Tracheostomy for COVID-19 Respiratory Failure: Multidisciplinary, Multicenter Data on Timing, Technique, and Outcomes.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 08 2021
01 08 2021
Historique:
pubmed:
25
5
2021
medline:
16
7
2021
entrez:
24
5
2021
Statut:
ppublish
Résumé
The aim of this study was to assess the outcomes of tracheostomy in patients with COVID-19 respiratory failure. Tracheostomy has an essential role in managing COVID-19 patients with respiratory failure who require prolonged mechanical ventilation. However, limited data are available on how tracheostomy affects COVID-19 outcomes, and uncertainty surrounding risk of infectious transmission has led to divergent recommendations and practices. It is a multicenter, retrospective study; data were collected on all tracheostomies performed in COVID-19 patients at 7 hospitals in 5 tertiary academic medical systems from February 1, 2020 to September 4, 2020. Tracheotomy was performed in 118 patients with median time from intubation to tracheostomy of 22 days (Q1-Q3: 18-25). All tracheostomies were performed employing measures to minimize aerosol generation, 78.0% by percutaneous technique, and 95.8% at bedside in negative pressure rooms. Seventy-eight (66.1%) patients were weaned from the ventilator and 18 (15.3%) patients died from causes unrelated to tracheostomy. No major procedural complications occurred. Early tracheostomy (≤14 days) was associated with decreased ventilator days; median ventilator days (Q1-Q3) among patients weaned from the ventilator in the early, middle and late groups were 21 (21-31), 34 (26.5-42), and 37 (32-41) days, respectively with P = 0.030. Compared to surgical tracheostomy, percutaneous technique was associated with faster weaning for patients weaned off the ventilator [median (Q1-Q3): 34 (29-39) vs 39 (34-51) days, P = 0.038]; decreased ventilator-associated pneumonia (58.7% vs 80.8%, P = 0.039); and among patients who were discharged, shorter intensive care unit duration [median (Q1-Q3): 33 (27-42) vs 47 (33-64) days, P = 0.009]; and shorter hospital length of stay [median (Q1-Q3): 46 (33-59) vs 59.5 (48-80) days, P = 0.001]. Early, percutaneous tracheostomy was associated with improved outcomes compared to surgical tracheostomy in a multi-institutional series of ventilated patients with COVID-19.
Sections du résumé
OBJECTIVE
The aim of this study was to assess the outcomes of tracheostomy in patients with COVID-19 respiratory failure.
SUMMARY BACKGROUND DATA
Tracheostomy has an essential role in managing COVID-19 patients with respiratory failure who require prolonged mechanical ventilation. However, limited data are available on how tracheostomy affects COVID-19 outcomes, and uncertainty surrounding risk of infectious transmission has led to divergent recommendations and practices.
METHODS
It is a multicenter, retrospective study; data were collected on all tracheostomies performed in COVID-19 patients at 7 hospitals in 5 tertiary academic medical systems from February 1, 2020 to September 4, 2020.
RESULT
Tracheotomy was performed in 118 patients with median time from intubation to tracheostomy of 22 days (Q1-Q3: 18-25). All tracheostomies were performed employing measures to minimize aerosol generation, 78.0% by percutaneous technique, and 95.8% at bedside in negative pressure rooms. Seventy-eight (66.1%) patients were weaned from the ventilator and 18 (15.3%) patients died from causes unrelated to tracheostomy. No major procedural complications occurred. Early tracheostomy (≤14 days) was associated with decreased ventilator days; median ventilator days (Q1-Q3) among patients weaned from the ventilator in the early, middle and late groups were 21 (21-31), 34 (26.5-42), and 37 (32-41) days, respectively with P = 0.030. Compared to surgical tracheostomy, percutaneous technique was associated with faster weaning for patients weaned off the ventilator [median (Q1-Q3): 34 (29-39) vs 39 (34-51) days, P = 0.038]; decreased ventilator-associated pneumonia (58.7% vs 80.8%, P = 0.039); and among patients who were discharged, shorter intensive care unit duration [median (Q1-Q3): 33 (27-42) vs 47 (33-64) days, P = 0.009]; and shorter hospital length of stay [median (Q1-Q3): 46 (33-59) vs 59.5 (48-80) days, P = 0.001].
CONCLUSION
Early, percutaneous tracheostomy was associated with improved outcomes compared to surgical tracheostomy in a multi-institutional series of ventilated patients with COVID-19.
Identifiants
pubmed: 34029231
doi: 10.1097/SLA.0000000000004955
pii: 00000658-202108000-00010
pmc: PMC8265239
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
234-239Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Ziehr DR, Alladina J, Petri CR, et al. Respiratory pathophysiology of mechanically ventilated patients with COVID-19: a cohort study. Am J Respir Crit Care Med 2020; 201:1560–1564.
Wu Z, McGoogan JM. Characteristics OF AND IMPORTANT LESSONS FROm the Coronavirus Disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020; 323:1239–1242.
Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020; 323:2052–2059.
Mahmood K, Wahidi MM. The changing role for tracheostomy in patients requiring mechanical ventilation. Clin Chest Med 2016; 37:741–751.
Young D, Harrison DA, Cuthbertson BH, et al. Effect of early vs late tracheostomy placement on survival in patients receiving mechanical ventilation: the TracMan randomized trial. JAMA 2013; 309:2121–2129.
Rumbak MJ, Newton M, Truncale T, et al. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med 2004; 32:1689–1694.
Jackson T, Deibert D, Wyatt G, et al. Classification of aerosol-generating procedures: a rapid systematic review. BMJ Open Respir Res 2020; 7:
Smith D, Montagne J, Raices M, et al. Tracheostomy in the intensive care unit: Guidelines during COVID-19 worldwide pandemic. Am J Otolaryngol 2020; 41:102578.
McGrath BA, Brenner MJ, Warrillow SJ, et al. Tracheostomy in the COVID-19 era: global and multidisciplinary guidance. Lancet Respir Med 2020; 8:717–725.
Lamb CR, Desai NR, Angel L, et al. Use of tracheostomy during the COVID-19 pandemic: American College of Chest Physicians/American Association for Bronchology and Interventional Pulmonology/Association of Interventional Pulmonology Program Directors Expert Panel Report. Chest 2020; 158:1499–1514.
Chao TN, Braslow BM, Martin ND, et al. Tracheotomy in ventilated patients with COVID-19. Ann Surg 2020; 272:e30–e32.
Schultz P, Morvan JB, Fakhry N, et al. French consensus regarding precautions during tracheostomy and post-tracheostomy care in the context of COVID-19 pandemic. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:167–169.
Sommer DD, Engels PT, Weitzel EK, et al. Recommendations from the CSO-HNS taskforce on performance of tracheotomy during the COVID-19 pandemic. J Otolaryngol Head Neck Surg 2020; 49:23.
Tay JK, Khoo ML, Loh WS. Surgical considerations for tracheostomy during the COVID-19 pandemic: lessons learned from the severe acute respiratory syndrome outbreak. JAMA Otolaryngol Head Neck Surg 2020; 146:517–518.
Schultz MJ, Teng MS, Brenner MJ. Timing of tracheostomy for patients with COVID-19 in the ICU-setting precedent in unprecedented times. JAMA Otolaryngol Head Neck Surg 2020; 146:887–888.
Bier-Laning C, Cramer JD, Roy S, et al. Tracheostomy during the COVID-19 pandemic: comparison of international perioperative care protocols and practices in 26 countries. Otolaryngol Head Neck Surg 2020; 194599820961985.
Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012; 307:2526–2533.
Angel L, Kon ZN, Chang SH, et al. Novel percutaneous tracheostomy for critically ill patients with COVID-19. Ann Thorac Surg 2020; 110:1006–1011.
Martin-Villares C, Perez Molina-Ramirez C, Bartolome-Benito M, et al. Outcome of 1890 tracheostomies for critical COVID-19 patients: a national cohort study in Spain. Eur Arch Otorhinolaryngol 2021; 278:1605–1612.
Riestra-Ayora J, Yanes-Diaz J, Penuelas O, et al. Safety and prognosis in percutaneous vs surgical tracheostomy in 27 patients with COVID-19. Otolaryngol Head Neck Surg 2020; 163:462–464.
Long SM, Chern A, Feit NZ, et al. Percutaneous and open tracheostomy in patients with COVID-19: comparison and outcomes of an institutional series in New York City. Ann Surg 2021; 273:403–409.
Zuazua-Gonzalez A, Collazo-Lorduy T, Coello-Casariego G, et al. Surgical tracheostomies in COVID-19 patients: indications, technique, and results in a second-level Spanish hospital. OTO Open 2020; 4:2473974X20957636.
Zhang S, Liu Y, Wang X, et al. SARS-CoV-2 binds platelet ACE2 to enhance thrombosis in COVID-19. J Hematol Oncol 2020; 13:120.
Putensen C, Theuerkauf N, Guenther U, et al. Percutaneous and surgical tracheostomy in critically ill adult patients: a meta-analysis. Crit Care 2014; 18:544.
Picetti E, Fornaciari A, Taccone FS, et al. Safety of bedside surgical tracheostomy during COVID-19 pandemic: a retrospective observational study. PLoS One 2020; 15:e0240014.
Chao TN, Harbison SP, Braslow BM, et al. Outcomes after Tracheostomy in COVID-19 Patients. Ann Surg 2010; 272:1483–1489.
Terragni PP, Antonelli M, Fumagalli R, et al. Early vs late tracheotomy for prevention of pneumonia in mechanically ventilated adult ICU patients: a randomized controlled trial. JAMA 2010; 303:1483–1489.
Siempos II, Ntaidou TK, Filippidis FT, et al. Effect of early versus late or no tracheostomy on mortality and pneumonia of critically ill patients receiving mechanical ventilation: a systematic review and meta-analysis. Lancet Respir Med 2015; 3:150–158.
Queen Elizabeth Hospital Birmingham COVID-19 airway team. Safety and 30-day outcomes of tracheostomy for COVID-19: a prospective observational cohort study. Br J Anaesth 2020; 125:872–879.
COVIDTrach collaborative. COVIDTrach; the outcomes of mechanically ventilated COVID-19 patients undergoing tracheostomy in the UK: Interim Report. Br J Surg 2020; 17:e583–e584.