Tracheotomies in COVID-19 Patients: Protocols and Outcomes

Carlson, Eric R.; Heidel, R. Eric; Houston, Kyle; Vahdani, Soheil; Winstead, Michael

doi:10.1016/j.joms.2021.03.004

Cited by 7 publications

(8 citation statements)

References 34 publications

(47 reference statements)

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“…We thus moved to placing Shiley 6 distal XLT tracheostomies as our default device. 13,14 Our median times to tracheostomy (19 d) and times to weaning (17 d) are similar to other reports in the literature. [2][3][4]15,16 Mata-Castro et al 16 found that a longer time from intubation to tracheostomy was related to a longer time from tracheostomy to weaning.…”

Section: Discussionsupporting

confidence: 88%

Outcomes of Percutaneous Tracheostomy for Patients With SARS-CoV-2 Respiratory Failure

Arnold¹,

Gao

Malsin

et al. 2022

Journal of Bronchology &Amp; Interventional Pulmonology

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Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause severe respiratory failure leading to prolonged mechanical ventilation. Data are just emerging about the practice and outcomes of tracheostomy in these patients. We reviewed our experience with tracheostomies for SARS-CoV-2. Methods: We retrospectively reviewed the demographics, comorbidities, timing of mechanical ventilation, tracheostomy, and intensive care unit and hospital lengths of stay in SARS-CoV-2 patients who received tracheostomies performed by the interventional pulmonary team. A tertiary care, teaching hospital in Chicago, Illinois. From March 2020 to April 2021, our center had 473 patients intubated for SARS-CoV-2, and 72 (15%) had percutaneous bedside tracheostomy performed by the interventional pulmonary team. Results: Median time from intubation to tracheostomy was 20 (interquartile range: 16 to 25) days. Demographics and comorbidities were similar between early and late tracheostomy, but early tracheostomy was associated with shorter intensive care unit lengths of stay and a shorter total duration of ventilation. To date, 39 (54%) patients have been decannulated, 17 (24%) before hospital discharge; median time to decannulation was 22 (IQR: 18 to 36) days. Patients that were decannulated were younger (56 vs. 69 y). The rate of decannulation for survivors was 82%. No providers developed symptoms or tested positive for SARS-CoV-2. Conclusion: Tracheostomy enhances care for patients with prolonged respiratory failure from SARS-CoV-2 since early tracheostomy is associated with shorter duration of critical care, and decannulation rates are high for survivors. It furthermore appears safe for both patients and operators.

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Section: Discussionsupporting

confidence: 88%

Outcomes of Percutaneous Tracheostomy for Patients With SARS-CoV-2 Respiratory Failure

Arnold¹,

Gao

Malsin

et al. 2022

Journal of Bronchology &Amp; Interventional Pulmonology

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“…Our findings are similar to a previous study by Carlson et al: of 17 COVID-19 patients who underwent tracheotomy, those who did and did not survive differed significantly in terms of mean PaO 2 /FiO 2 ratio (203 and 138, respectively). 21 Our results expand upon these findings by stratifying a larger cohort of patients into 3 FiO 2 groups (<40%, 41%-65%, 66%-100%). We found that an FiO 2 > 65% at the time of tracheotomy resulted in a significantly higher chance of 30-day mortality.…”

Section: Discussionsupporting

confidence: 76%

“…While most of the body of literature regarding post-tracheotomy mortality draws from the pre-pandemic era, 18-20 there are recent studies evaluating the outcomes of patients with COVID-19. These have indicated that the timing of tracheotomy following intubation, 5-7,9 patient age, 21 and partial pressure of oxygen (PaO 2 )/FiO 2 ratio 21 correlate with patient survival after tracheotomy placement.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Mortality in Patients With COVID-19 Undergoing Tracheotomy

Mitton

Atwood

Kenee

et al. 2022

Ann Otol Rhinol Laryngol

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Objective: To identify factors predictive of 30-day mortality following tracheotomy in patients with COVID-19. Methods: A retrospective chart review of patients with COVID-19 who underwent tracheotomy at a tertiary medical center between March 2020 and October 2021 was conducted. Univariate and multivariable analyses of factors correlated with 30-day post-tracheotomy mortality were performed. The outcomes of tracheotomies performed in the operating room and at bedside were compared with t-tests and multivariable analysis. Results: One hundred-twenty patients met inclusion criteria, with 48 female patients (40%). Mean age was 59.8 [12.6] years, and the 30-day mortality rate was 18.3%. On univariate analysis, age (odds ratio (OR) = 1.06; P = .015), FiO2 at the time of tracheotomy (OR = 1.06; P < .001), and bedside tracheotomy (OR = 3.21; P = .019) were associated with increased risk of 30-day mortality. After including control variables, increased FiO2 continued to predict increased odds of 30-day mortality (OR = 1.08; P = .02); specifically, patients with FiO2 > 65% were significantly more likely to pass within 30 days than those with FiO2 ≤ 40% (OR = 28.24; P < .001). There was a significant difference in the 30-day mortality rate of bedside tracheotomies (31%) and OR tracheotomies (12%; P = .02), but this association was eliminated on multivariable analysis (OR = 0.95; P = .96). Conclusion: Intubated patients with COVID-19 undergoing tracheotomy with FiO2 > 65% have 25 times greater odds of 30-day mortality than those with FiO2 ≤ 40%. There were no differences in outcomes between bedside and OR tracheotomies.

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“…This study adds to emerging data supporting the safety of tracheostomy insertion in patients with Covid-19 (48,49,(78)(79)(80)(81)(82)(83). Similar to other studies, no staff transmission was reported (79)(80)(81)(82)(83), highlighting the importance of adhering to guidance, and the effectiveness of full PPE (44,(61)(62)(63)(64)(65)(78)(79)(80)(81)(82)(83)(84)(85). Despite these reassuring findings, the possibility of staff transmission of Covid-19 during aerosol generating procedures should not be discounted.…”

Section: Discussionsupporting

confidence: 70%

Tracheostomy insertion in COVID-19: insertion practice and factors leading to unplanned tube exchange

McCauley¹,

Mohammed²,

Casey³

et al. 2023

J Thorac Dis

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Background: Tracheostomy insertion in patients with Covid-19 presents unique challenges. Patients frequently have high ventilatory requirements, and as an aerosol generating procedure, tracheostomy insertion creates the potential for staff transmission. Problems with tracheostomies contribute to morbidity and mortality, and tracheostomy changes may increase risks of staff transmission. We sought to quantify the incidence of clinically necessitated tracheostomy changes, establish the indications for change and investigate the incidence of staff transmission. Methods: We conducted a single institution, retrospective, observational cohort study of all intensive care unit (ICU) patients with Covid-19 who had a tracheostomy between March 2020 and April 2021. The institution is a large tertiary referral centre in Ireland. Results: Forty-three patients had a tracheostomy during the study period. All were a Shiley™ Flexible Adult Taperguard or Shiley™ XLT Tracheostomy. 14 patients (33%) required a tracheostomy change, with the majority (57%) involving a change from a standard size to an extended length tracheostomy. Persistent leak was the most common indication for change (71.6%). Other indications included patient-ventilator dyssynchrony, persistent cough and accidental decannulation. No staff transmission of Covid-19 occurred during this study. Conclusions: The incidence of tracheostomy change was 33%, highlighting the importance of selecting the right tracheostomy for each patient. We discuss how key characteristics of tracheostomies such as type, size, length and inner diameter may impact flow, resistance and work of breathing, leading to unplanned tracheostomy change. No staff transmission occurred arising from tracheostomy insertion, adding to increasing evidence that tracheostomy insertion in Covid-19 appears safe with adherence to guidelines describing the correct use of personal protective equipment.

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Tracheotomies in COVID-19 Patients: Protocols and Outcomes

Cited by 7 publications

References 34 publications

Outcomes of Percutaneous Tracheostomy for Patients With SARS-CoV-2 Respiratory Failure

Outcomes of Percutaneous Tracheostomy for Patients With SARS-CoV-2 Respiratory Failure

Predictors of Mortality in Patients With COVID-19 Undergoing Tracheotomy

Tracheostomy insertion in COVID-19: insertion practice and factors leading to unplanned tube exchange

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