Tracheostomy Timing and Outcome in Severe COVID-19: The WeanTrach Multicenter Study

Abstract

Background: Tracheostomy can be performed safely in patients with coronavirus disease 2019 (COVID-19). However, little is known about the optimal timing, effects on outcome, and complications. Methods: A multicenter, retrospective, observational study. This study included 153 tracheostomized COVID-19 patients from 11 intensive care units (ICUs). The primary endpoint was the median time to tracheostomy in critically ill COVID-19 patients. Secondary endpoints were survival rate, length of ICU stay, and post-tracheostomy complications, stratified by tracheostomy timing (early versus late) and technique (surgical versus percutaneous). Results: The median time to tracheostomy was 15 (1–64) days. There was no significant difference in survival between critically ill COVID-19 patients who received tracheostomy before versus after day 15, nor between surgical and percutaneous techniques. ICU length of stay was shorter with early compared to late tracheostomy (p < 0.001) and percutaneous compared to surgical tracheostomy (p = 0.050). The rate of lower respiratory tract infections was higher with surgical versus percutaneous technique (p = 0.007). Conclusions: Among critically ill patients with COVID-19, neither early nor percutaneous tracheostomy improved outcomes, but did shorten ICU stay. Infectious complications were less frequent with percutaneous than surgical tracheostomy.

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

“… 3 Though we withheld therapeutic dose, low molecular weight heparin 24 hours prior to procedure as a protocol, still the presence of a hypocoagulative state (DIC like state), with increase in proinflammatory cytokines, coagulation disorders, and endothelial and microvascular damage, may have contributed to the bleeding complication. 1 In most patients, bleeding was managed conservatively, except one where surgical intervention was needed.…”

“…Tracheostomy is a standard of care in patients on invasive mechanical ventilation in coronavirus disease-2019 (COVID-19). 1 – 3 Despite some guidelines and case series published, evidence on weaning and mortality after elective Tracheostomy in critical COVID-19 patients on mechanical ventilation from India is scarce. 4 – 7…”

Complicaciones de traqueotomías asociadas a intubaciones prolongadas. Revisión sistemática

“…Además, Battaglin et al (32), indicaron que la TQ tardía tiende a tener mayores días de estancia en las UCI (TQ temprana vs TQ tardía; 24,0 IQR [5-98] vs 46 IQR ; p: <.001).…”

Soporte ventilatorio en pacientes críticos con COVID-19:a 18 meses de la pandemia en Chile

“…Múltiples series han demostrado que la técnica percutánea (con o sin apoyo broncoscópico) es segura y eficiente en este contexto [65]. Si bien la discusión en la literatura ha estado enfocada en identificar los beneficios de la traqueostomía precoz versus tardía en el contexto CoviD-19 [66]- [68], creemos que hay que replantear el foco de la pregunta. Más allá de determinar la mejor temporalidad del procedimiento, hay que intentar identificar aquellos pacientes en que el procedimiento maximizará sus chances de liberarse del ventilador mecánico y de sobrevida.…”