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

Abstract

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.

Systematic review and meta-analysis of tracheostomy outcomes in COVID-19 patients

“…Moreover, overall weighted means reported in this study are estimates, borne from differences in reporting between individual studies. As highlighted by Benito et al, this likely gives rise to selection bias 69 . Notwithstanding, the current study provides the largest meta-analysis on tracheostomy outcomes in COVID-19 patients to date, and includes an overview of key tracheostomy outcomes, as well as comparisons between clinically relevant patient cohorts.…”

“…A previous meta-analysis on tracheostomy outcomes in COVID-19 patients by Benito et al identified the cumulative incidence of mortality, mechanical weaning and decannulation across 18 studies 69 . Although this study provided useful insight into overall mortality, weaning and J o u r n a l P r e -p r o o f decannulation in the COVID-19 patient population, estimates given were limited by the comparatively short follow up durations reported at the time of meta-analysis.…”

Shared Decision-making and Stakeholder Engagement in COVID-19 Tracheostomy

“…However, each of these methods has considerable limitations. [1][2][3] Unfortunately, the authors did not present any differences in the results depending on the tracheostomy method used.…”

“…Understanding what patients and families want can inform choice or timing of interventions beyond simply surviving. 3 Early tracheostomy may mitigate airway injury risks, 4 allow earlier restoration of speech and swallowing, and avoid prolonged sedation, which risks muscle wasting, cognitive impairment, and psychiatric morbidity.…”

“…

compared with conventional hemostasis for thyroidectomy. 3 Second, data on thyroid-stimulating hormone levels were only collected at the first preoperative consultation; we did not collect data on thyroid-stimulating hormone, triiodothyronine hormone, or thyroxine hormone levels on the day of surgery. Because the study lacked data on thyroid hormone levels immediately before surgery, the effectiveness of preoperative treatments could not be assessed.Medical treatment should precede surgery.

…”