Systematic review and meta-analysis of tracheostomy outcomes in COVID-19 patients

Ferro, A; Kotecha, Sanjeev; Auzinger, G.; Yeung, Elizabeth; Fan, Kathleen

doi:10.1016/j.bjoms.2021.05.011

Cited by 35 publications

(52 citation statements)

References 75 publications

(379 reference statements)

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“…This is most likely attributable to the addition of several studies after March 4, 2021. Another meta-analysis has also failed to show that ET improves the rate of overall mortality, but this meta-analysis was limited due to the small number of patients investigated [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…Johansson et al 34 Intravenous prostacyclin failed to show benefit in mortality, ventilator-free days, need for RRT or vasopressor requirement. Ferro et al 35 Early tracheostomy did not confer mortality benefit nor did it decrease the time to ECMO decannulation. Staibano et al 37 Tracheostomy decreased mortality in COVID-19 patients, and early tracheostomy resulted in shorter ICU duration of stay.…”

Section: Covid-19mentioning

confidence: 95%

“…Two meta-analyses from the past year evaluated for similar findings in the COVID-19 population. 35,36…”

Section: Covid-19mentioning

confidence: 99%

“…Two metaanalyses from the past year evaluated for similar findings in the COVID-19 population. 35,36 Ferro et al reviewed 39 studies from the United States, the United Kingdom, Spain, Italy, China, and India which investigated outcomes following tracheostomy in COVID-19 patients. 35 Included studies were those specific to COVID-19 that included outcome data for mortality, timing of decannulation, weaning of mechanical ventilation, and complication rates.…”

Section: Tracheostomymentioning

confidence: 99%

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Year in Review 2021: Noteworthy Literature in Cardiothoracic Critical Care

Weitzel

2022

Semin Cardiothorac Vasc Anesth

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This year marked a number of milestones in critical care. As vaccines for the SARS-CoV-2 virus became widely available and were confirmed to be exceptionally effective against severe illness and hospitalization, we were then faced with new variants and the resource-intense responses necessary to combat them. Despite challenges new and old, we have persevered and continued to provide excellent care to our patients while pushing the boundaries of clinical research. This article is a collection of studies published in 2021 relevant to critical care, with a specific focus on cardiothoracic critical care. To ignore the impact of the COVID-19 pandemic would do a disservice to our colleagues, many of whom have made incredible breakthroughs in novel therapies to the coronavirus, and yet we present additional themes of delirium, acute kidney injury, lung transplant, advances in ECMO as well as biomarkers of sepsis.

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“…Tracheostomy is considered an effective alternative to invasive MV via tracheal tube since it helps to reduce dead-space ventilation and decreases airway resistance and the risk of aspiration, as well as the need for sedation, facilitating weaning from a ventilator [ 18 ]. During the COVID-19 pandemic, there was incomplete evidence that early tracheostomy is preferable to late tracheostomy, and there is no compelling evidence that percutaneous is preferable to surgical (open) [ 5 , 19 , 20 , 21 ]. Consequently, the appropriate MV strategy for COVID-19 respiratory failure is still disputed.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Different Ventilatory Strategies on Clinical Outcomes in Patients with COVID-19 Pneumonia

Rocans

Ozoliņa

Battaglini

et al. 2022

JCM

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Introduction: The aim was to investigate the impact of different ventilator strategies (non-invasive ventilation (NIV); invasive MV with tracheal tube (TT) and with tracheostomy (TS) on outcomes (mortality and intensive care unit (ICU) length of stay) in patients with COVID-19. We also assessed the impact of timing of percutaneous tracheostomy and other risk factors on mortality. Methods: The retrospective cohort included 868 patients with severe COVID-19. Demographics, MV parameters and duration, and ICU mortality were collected. Results: MV was provided in 530 (61.1%) patients, divided into three groups: NIV (n = 139), TT (n = 313), and TS (n = 78). Prevalence of tracheostomy was 14.7%, and ICU mortality was 90.4%, 60.2%, and 30.2% in TT, TS, and NIV groups, respectively (p < 0.001). Tracheostomy increased the chances of survival and being discharged from ICU (OR 6.3, p < 0.001) despite prolonging ICU stay compared to the TT group (22.2 days vs. 10.7 days, p < 0.001) without differences in survival rates between early and late tracheostomy. Patients who only received invasive MV had higher odds of survival compared to those receiving NIV in ICU prior to invasive MV (OR 2.7, p = 0.001). The odds of death increased with age (OR 1.032, p < 0.001), obesity (1.58, p = 0.041), chronic renal disease (1.57, p = 0.019), sepsis (2.8, p < 0.001), acute kidney injury (1.7, p = 0.049), multiple organ dysfunction (3.2, p < 0.001), and ARDS (3.3, p < 0.001). Conclusions: Percutaneous tracheostomy compared to MV via TT significantly increased survival and the rate of discharge from ICU, without differences between early or late tracheostomy.

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Systematic review and meta-analysis of tracheostomy outcomes in COVID-19 patients

Cited by 35 publications

References 75 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

Year in Review 2021: Noteworthy Literature in Cardiothoracic Critical Care

The Impact of Different Ventilatory Strategies on Clinical Outcomes in Patients with COVID-19 Pneumonia

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