Tracheostomy in the coronavirus disease 2019 patient: evaluating feasibility, challenges and early outcomes of the 14-day guidance

Abstract

Objectives To report feasibility, early outcomes and challenges of implementing a 14-day threshold for undertaking surgical tracheostomy in the critically ill coronavirus disease 2019 patient. Methods Twenty-eight coronavirus disease 2019 patients underwent tracheostomy. Demographics, risk factors, ventilatory assistance, organ support and logistics were assessed. Results The mean time from intubation to tracheostomy formation was 17.0 days (standard deviation = 4.4, range 8–26 days). Mean time to decannulation was 15.8 days (standard deviation = 9.4) and mean time to intensive care unit stepdown to a ward was 19.2 days (standard deviation = 6.8). The time from intubation to tracheostomy was strongly positively correlated with: duration of mechanical ventilation (r(23) = 0.66; p < 0.001), time from intubation to decannulation (r(23) = 0.66; p < 0.001) and time from intubation to intensive care unit discharge (r(23) = 0.71; p < 0.001). Conclusion Performing a tracheostomy in coronavirus disease 2019 positive patients at 8–14 days following intubation is compatible with favourable outcomes. Multidisciplinary team input is crucial to patient selection.

Assessment of the harms and potential benefits of tracheostomy in COVID-19 patients: Narrative review of outcomes and recommendations

“…et al [ 7 ] 72 Median 26 (IQR18.8–3) 44/72 61.1% median 10 days 25/72 7/72 (9.7%) Tornari C. et al [ 5 ] 78 b Median 21 (IQR 15–28) 46/69 (66.6%) 35/69 4/78 (5.1%) Picetti E. et al [ 8 ] 66 Retrospective study Mean 21.4 days (SD 7.2) N/A 15/66 (22.7%) Chao T.N. et al [ 12 ] 53 Minimum 14 days PT 30/53 (56.6%) 11.8 days (SD 6.9) 7/53 (13.2%) 16.6 days (SD 5.0) 6/53 (11.3%) Botti C. et al [ 13 ] 44 Median 22 days PI Median 35 days PI (18–79) Mean 36 (10–77) day PT 15/44 (34.1%) Floyd E. et al [ 14 ] 38 Minimum 14 days PT 21/38 (55.2%) median 10 days 7/38 (18.4%) median 14 days 2/38 (5.3%) Zuazua-Gonzalez A. et al [ 6 ] 30 Minimum 14 days PT 7/30 mean 28.14 days (SD 10.1) N/A 17/30 (56.7%) Glibbery N. et al [ 15 ] 28 Mean 57.7 PT (SD11.7) 25/28 mean 13.4 days PT N/A mean 15.8 day PT 2/28 (7.1%) Volo et al [ 16 ] 23 Median 50 days N/A 6/23 (26%) 9/23 (39%) Zhang X et al [ 17 ] 11 Retrospective study 9/11 (81.8%) mean 6.9 days N/A N/A Broderick D. et al [ 18 ] …”

“…Experts in the field suggest that applying the essential infection-control measures would lessen the viral transmissibility. As evidenced by this review, in all the tracheostomies carried out in multiple centres worldwide, regardless of the timing or the technique, none of the health care workers or hospital staff involved in the procedure, be it surgeons, anaesthesiologists or nurses, reported any symptoms and/or demonstrated seroconversion within 2 weeks of this procedure, provided that they all followed the guidelines and committed to the use of appropriate PPE and adhered to strict donning and doffing procedures [ [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] ].…”

Tracheostomy is Safe in Patients with Prolonged Intubation After Coronavirus Disease 2019 Infection

“…To our knowledge, there are no previous studies that have evaluated outcomes of COVID-19 patients who received tracheostomies after 21 days of intubation. Prior studies have focused on tracheostomies performed an average of 10-20 days post intubation and demonstrated variable mortality rates 7-24% 6 , 7 , 8 , 9 . Our study seeks to examine the in-hospital mortality rate and outcomes of patients with COVID-19 undergoing tracheostomy.…”

Coronavirus disease 2019 in otolaryngology: special issue

“…As represented by several articles in this month's issue, Covid-19 has, in many cases, resulted in the restructuring of ENT services, including ENT out-patient departments, 3 head and neck cancer services, 4,5 tracheostomy provision and care, 6 surgical techniques, 7 novel methods for performing flexible nasolaryngoscopy, 8 and PPE use. 9…”