaryngologic issues, including acute airway issues, head and neck lesions, severe sinusitis and epistaxis, are essential and need to be addressed in the inpatient setting, whereas the significant drop in other consults suggests that they may be appropriately managed on an outpatient basis.

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“…Due to the high volume of patients requiring mechanical ventilation in NYC, tracheostomy offered an opportunity to relieve resources and facilitate ventilator weaning, including personnel to manage ventilation and sedation, as well as equipment associated with endotracheal management. 5 Additionally, benefits of tracheostomy include improved comfort and reduced need of sedation, paralytic support, and subsequent intensive care unit (ICU)–level support, which reduced the risk of COVID-19 transmission among health care workers. 6 Therefore, percutaneous and open tracheostomies were common in many hospitals in NYC, and current data show that tracheostomy in patients with COVID-19 was safe and had high utility.…”

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confidence: 99%

Tracheostomy Outcomes in Patients With COVID‐19 at a New York City Hospital

Sharma¹,

Grewal²,

Long³

et al. 2022

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Objective Tracheostomies have been performed in patients with prolonged intubation due to COVID-19. Understanding outcomes in different populations is crucial to tackle future epidemics. Study Design Prospective cohort study. Setting Tertiary academic medical center in New York City. Methods A prospectively collected database of patients with COVID-19 undergoing open tracheostomy between March 2020 and April 2020 was reviewed. Primary endpoints were weaning from the ventilator and from sedation and time to decannulation. Results Sixty-six patients underwent tracheostomy. There were 42 males (64%) with an average age of 62 years (range, 23-91). Patients were intubated for a median time of 26 days prior to tracheostomy (interquartile range [IQR], 23-30). The median time to weaning from ventilatory support after tracheostomy was 18 days (IQR, 10-29). Of those sedated at the time of tracheostomy, the median time to discontinuation of sedation was 5 days (IQR, 3-9). Of patients who survived, 39 (69%) were decannulated. Of those decannulated before discharge (n = 39), the median time to decannulation was 36 days (IQR, 27-49) following tracheostomy. The median time from ventilator liberation to decannulation was 14 days (IQR, 8-22). Thirteen patients (20.0%) had minor bleeding requiring packing. Two patients (3%) had bleeding requiring neck exploration. The all-cause mortality rate was 10.6%. No patients died of procedural causes, and no surgeons acquired COVID-19. Conclusion Open tracheostomies were successfully and safely performed at our institution in the peak of the COVID-19 pandemic. The majority of patients were successfully weaned from the ventilator and sedation. Approximately 60% of patients were decannulated prior to hospital discharge.

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Percutaneous and Open Tracheostomy in Patients With COVID‐19: The Weill Cornell Experience in New York City

Cited by 13 publications

References 42 publications

Post-COVID-19 airway stenosis treated by tracheal resection and anastomosis: a bicentric experience

Post-COVID-19 airway stenosis treated by tracheal resection and anastomosis: a bicentric experience

Essential inpatient otolaryngology: what COVID-19 has revealed

Tracheostomy Outcomes in Patients With COVID‐19 at a New York City Hospital

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