The safety and efficacy of open bedside tracheotomy: A retrospective analysis of 1000 patients

Liao, David; Mehta, Vikas; Kinkhabwala, Corin; Li, Daniel; Palsen, Sarah; Schiff, Bradley A.

doi:10.1002/lary.28234

Cited by 16 publications

(37 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…25,26 In a study by Liao et al, among 1,000 patients undergoing tracheotomies, the incidence of minor complications was 20% and the incidence of major complications were 1%. 15 We reported a minor complication rate of 9% and major complication rate of 9%. The slight increase in major complications in our study may be attributable to the effects of COVID-19 on the respiratory system as well as changes in surgical technique for COVID-19 patients.…”

Section: Tracheotomy Complicationsmentioning

confidence: 78%

Tracheotomy Outcomes in 64 Ventilated COVID‐19 Patients at a High‐Volume Center in Bronx, NY

et al. 2021

Self Cite

View full text Add to dashboard Cite

Objectives/Hypothesis: The COVID-19 pandemic has resulted in a dramatic increase in the number of patients requiring prolonged mechanical ventilation. Few studies have reported COVID-19 specific tracheotomy outcomes, and the optimal timing and patient selection criteria for tracheotomy remains undetermined. We delineate our outcomes for tracheotomies performed on COVID-19 patients during the peak of the pandemic at a major epicenter in the United States.Methods: This is a retrospective observational cohort study. Mortality, ventilation liberation rate, complication rate, and decannulation rate were analyzed.Results: Sixty-four patients with COVID-19 underwent tracheotomy between April 1, 2020 and May 19, 2020 at two tertiary care hospitals in Bronx, New York. The average duration of intubation prior to tracheotomy was 20 days ((interquartile range [IQR] 16.5-26.0). The mortality rate was 33% (n = 21), the ventilation liberation rate was 47% (n = 30), the decannulation rate was 28% (n = 18), and the complication rate was 19% (n = 12). Tracheotomies performed by Otolaryngology were associated with significantly improved survival (P < .05) with 60% of patients alive at the conclusion of the study compared to 9%, 12%, and 19% of patients undergoing tracheotomy performed by Critical Care, General Surgery, and Pulmonology, respectively.Conclusions: So far, this is the second largest study describing tracheotomy outcomes in COVID-19 patients in the United States. Our early outcomes demonstrate successful ventilation liberation and decannulation in COVID-19 patients. Further inquiry is necessary to determine the optimal timing and identification of patient risk factors predictive of improved survival in COVID-19 patients undergoing tracheotomy.

show abstract

Section: Tracheotomy Complicationsmentioning

confidence: 78%

Tracheotomy Outcomes in 64 Ventilated COVID‐19 Patients at a High‐Volume Center in Bronx, NY

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…The observed pooled rate for decannulation in this study (34.9%) fits within the broad range of reported decannulation rates for critical care patients in the literature (16.7%-94%). [38][39][40][41] A recent study by Liao et al 39 observed a 16.7% decannulation rate in a consecutive series of 1000 ICU patients who underwent bedside tracheotomy, most commonly for prolonged intubation (96.6%), with an average time to decannulation of 40.9 days. While tracheotomy has not yet been demonstrated to provide a mortality benefit in patients with COVID-19, the well-known long-term sequelae of prolonged intubation have made it a necessary component of the management of patients with COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Tracheotomy in COVID‐19 Patients: A Systematic Review and Meta‐analysis of Weaning, Decannulation, and Survival

Benito

Bestourous

Tong

et al. 2021

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

Objectives A systematic review and meta-analysis was conducted to determine the cumulative incidences of decannulation and mechanical ventilation weaning in patients with coronavirus disease 2019 (COVID-19) who have undergone a tracheotomy. Weighted average mean times to tracheotomy, to decannulation, and to death were calculated from reported or approximated means. Data Sources PubMed, SCOPUS, CINAHL, and the Cochrane library. Review Methods Studies were screened by 3 investigators independently. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Studies including patients with COVID-19 who underwent a tracheotomy were identified. Studies without reported mechanical ventilation weaning or decannulation were excluded. Data were pooled using a random-effects model. Results After identifying 232 unique studies, 18 articles encompassing outcomes for 3234 patients were ultimately included for meta-analysis, with a weighted mean follow-up time of 28.6 ± 6.2 days after tracheotomy. Meta-analysis revealed that 55.0% of tracheotomized patients were weaned successfully from mechanical ventilation (95% CI, 47.4%-62.2%). Approximately 34.9% of patients were decannulated successfully, with a mean decannulation time of 18.6 ± 5.7 days after tracheotomy. The pooled mortality in tracheotomized patients with COVID-19 was 13.1%, with a mean time of death of 13.0 ± 4.0 days following tracheotomy. Conclusion At the current state of the coronavirus pandemic, over half of patients who have required tracheotomies are being weaned off of mechanical ventilation. While 13.1% patients have died prior to decannulation, over a third of all tracheotomized patients with COVID-19 reported in the literature have undergone successful decannulation.

show abstract

“…In particular, very high max-PEEP, comorbidity and sex were not associated with higher complication rates. In the literature, the association between comorbidity and the incidence of postoperative complications after tracheostomy is controversial: some Authors [19] didn't report any relationship, while others [20 , 21] described an association between obesity and late complications (airway stenosis), and between chronic hepatitis or platelet count and the risk of mortality. However, we must underline that the small sample size is a limit of this study, therefore we can't exclude that comorbidities or other variables could be associated with higher complication rates if the patients’ number was higher.…”

Section: Discussionmentioning

confidence: 99%

Comparison of percutaneous dilatational tracheotomy versus open surgical technique in severe COVID-19: Complication rates, relative risks and benefits

et al. 2021

View full text Add to dashboard Cite

Objective Patients with acute respiratory failure due to COVID-19 have a high likelihood of needing prolonged intubation and may subsequently require tracheotomy. Usually, the choice of technique (percutaneous dilatational tracheotomy [PDT] versus open surgical tracheotomy [OST]) depends on the preference of surgeons and patient-related factors. In case of COVID-19, airborne spread of viral particles and limited time of apnea must be considered in the choice of the safest technique. The aim of this study is to compare the complication rates and offer an assessment of relative risks and benefits of PDT versus OST in patients with severe COVID-19. Methods We performed a retrospective study considering 47 consecutive patients affected by severe acute respiratory distress syndrome due to SARS-CoV-2 infection, needing invasive mechanical ventilation and subsequent tracheostomy. This study was performed at the Intensive Care Unit of our tertiary referral center. Complication rates were analyzed. Results Seventeen patients underwent PDT and 30 patients were submitted to OST. Twenty-six patients (55.3%) had post-operative complications (local infection, hemorrhage, subcutaneous emphysema) with no significant difference between PDT and OST. Conclusion PDT and OST are characterized by similar postoperative complication rates in severe COVID-19 patients. These findings suggest that OST might be preferred if expert ENT surgeons are available, as PDT could result in longer apnea and exposure to generated aerosol. However, authors recommend considering either OST or PDT at the discretion of the medical staff involved, according to the personal experience of the operators performing the procedure.

show abstract

The safety and efficacy of open bedside tracheotomy: A retrospective analysis of 1000 patients

Cited by 16 publications

References 35 publications

Tracheotomy Outcomes in 64 Ventilated COVID‐19 Patients at a High‐Volume Center in Bronx, NY

Tracheotomy Outcomes in 64 Ventilated COVID‐19 Patients at a High‐Volume Center in Bronx, NY

Tracheotomy in COVID‐19 Patients: A Systematic Review and Meta‐analysis of Weaning, Decannulation, and Survival

Comparison of percutaneous dilatational tracheotomy versus open surgical technique in severe COVID-19: Complication rates, relative risks and benefits

Contact Info

Product

Resources

About