Tracheostomy in COVID‐19 Patients: Why Delay or Avoid?

Kwak, Paul E.; Persky, Michael J.; Angel, Luis F.; Rafeq, Samaan; Amin, Milan R.

doi:10.1177/0194599820953371

Cited by 6 publications

(19 citation statements)

References 6 publications

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“…Volo et al found that early tracheostomy (within 10 days) was associated with higher mortality rate [ 3 ]. However, this study is an exception as the majority investigators report no difference in mortality, but found that early tracheostomy benefits in sedation reduction, secretion management, IMV weaning, ICU length of stay and time to decannulation [ [4] , [5] , [6] , 15 ]. Nevertheless, most of these studies did not follow the patients for long periods.…”

Section: Discussionmentioning

confidence: 91%

“…Since the outbreak of the pandemic there is a rigorous discussion regarding many aspects of the tracheostomy procedure and mainly regarding the appropriate timing. Current studies show conflicting results about the effect of the timing of the procedure on mortality, length of stay at the ICU, time to decannulation and more [ 1 , [3] , [4] , [5] , [6] ]. Due to the inconsistent results, different recently published guidelines on tracheostomy in COVID-19 patients present contradicting suggestions regarding the appropriate timing to operate [ [7] , [8] , [9] , [10] ].…”

Section: Introductionmentioning

confidence: 99%

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Early vs. late tracheostomy in ventilated COVID-19 patients – A retrospective study

Livneh

Mansour

Lerner

et al. 2021

American Journal of Otolaryngology

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Background Tracheostomy is one of the most common surgical procedures performed on ventilated COVID-19 patients yet the appropriate timing for operating is controversial. Objectives Assessing the effect of early tracheostomy on mortality and decannulation; elucidating changes in ventilation parameters, vasopressors and sedatives dosages immediately following the procedure. Methods A retrospective cohort of 38 ventilated COVID-19 patients, 19 of them (50%) underwent tracheostomy within 7 days of intubation (early tracheostomy group) and the rest underwent tracheostomy after 8 days or more (late tracheostomy group). Results Decannulation rates were significantly higher while mortality rates were non-significantly lower in the early tracheostomy group compared with the late tracheostomy group (58% vs 21% p < 0.05; 42% vs 74% p = 0.1, respectively). Tidal volume increased (446 ml vs 483 ml; p = 0.02) while PEEP (13 cmH 2 0 vs 11.6 cmH 2 O, p = 0.04) decreased at the immediate time following the procedure. No staff member participating in the procedures was infected with SARS-CoV-2 virus. Conclusion Early tracheostomy might offer improved outcomes with higher decannulation rates and lower mortality rates in ventilated COVID-19 patients, yet larger scale studies are needed. Most likely, early exposure to COVID-19 patients with appropriate personal protective equipment during open tracheostomy does not put the surgical team at risk.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Early vs. late tracheostomy in ventilated COVID-19 patients – A retrospective study

Livneh

Mansour

Lerner

et al. 2021

American Journal of Otolaryngology

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“…Decannulation and weaning from mechanical ventilation were used as independent variables. 11,12,[14][15][16]18,19 Finally, the outcome subscale revealed the length and adequacy of follow-up in studies.…”

Section: Assessment Of Study Quality and Biasmentioning

confidence: 99%

“…Data on timing of tracheotomy following intubation were reported in 17 studies. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] The estimated overall mean timing was calculated as 13.6 6 3.1 days after intubation, with a range of 0 to 42 days. Criteria for tracheotomy in each study are included in Table 1.…”

Section: Timing Of Tracheotomymentioning

confidence: 99%

“…Thus far, many case series of tracheotomies performed on patients with COVID-19 have been published in the literature. 7-23 However, there is widely varied and often inconsistent reporting relating to patient comorbidities, techniques, and short and long-term outcomes. The rapidly evolving nature of the COVID-19 pandemic has limited the quantity of reportable data available, and this scenario has made it difficult to distinguish the subset of patients with COVID-19 who would most benefit from tracheotomy.…”

mentioning

confidence: 99%

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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.

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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.

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

et al. 2021

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Objective Report long‐term tracheostomy outcomes in patients with COVID‐19. Study Design Review of prospectively collected data. Methods Prospectively collected data were extracted for adults with COVID‐19 undergoing percutaneous or open tracheostomy between April 4, 2020 and June 2, 2020 at a major medical center in New York City. The primary endpoint was weaning from mechanical ventilation. Secondary outcomes included sedation weaning, decannulation, and discharge. Results One hundred one patients underwent tracheostomy, including 48 percutaneous (48%) and 53 open (52%), after a median intubation time of 24 days (IQR 20, 31). The most common complication was minor bleeding (n = 18, 18%). The all‐cause mortality rate was 15% and no deaths were attributable to the tracheostomy. Eighty‐three patients (82%) were weaned off mechanical ventilation, 88 patients (87%) were weaned off sedation, and 72 patients (71%) were decannulated. Censored median times from tracheostomy to sedation and ventilator weaning were 8 (95% CI 6–11) and 18 (95% CI 14–22) days, respectively (uncensored: 7 and 15 days). Median time from tracheostomy to decannulation was 36 (95% CI 32–47) days (uncensored: 32 days). Of those decannulated, 82% were decannulated during their index admission. There were no differences in outcomes or complication rates between percutaneous and open tracheostomy. Likelihood of discharge from the ICU was inversely related to intubation time, though the clinical relevance of this was small (HR 0.97, 95% CI 0.943–0.998; P = .037). Conclusion Tracheostomy by either percutaneous or open technique facilitated sedation and ventilator weaning in patients with COVID‐19 after prolonged intubation. Additional study on the optimal timing of tracheostomy in patients with COVID‐19 is warranted. Level of Evidence 3 Laryngoscope , 2021

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Tracheostomy in COVID‐19 Patients: Why Delay or Avoid?

Cited by 6 publications

References 6 publications

Early vs. late tracheostomy in ventilated COVID-19 patients – A retrospective study

Early vs. late tracheostomy in ventilated COVID-19 patients – A retrospective study

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

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

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