Timing and clinical outcomes of tracheostomy in patients with COVID-19

Ahn, Dongbin; Lee, G J; Choi, Youngah; Park, J W; Kim, J K; Kim, E J; Lee, Y H

doi:10.1093/bjs/znaa064

“…The database search generated 1877 citations, of which 156 (8.3%) underwent full-text review (Figure 1). Overall, 69 studies (N = 4669 patients) were included within the qualitative synthesis, and 14 studies were included in the meta-analyses . Interrater reliability between independent reviewers was 0.81 and 0.64 for the abstract screening and full-text stages, respectively.…”

Section: Resultsmentioning

confidence: 99%

Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals

Staibano

¹

,

Levin

²

,

McHugh

³

et al. 2021

JAMA Otolaryngol Head Neck Surg

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“…Considering the risk of infection that clinicians face during tracheostomy operations, multiple consensus guidelines recommended avoiding or delaying tracheostomy at least until post-intubation day 10 [ 40 , 41 ]. Ahn et al proposed that a timely tracheostomy can be conducted regardless of intubation duration or a positive COVID-19 test [ 42 ]. In fact, COVID-19 reaches its peak concentration before day 5 and steadily decreased infectivity thereafter [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of delayed tracheostomy on critically ill patients receiving mechanical ventilation: a retrospective cohort study in a chinese tertiary hospital

Zhao,

Zheng,

Xuan

et al. 2024

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Objectives The timing of tracheostomy for critically ill patients on mechanical ventilation (MV) is a topic of controversy. Our objective was to determine the most suitable timing for tracheostomy in patients undergoing MV. Design Retrospective cohort study. Setting and participants One thousand eight hundred eighty-four hospitalisations received tracheostomy from January 2011 to December 2020 in a Chinese tertiary hospital. Methods Tracheostomy timing was divided into three groups: early tracheostomy (ET), intermediate tracheostomy (IMT), and late tracheostomy (LT), based on the duration from tracheal intubation to tracheostomy. We established two criteria to classify the timing of tracheostomy for data analysis: Criteria I (ET ≤ 5 days, 5 days < IMT ≤ 10 days, LT > 10 days) and Criteria II (ET ≤ 7 days, 7 days < IMT ≤ 14 days, LT > 14 days). Parameters such as length of ICU stay, length of hospital stay, and duration of MV were used to evaluate outcomes. Additionally, the outcomes were categorized as good prognosis, poor prognosis, and death based on the manner of hospital discharge. Student’s t-test, analysis of variance (ANOVA), Mann–Whitney U test, Kruskal–Wallis test, Chi-square test, and Fisher’s exact test were employed as appropriate to assess differences in demographic data and individual characteristics among the ET, IMT, and LT groups. Univariate Cox regression model and multivariable Cox proportional hazards regression model were utilized to determine whether delaying tracheostomy would increase the risk of death. Results In both of two criterion, patients with delayed tracheostomies had longer hospital stays (p < 0.001), ICU stays (p < 0.001), total time receiving MV (p < 0.001), time receiving MV before tracheostomy (p < 0.001), time receiving MV after tracheostomy (p < 0.001), and sedation durations. Similar results were also found in sub-population diagnosed as trauma, neurogenic or digestive disorders. Multinomial Logistic regression identified LT was independently associated with poor prognosis, whereas ET conferred no clinical benefits compared with IMT. Conclusions In a mixed ICU population, delayed tracheostomy prolonged ICU and hospital stays, sedation durations, and time receiving MV. Multinomial logistic regression analysis identified delayed tracheostomies as independently correlated with worse outcomes. Trial registration ChiCTR2100043905. Registered 05 March 2021.http://www.chictr.org.cn/listbycreater.aspx

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“… 19 , 21 – 23 Earlier recommendations deferred tracheostomy beyond 21 days of intubation to decrease the risk of infection to healthcare workers (HCWs). 24 , 25 Volo et al suggested to wait at least 14 days before tracheostomy with postponement of procedure with SOFA score >6. 19 Angel et al and Consensus group have favored tracheostomy around 10th day of intubation with maximal utilization of ICU resources in patients with clinical improvement.…”

Section: Discussionmentioning

confidence: 99%

Weaning Outcomes and 28-day Mortality after Tracheostomy in COVID-19 Patients in Central India: A Retrospective Observational Cohort Study

Gupta¹,

Sharma²,

Shrivastava³

et al. 2022

Indian Journal of Critical Care Medicine

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A bstract Background Tracheostomy is integral in long-term intensive care of coronavirus disease-2019 (COVID-19) patients. There is a paucity of studies on weaning outcomes and mortality after tracheostomy in COVID-19 in Indian scenario. Materials and methods We conducted a retrospective, single-center, observational study of severe COVID-19 patients who underwent elective tracheostomy ( n = 65) during critical care in a tertiary care institute in Central India from May 1, 2020, to April 30, 2021. Data were collected from Medical records, ICU charts, and follow-up visits by patient. A primary objective was to study the clinical characteristics, tracheostomy complications, weaning outcomes, and mortality at 28 and 60 days of ICU admission. We categorized the cohort into two groups (deceased and survivor) and studied association of clinical parameters with 28-day mortality. Cox Proportional regression analysis was applied to calculate the hazard ratio among the predictors of mortality with p value <0.05 as significant. Results Elective tracheostomy was done in 69 of 436 (15.8%) patients on invasive mechanical ventilation, of which 65 were included. Tracheostomy was percutaneous in 45/65 (69%) and surgical in 20/65 (31%) with timing from intubation as early in 41/65 and late in 24/65 with most common indication as weaning failure followed by anticipated prolonged ventilation. Tracheostomy complications were present in 29/65 (45%) patients with no difference in complication rates between timing and type of tracheostomy. Downsizing, decannulation, and weaning were successful in 22%, 32 (49%), and 35/65 (54%) patients after tracheostomy. The 28-day mortality was 30/65 (46%). The fractional inspired oxygen concentration (FiO 2 ) requirement in survivors was lower (0.4–0.6, p = 0.015) with a higher PaO 2 /FiO 2 ratio (118–200, p = 0.033). Early tracheostomy within 7 days of intubation was not associated with weaning or survival benefit. Conclusions We suggest that tracheostomy should be delayed to after 7 days of intubation, especially till FiO 2 reduces to 0.5 with improvement in PaO 2 /FiO 2 for better outcomes and avoiding a wasted procedure (CTRI/2021/07/034768). Study Highlights Tracheostomy is integral in care of COVID-19 patients needing prolonged ventilation. There is no difference in complications in early/late or percutaneous dilatational/surgical technique. We observed successful weaning post-tracheostomy in 54% patients. Mortality at 28 days was 46%. Early tracheostomy within 7 days of intubation did not improve weaning or survival. How to cite this article Karn...

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Timing and clinical outcomes of tracheostomy in patients with COVID-19

Cited by 10 publications

References 2 publications

Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals

Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals

The impact of delayed tracheostomy on critically ill patients receiving mechanical ventilation: a retrospective cohort study in a chinese tertiary hospital

Weaning Outcomes and 28-day Mortality after Tracheostomy in COVID-19 Patients in Central India: A Retrospective Observational Cohort Study

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