Practice of tracheostomy in patients with acute respiratory failure related to COVID–19 – Insights from the PRoVENT–COVID study

Tsonas, Anissa M.; Botta, Michela; Teng, Marita S.; McGrath, Brendan A.; Schultz, Marcus J.; Paulus, Frederique

doi:10.1016/j.pulmoe.2021.08.012

Cited by 10 publications

(6 citation statements)

References 41 publications

(50 reference statements)

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“…Assessing our data from the first wave, we observed long ITTs of 18.64 ± 5.46 days in April 2020. Similar data can be observed in the Netherlands, for example, which suggest that tracheostomy was performed exceptionally late during the first wave of the pandemic from March to May 2020 in comparison to standard practice 41 . This observation may be explained by particular concerns of infection of healthcare providers when performing tracheostomy at the beginning of this pandemic which resulted in recommendations by many medical societies to delay this aerosol generating procedure 28 .…”

Section: Discussionsupporting

confidence: 75%

“…With an increased mortality hazard ratio when performing tracheostomy at day 10 or earlier, early tracheostomy appears to worsen patient outcome in COVID-19. This is rather surprising, as we expected a benefit or at least non-inferiority of early tracheostomy for our patients, because studies in patients with or without COVID-19 infection scarcely indicated increased mortality in patients undergoing early tracheostomy 12 – 18 , 41 , 43 . Our data appear to indicate that delaying tracheostomy may in fact benefit our patients.…”

Section: Discussionmentioning

confidence: 80%

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

Flinspach

Booke

Zacharowski

et al. 2022

Sci Rep

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COVID-19 adds to the complexity of optimal timing for tracheostomy. Over the course of this pandemic, and expanded knowledge of the disease, many centers have changed their operating procedures and performed an early tracheostomy. We studied the data on early and delayed tracheostomy regarding patient outcome such as mortality. We performed a retrospective analysis of all tracheostomies at our institution in patients diagnosed with COVID-19 from March 2020 to June 2021. Time from intubation to tracheostomy and mortality of early (≤ 10 days) vs. late (> 10 days) tracheostomy were the primary objectives of this study. We used mixed cox-regression models to calculate the effect of distinct variables on events. We studied 117 tracheostomies. Intubation to tracheostomy shortened significantly (Spearman’s correlation coefficient; rho = − 0.44, p ≤ 0.001) during the course of this pandemic. Early tracheostomy was associated with a significant increase in mortality in uni- and multivariate analysis (Hazard ratio 1.83, 95% CI 1.07–3.17, p = 0.029). The timing of tracheostomy in COVID-19 patients has a potentially critical impact on mortality. The timing of tracheostomy has changed during this pandemic tending to be performed earlier. Future prospective research is necessary to substantiate these results.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 80%

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

Flinspach

Booke

Zacharowski

et al. 2022

Sci Rep

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“…No RCTs were, however, available for this meta-analysis. Newly published both prospective [ 21 ] and retrospective [ 22 ] studies indicate that early tracheotomy implies fewer days of MV and shorter length of stay at the ICU. In accordance to the findings of the latter studies, a retrospective analysis of COVID-19 patients from the first wave of the pandemic performed at our department suggested early tracheotomy to be correlated with a shorter time on MV and, consequently, a shorter ICU stay [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

TTCOV19: timing of tracheotomy in SARS-CoV-2-infected patients: a multicentre, single-blinded, randomized, controlled trial

et al. 2022

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Background Critically ill COVID-19 patients may develop acute respiratory distress syndrome and the need for respiratory support, including mechanical ventilation in the intensive care unit. Previous observational studies have suggested early tracheotomy to be advantageous. The aim of this parallel, multicentre, single-blinded, randomized controlled trial was to evaluate the optimal timing of tracheotomy. Methods SARS-CoV-2-infected patients within the Region Västra Götaland of Sweden who needed intubation and mechanical respiratory support were included and randomly assigned to early tracheotomy (≤ 7 days after intubation) or late tracheotomy (≥ 10 days after intubation). The primary objective was to compare the total number of mechanical ventilation days between the groups. Results One hundred fifty patients (mean age 65 years, 79% males) were included. Seventy-two patients were assigned to early tracheotomy, and 78 were assigned to late tracheotomy. One hundred two patients (68%) underwent tracheotomy of whom sixty-one underwent tracheotomy according to the protocol. The overall median number of days in mechanical ventilation was 18 (IQR 9; 28), but no significant difference was found between the two treatment regimens in the intention-to-treat analysis (between-group difference: − 1.5 days (95% CI − 5.7 to 2.8); p = 0.5). A significantly reduced number of mechanical ventilation days was found in the early tracheotomy group during the per-protocol analysis (between-group difference: − 8.0 days (95% CI − 13.8 to − 2.27); p = 0.0064). The overall correlation between the timing of tracheotomy and days of mechanical ventilation was significant (Spearman’s correlation: 0.39, p < 0.0001). The total death rate during intensive care was 32.7%, but no significant differences were found between the groups regarding survival, complications or adverse events. Conclusions The potential superiority of early tracheotomy when compared to late tracheotomy in critically ill patients with COVID-19 was not confirmed by the present randomized controlled trial but is a strategy that should be considered in selected cases where the need for MV for more than 14 days cannot be ruled out. Trial registrationNCT04412356, registered 05/24/2020. Graphic abstract

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“…Although there exist several protocols, universally accepted ones are lacking as well as RCTs on this critical issue 53 . Training in pulmonological techniques may help 54 .…”

Section: Tracheostomy and Decannulationmentioning

confidence: 99%

Prolonged Weaning and Respiratory Intensive Care Units. A Narrative Review

Ambrosino¹,

Vitacca²

2022

BRN

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Progress in management, while improving hospital survival of critically ill individuals in intensive care units (ICU), has also increased the prevalence of individuals needing prolonged weaning from mechanical ventilation (PMV). Respiratory intensive care units (RICUs) may provide an environment also for these individuals. A narrative review searching literature was performed in PubMed and Scopus databases of publications between 1990 and 2022 using the keywords "chronic critical illness", "non-invasive mechanical ventilation", "physiotherapy and ICU", "RICU", "tracheostomy", "ventilator assisted individuals", "weaning mechanical ventilation". Results show that there are recent developments in ventilatory strategies, protocols, physiotherapy, and location for individuals needing PMV to be managed also in RICU. In conclusion, present medical training of clinicians and locations like ICU do not appear to be enough to face problems posed by PMV. RICU may be helpful.

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Practice of tracheostomy in patients with acute respiratory failure related to COVID–19 – Insights from the PRoVENT–COVID study

Cited by 10 publications

References 41 publications

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

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

TTCOV19: timing of tracheotomy in SARS-CoV-2-infected patients: a multicentre, single-blinded, randomized, controlled trial

Prolonged Weaning and Respiratory Intensive Care Units. A Narrative Review

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