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Patel D, Devivo A, Leibner E, Shittu A, Govindarajulu U, Tandon P, Lee D, Owen R, Fernandez-Ranvier G, Hiensch R, Marin M, Kohli-Seth R, Bassily-Marcus A. The COVID-19 Tracheostomy Experience at a Large Academic Medical Center in New York during the First Year. J Clin Med 2024; 13:2130. [PMID: 38610895 PMCID: PMC11012500 DOI: 10.3390/jcm13072130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Background: New York City was the epicenter of the initial surge of the COVID-19 pandemic in the United States. Tracheostomy is a critical procedure in the care of patients with COVID-19. We hypothesized that early tracheostomy would decrease the length of time on sedation, time on mechanical ventilation, intensive care unit length of stay, and mortality. Methods: A retrospective analysis of outcomes for all patients with COVID-19 who underwent tracheostomy during the first year of the COVID-19 pandemic at the Mount Sinai Hospital in New York City, New York. All adult intensive care units at the Mount Sinai Hospital, New York. Patients/subjects: 888 patients admitted to intensive care with COVID-19. Results: All patients admitted to the intensive care unit with COVID-19 (888) from 1 March 2020 to 1 March 2021 were analyzed and separated further into those intubated (544) and those requiring tracheostomy (177). Of those receiving tracheostomy, outcomes were analyzed for early (≤12 days) or late (>12 days) tracheostomy. Demographics, medical history, laboratory values, type of oxygen and ventilatory support, and clinical outcomes were recorded and analyzed. Conclusions: Early tracheostomy resulted in reduced duration of mechanical ventilation, reduced hospital length of stay, and reduced intensive care unit length of stay in patients admitted to the intensive care unit with COVID-19. There was no effect on overall mortality.
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Affiliation(s)
- Dhruv Patel
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.P.); (A.D.); (A.B.-M.)
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Anthony Devivo
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.P.); (A.D.); (A.B.-M.)
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Evan Leibner
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.P.); (A.D.); (A.B.-M.)
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Atinuke Shittu
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.P.); (A.D.); (A.B.-M.)
| | - Usha Govindarajulu
- Center for Biostatistics, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Pranai Tandon
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - David Lee
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Randall Owen
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | - Robert Hiensch
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Michael Marin
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Roopa Kohli-Seth
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.P.); (A.D.); (A.B.-M.)
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Adel Bassily-Marcus
- Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.P.); (A.D.); (A.B.-M.)
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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2
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Bui R, Kasabali A, Dewan K. A retrospective analysis of COVID-19 tracheostomies: Early versus late tracheostomy. Laryngoscope Investig Otolaryngol 2023; 8:1154-1158. [PMID: 37899865 PMCID: PMC10601556 DOI: 10.1002/lio2.1135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/30/2023] [Accepted: 07/16/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives To assess the impact of early tracheostomy (ET) versus late tracheostomy (LT) placement on mortality and decannulation rates of COVID patients. Methods A retrospective chart review was performed of all patients infected with COVID-19 who underwent tracheostomy tube placement in an Ochsner-affiliated hospital from March 2020 to May 2022. Patients were identified using the electronic medical record and data was collated using the "Epic SlicerDicer" tool. Descriptive statistics were gathered and compared between patients who underwent ET placement and those who underwent LT placement. Patient demographics, previous medical history, tracheostomy procedural details, arterial blood gases, complications, and outcomes including time to wean from the ventilator, and time to decannulation were recorded. Results Two-hundred nineteen patients were included in the study. There were no statistically significant differences in liberation from mechanical ventilation rates between early and LT (62% vs. 55%, p = .19), or in decannulation rates (40% vs. 32%, p = .14). The mean duration of time to liberation from mechanical ventilation for early trach was 13.88 versus 18.17 days for late trach, however, no statistically significant difference was found (p = .12). Similarly, mean duration of time to decannulation was 41.17 days for early versus 47.72 for late trach (p = .15). Conclusion Contrary to some studies in the literature, the results presented here suggest ETs are not associated with hastened liberation from mechanical ventilation or increased decannulation rates. Further prospective studies may be warranted in assessing the impact of early versus LT in the COVID patient population. Level of Evidence III.
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Affiliation(s)
- Roger Bui
- Department of Otolaryngology—Head and Neck SurgeryLouisiana State University ShreveportShreveportLouisianaUSA
| | - Ahmad Kasabali
- Department of Otolaryngology—Head and Neck SurgeryLouisiana State University ShreveportShreveportLouisianaUSA
| | - Karuna Dewan
- Department of Otolaryngology—Head and Neck SurgeryLouisiana State University ShreveportShreveportLouisianaUSA
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Mukai N, Okada M, Konishi S, Okita M, Ogawa S, Nishikawa K, Annen S, Ohshita M, Matsumoto H, Murata S, Harima Y, Kikuchi S, Aibara S, Sei H, Aoishi K, Asayama R, Sato E, Takagi T, Tanaka-Nishikubo K, Teraoka M, Hato N, Takeba J, Sato N. Cricotracheostomy for patients with severe COVID-19: A case control study. Front Surg 2023; 10:1082699. [PMID: 36733889 PMCID: PMC9888534 DOI: 10.3389/fsurg.2023.1082699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
Background Tracheostomy is an important procedure for the treatment of severe coronavirus disease-2019 (COVID-19). Older age and obesity have been reported to be associated with the risk of severe COVID-19 and prolonged intubation, and anticoagulants are often administered in patients with severe COVID-19; these factors are also related to a higher risk of tracheostomy. Cricotracheostomy, a modified procedure for opening the airway through intentional partial cricoid cartilage resection, was recently reported to be useful in cases with low-lying larynx, obesity, stiff neck, and bleeding tendency. Here, we investigated the usefulness and safety of cricotracheostomy for severe COVID-19 patients. Materials and methods Fifteen patients with severe COVID-19 who underwent cricotracheostomy between January 2021 and April 2022 with a follow-up period of ≥ 14 days were included in this study. Forty patients with respiratory failure not related to COVID-19 who underwent traditional tracheostomy between January 2015 and April 2022 comprised the control group. Data were collected from medical records and comprised age, sex, body mass index, interval from intubation to tracheostomy, use of anticoagulants, complications of tracheostomy, and decannulation. Results Age, sex, and days from intubation to tracheostomy were not significantly different between the COVID-19/cricotracheostomy and control/traditional tracheostomy groups. Body mass index was significantly higher in the COVID-19 group than that in the control group (P = 0.02). The rate of use of anticoagulants was significantly higher in the COVID-19 group compared with the control group (P < 0.01). Peri-operative bleeding, subcutaneous emphysema, and stomal infection rates were not different between the groups, while stomal granulation was significantly less in the COVID-19 group (P = 0.04). Conclusions These results suggest that cricotracheostomy is a safe procedure in patients with severe COVID-19.
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Affiliation(s)
- Naoki Mukai
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Masahiro Okada
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan,Correspondence: Masahiro Okada
| | - Saki Konishi
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Mitsuo Okita
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Siro Ogawa
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kosuke Nishikawa
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan,Department of Bone and Joint Surgery, Ehime University School of Medicine, Toon, Japan
| | - Suguru Annen
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Muneaki Ohshita
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Hironori Matsumoto
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Satoru Murata
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Yutaka Harima
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Satoshi Kikuchi
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Shiori Aibara
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Hirofumi Sei
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kunihide Aoishi
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Rie Asayama
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Eriko Sato
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Taro Takagi
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Kaori Tanaka-Nishikubo
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Masato Teraoka
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Naohito Hato
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Toon, Japan
| | - Jun Takeba
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
| | - Norio Sato
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
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Shreckengost CSH, Wan L, Reitz AW, Lin A, Dhamsania RK, Spychalski J, Douglas JM, Lane A, Amin D, Roser S, Berkowitz D, Foianini JE, Moore R, Sreedharan JK, Niroula A, Smith R, Khullar OV. Tracheostomies of Patients With COVID-19: A Survey of Infection Reported by Health Care Professionals. Am J Crit Care 2023; 32:9-20. [PMID: 36065019 DOI: 10.4037/ajcc2022337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Health care professionals (HCPs) performing tracheostomies in patients with COVID-19 may be at increased risk of infection. OBJECTIVE To evaluate factors underlying HCPs' COVID-19 infection and determine whether tracheostomy providers report increased rates of infection. METHODS An anonymous international survey examining factors associated with COVID-19 infection was made available November 2020 through July 2021 to HCPs at a convenience sample of hospitals, universities, and professional organizations. Infections reported were compared between HCPs involved in tracheostomy on patients with COVID-19 and HCPs who were not involved. RESULTS Of the 361 respondents (from 33 countries), 50% (n = 179) had performed tracheostomies on patients with COVID-19. Performing tracheostomies on patients with COVID-19 was not associated with increased infection in either univariable (P = .06) or multivariable analysis (odds ratio, 1.48; 95% CI, 0.90-2.46; P = .13). Working in a low- or middle-income country (LMIC) was associated with increased infection in both univariable (P < .001) and multivariable analysis (odds ratio, 2.88; CI, 1.50-5.53; P = .001). CONCLUSIONS Performing tracheostomy was not associated with COVID-19 infection, suggesting that tracheostomies can be safely performed in infected patients with appropriate precautions. However, HCPs in LMICs may face increased infection risk.
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Affiliation(s)
| | - Limeng Wan
- Limeng Wan is a student, Rollins School of Public Health, Emory University
| | - Alexandra W Reitz
- Alexandra W. Reitz is a resident physician, Department of Surgery, Emory University
| | - Alice Lin
- Alice Lin is a student, Rollins School of Public Health, Emory University
| | - Rohan K Dhamsania
- Rohan K. Dhamsania is a student, Philadelphia College of Osteopathic Medicine, Suwanee, Georgia
| | - Julia Spychalski
- Julia Spychalski is a student, Rollins School of Public Health, Emory University
| | - J Miller Douglas
- J. Miller Douglas is a student, Department of Surgery and Rollins School of Public Health, Emory University
| | - Andrea Lane
- Andrea Lane is a student, Rollins School of Public Health, Emory University
| | - Dina Amin
- Dina Amin is an assistant professor, Department of Surgery, Emory University and a surgeon, Oral and Maxillofacial Surgery, Grady Memorial Hospital, Atlanta, Georgia
| | - Steven Roser
- Steven Roser is a professor, Department of Surgery, Emory University and a surgeon, Oral and Maxillofacial Surgery, Grady Memorial Hospital, Atlanta, Georgia
| | - David Berkowitz
- David Berkowitz is a physician and professor, Department of Medicine, School of Medicine, Emory University
| | | | - Renée Moore
- Renée Moore is a professor, Rollins School of Public Health, Emory University
| | - Jithin K Sreedharan
- Jithin K. Sreedharan is general secretary, Indian Association of Respiratory Care, Kochi, India
| | - Abesh Niroula
- Abesh Niroula is a physician, Department of Medicine, School of Medicine, Emory University
| | - Randi Smith
- Randi Smith is a surgeon, Department of Surgery, Emory University, a professor, Rollins School of Public Health, Emory University, and a surgeon, Trauma and Surgical Critical Care, Grady Memorial Hospital
| | - Onkar V Khullar
- Onkar V. Khullar is a surgeon, Department of Surgery, Emory University
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What Have We Learned About Transmission of COVID-19: Implications for PFT and Pulmonary Procedures. Clin Chest Med 2022; 44:215-226. [PMID: 37085215 PMCID: PMC9678821 DOI: 10.1016/j.ccm.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Because of the potential for high aerosol transmission during pulmonary function testing and pulmonary procedures, performing these tests and procedures must be considered carefully during the coronavirus disease-2019 (COVID-19) pandemic. Much has been learned about the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by aerosols and the potential for such transmission through pulmonary function tests and pulmonary procedures, and subsequently preventative practices have been enhanced and developed to reduce the risk of transmission of virus to patients and personnel. This article reviews what is known about the potential for transmission of SARS-CoV-2 during pulmonary function testing and pulmonary procedures and the recommended mitigation steps to prevent the spread of COVID-19.
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Karic E, Mitwally H, Alansari LM, Ganaw A, Saad MO, Azhaghdani A. Impact of Early Tracheostomy on Weaning From Ventilation and Sedation in COVID-19 Pregnant and Early Postpartum Patient: Two Case Reports. Cureus 2022; 14:e29633. [PMID: 36320992 PMCID: PMC9606483 DOI: 10.7759/cureus.29633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 11/20/2022] Open
Abstract
Pregnant women are at high risk of coronavirus disease 2019 (COVID-19) complications, including acute respiratory distress syndrome (ARDS) and the need for mechanical ventilation. There is no literature on the optimal strategy for the management of difficult-to-wean pregnant and early postpartum patients. We report two cases of pregnant women with COVID-19 pneumonia and ARDS, who required mechanical ventilation and high doses of analgesia, and sedation with neuromuscular blocking agents to facilitate ventilation and oxygenation. Both patients had a tracheostomy procedure to facilitate weaning from mechanical ventilation and sedation. Shortly after tracheostomy, sedation and analgesia, along with ventilatory support were weaned off. Both patients were discharged home. These cases propose early tracheostomy as a strategy to facilitate weaning from mechanical ventilation and sedation in pregnant and early postpartum patients.
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Battaglini D, Premraj L, White N, Sutt AL, Robba C, Cho SM, Di Giacinto I, Bressan F, Sorbello M, Cuthbertson B, Bassi GL, Suen J, Fraser J, Pelosi P. Tracheostomy outcomes in critically ill COVID-19 patients: a systematic review, meta-analysis, and meta-regression. Br J Anaesth 2022; 129:679-692. [PMID: 36182551 PMCID: PMC9345907 DOI: 10.1016/j.bja.2022.07.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/12/2022] [Accepted: 07/12/2022] [Indexed: 11/22/2022] Open
Abstract
Background We performed a systematic review of mechanically ventilated patients with COVID-19, which analysed the effect of tracheostomy timing and technique (surgical vs percutaneous) on mortality. Secondary outcomes included intensive care unit (ICU) and hospital length of stay (LOS), decannulation from tracheostomy, duration of mechanical ventilation, and complications. Methods Four databases were screened between January 1, 2020 and January 10, 2022 (PubMed, Embase, Scopus, and Cochrane). Papers were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Population or Problem, Intervention or exposure, Comparison, and Outcome (PICO) guidelines. Meta-analysis and meta-regression for main outcomes were performed. Results The search yielded 9024 potentially relevant studies, of which 47 (n=5268 patients) were included. High levels of between-study heterogeneity were observed across study outcomes. The pooled mean tracheostomy timing was 16.5 days (95% confidence interval [CI]: 14.7–18.4; I2=99.6%). Pooled mortality was 22.1% (95% CI: 18.7–25.5; I2=89.0%). Meta-regression did not show significant associations between mortality and tracheostomy timing, mechanical ventilation duration, time to decannulation, and tracheostomy technique. Pooled mean estimates for ICU and hospital LOS were 29.6 (95% CI: 24.0–35.2; I2=98.6%) and 38.8 (95% CI: 32.1–45.6; I2=95.7%) days, both associated with mechanical ventilation duration (coefficient 0.8 [95% CI: 0.2–1.4], P=0.02 and 0.9 [95% CI: 0.4–1.4], P=0.01, respectively) but not tracheostomy timing. Data were insufficient to assess tracheostomy technique on LOS. Duration of mechanical ventilation was 23.4 days (95% CI: 19.2–27.7; I2=99.3%), not associated with tracheostomy timing. Data were insufficient to assess the effect of tracheostomy technique on mechanical ventilation duration. Time to decannulation was 23.8 days (95% CI: 19.7–27.8; I2=98.7%), not influenced by tracheostomy timing or technique. The most common complications were stoma infection, ulcers or necrosis, and bleeding. Conclusions In patients with COVID-19 requiring tracheostomy, the timing and technique of tracheostomy did not clearly impact on patient outcomes. Systematic Review Protocol PROSPERO CRD42021272220.
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8
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Sharma RK, Grewal MR, Long SM, DiDonna B, Sturm J, Hills SE, Troob SH. Tracheostomy Outcomes in Patients With COVID-19 at a New York City Hospital. OTO Open 2022; 6:2473974X221101025. [PMID: 35663351 PMCID: PMC9160903 DOI: 10.1177/2473974x221101025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/28/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Tracheostomies have been performed in patients with prolonged intubation due to COVID-19. Understanding outcomes in different populations is crucial to tackle future epidemics. Study Design Prospective cohort study. Setting Tertiary academic medical center in New York City. Methods A prospectively collected database of patients with COVID-19 undergoing open tracheostomy between March 2020 and April 2020 was reviewed. Primary endpoints were weaning from the ventilator and from sedation and time to decannulation. Results Sixty-six patients underwent tracheostomy. There were 42 males (64%) with an average age of 62 years (range, 23-91). Patients were intubated for a median time of 26 days prior to tracheostomy (interquartile range [IQR], 23-30). The median time to weaning from ventilatory support after tracheostomy was 18 days (IQR, 10-29). Of those sedated at the time of tracheostomy, the median time to discontinuation of sedation was 5 days (IQR, 3-9). Of patients who survived, 39 (69%) were decannulated. Of those decannulated before discharge (n = 39), the median time to decannulation was 36 days (IQR, 27-49) following tracheostomy. The median time from ventilator liberation to decannulation was 14 days (IQR, 8-22). Thirteen patients (20.0%) had minor bleeding requiring packing. Two patients (3%) had bleeding requiring neck exploration. The all-cause mortality rate was 10.6%. No patients died of procedural causes, and no surgeons acquired COVID-19. Conclusion Open tracheostomies were successfully and safely performed at our institution in the peak of the COVID-19 pandemic. The majority of patients were successfully weaned from the ventilator and sedation. Approximately 60% of patients were decannulated prior to hospital discharge.
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Affiliation(s)
- Rahul K. Sharma
- Department of Otolaryngology–Head and Neck Surgery, Columbia University Irving Medical Center, NewYork–Presbyterian Hospital, New York, New York, USA
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Maeher R. Grewal
- Department of Otolaryngology–Head and Neck Surgery, Columbia University Irving Medical Center, NewYork–Presbyterian Hospital, New York, New York, USA
| | - Sallie M. Long
- Department of Otolaryngology–Head and Neck Surgery, Columbia University Irving Medical Center, NewYork–Presbyterian Hospital, New York, New York, USA
| | - Brendon DiDonna
- Department of Otolaryngology–Head and Neck Surgery, Columbia University Irving Medical Center, NewYork–Presbyterian Hospital, New York, New York, USA
| | - Joshua Sturm
- Department of Otolaryngology–Head and Neck Surgery, Columbia University Irving Medical Center, NewYork–Presbyterian Hospital, New York, New York, USA
| | - Susannah E. Hills
- Department of Otolaryngology–Head and Neck Surgery, Columbia University Irving Medical Center, NewYork–Presbyterian Hospital, New York, New York, USA
| | - Scott H. Troob
- Department of Otolaryngology–Head and Neck Surgery, Columbia University Irving Medical Center, NewYork–Presbyterian Hospital, New York, New York, USA
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ICU tracheotomies in patients with COVID-19: a lesson learned for future viral pandemic. Eur Arch Otorhinolaryngol 2022; 279:4181-4188. [PMID: 35552798 PMCID: PMC9098145 DOI: 10.1007/s00405-022-07360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/15/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The coronavirus SARS-CoV-2 pandemic has resulted in a large number of patients requiring intubation and prolonged mechanical ventilation. The current knowledge on the tracheotomies regarding the time form intubation, method and ventilatory parameters optimal for their performance in the mechanically ventilated patients with COVID ARDS are scarce; thus, the aim of this study is to present new data regarding their safety, adverse events and timing. MATERIALS AND METHODS This retrospective observational study is based on the data of 66 critically ill COVID patients including demographic data, timing and technique of tracheotomy, ventilatory parameters in the time of procedure, as well as complication and survival rate. RESULTS A number of 66 patients with COVID-related pneumonia were included in the study, among whom 32 were tracheotomized-25 patients underwent an early tracheotomy and 7 patients had late tracheotomy. The median duration of mechanical ventilation before the tracheotomy in the early group was 8 days (IQR 6-10) compared to 11 days (IQR 11-12.5.) p < 0.001) in late group. Risk of death in tracheotomy patients was significantly growing with growing level of PEEP and FiO2 at the moment of decision on tracheotomy, OR = 1.91 CI95 (1.23;3.57); p = 0.014 and OR = 1.18 CI95(1.03;1.43); p = 0.048, respectively. CONCLUSION Early percutaneous tracheotomy is safe (both in terms of risk of viral transmission and complication rate) and feasible in COVID-19 patients. Stability of gas exchange, and ventilatory parameters are the main prognostic factors of the outcome.
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Chong WH, Tan CK. Clinical Outcomes of Early Versus Late Tracheostomy in Coronavirus Disease 2019 Patients: A Systematic Review and Meta-Analysis. J Intensive Care Med 2022; 37:1121-1132. [PMID: 35506907 DOI: 10.1177/08850666221098930] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND A significant proportion of Coronavirus Disease 2019 (COVID-19) patients require admission to the intensive care unit (ICU) and invasive mechanical ventilation (IMV). Tracheostomy is increasingly performed when a prolonged course of IMV is anticipated. OBJECTIVES To determine clinical and resource utilization benefits of early versus late tracheostomy among COVID-19 patients. METHODS Pubmed, Cochrane Library, Scopus, and Embase were used to identify relevant studies comparing outcomes of COVID-19 patients undergoing early and late tracheostomy from January 1, 2020, to December 1, 2021. RESULTS Twelve studies were selected, and 2222 critically ill COVID-19 patients hospitalized between January to December 2020 were included. Among the included patients, 34.5% and 65.5% underwent early and late tracheostomy, respectively. Among the included studies, 58.3% and 41.7% defined early tracheostomy using cutoffs of 14 and 10 days, respectively. All-cause in-hospital mortality was not different between the early and late tracheostomy groups (32.9% vs. 33.1%; OR = 1.00; P = 0.98). Sensitivity analysis demonstrated a similar mortality rate in studies using a cutoff of 10 days (34.6% vs. 35.5%; OR = 0.97; P = 0.89) or 14 days (31.2% vs. 27.7%; OR = 1.05; P = 0.78). The early tracheostomy group had shorter ICU length of stay (LOS) (mean: 23.18 vs. 30.51 days; P < 0.001) and IMV duration (mean: 20.49 vs. 28.94 days; P < 0.001) than the late tracheostomy group. The time from tracheostomy to decannulation was longer (mean: 23.36 vs. 16.24 days; P = 0.02) in the early tracheostomy group than in the late tracheostomy group, but the time from tracheostomy to IMV weaning was similar in both groups. Other clinical characteristics, including age, were similar in both groups. CONCLUSIONS Early tracheostomy reduced the ICU LOS and IMV duration among COVID-19 patients compared with late tracheostomy, but the mortality rate was similar in both groups. The findings have important implications for the treatment of COVID-19 patients, especially in a resource-limited setting.
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Affiliation(s)
- Woon Hean Chong
- Department of Intensive Care Medicine, 242949Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
| | - Chee Keat Tan
- Department of Intensive Care Medicine, 242949Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore
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11
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Lee PE, Kozak R, Alavi N, Mbareche H, Kung RC, Murphy KE, Perruzza D, Jarvi S, Salvant E, Ladhani NNN, Yee AJM, Gagnon LH, Jenkinson R, Liu GY. Detection of SARS-CoV-2 contamination in the operating room and birthing room setting: a cross-sectional study. CMAJ Open 2022; 10:E450-E459. [PMID: 35609928 PMCID: PMC9259417 DOI: 10.9778/cmajo.20210321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The exposure risks to front-line health care workers caring for patients with SARS-CoV-2 infection undergoing surgery or obstetric delivery are unclear, and an understanding of sample types that may harbour virus is important for evaluating risk. We sought to determine whether SARS-CoV-2 viral RNA from patients with SARS-CoV-2 infection undergoing surgery or obstetric delivery was present in the peritoneal cavity of male and female patients, in the female reproductive tract, in the environment of the surgery or delivery suite (surgical instruments or equipment used, air or floors), and inside the masks of the attending health care workers. METHODS We conducted a cross-sectional study from November 2020 to May 2021 at 2 tertiary academic Toronto hospitals, during urgent surgeries or obstetric deliveries for patients with SARS-CoV-2 infection. The presence of SARS-CoV-2 viral RNA in patient, environmental and air samples was identified by real-time reverse transcription polymerase chain reaction (RT-PCR). Air samples were collected using both active and passive sampling techniques. The primary outcome was the proportion of health care workers' masks positive for SARS-CoV-2 RNA. We included adult patients with positive RT-PCR nasal swab undergoing obstetric delivery or urgent surgery (from across all surgical specialties). RESULTS A total of 32 patients (age 20-88 yr) were included. Nine patients had obstetric deliveries (6 cesarean deliveries), and 23 patients (14 male) required urgent surgery from the orthopedic or trauma, general surgery, burn, plastic surgery, cardiac surgery, neurosurgery, vascular surgery, gastroenterology and gynecologic oncology divisions. SARS-CoV-2 RNA was detected in 20 of 332 (6%) patient and environmental samples collected: 4 of 24 (17%) patient samples, 5 of 60 (8%) floor samples, 1 of 54 (2%) air samples, 10 of 23 (43%) surgical instrument or equipment samples, 0 of 24 cautery filter samples and 0 of 143 (95% confidence interval 0-0.026) inner surface of mask samples. INTERPRETATION During the study period of November 2020 to May 2021, we found evidence of SARS-CoV-2 RNA in a small but important number of samples obtained in the surgical and obstetric operative environment. The finding of no detectable virus inside the masks worn by the health care teams would suggest a low risk of infection for health care workers using appropriate personal protective equipment.
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Affiliation(s)
- Patricia E Lee
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont.
| | - Robert Kozak
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Nasrin Alavi
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Hamza Mbareche
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Rose C Kung
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Kellie E Murphy
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Darian Perruzza
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Stephanie Jarvi
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Elsa Salvant
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Noor Niyar N Ladhani
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Albert J M Yee
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Louise-Helene Gagnon
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Richard Jenkinson
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - Grace Y Liu
- Divisions of Urogynecology and Minimally Invasive Gynecologic Surgery (Lee, Kung, Gagnon, Liu), Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto; Division of Microbiology (Kozak), Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto; Sunnybrook Research Institute (Alavi, Mbareche, Perruzza, Jarvi, Salvant), Sunnybrook Health Sciences Centre, University of Toronto; Division of Maternal Fetal Medicine (Murphy), Department of Obstetrics and Gynecology, Sinai Health System; Temerty Faculty of Medicine (Perruzza, Jarvi); Division of Maternal Fetal Medicine (Ladhani), Department of Obstetrics and Gynecology; Divisions of Orthopaedic Surgery and Trauma Surgery (Yee, Jenkinson), Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
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12
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Polok K, Fronczek J, van Heerden PV, Flaatten H, Guidet B, De Lange DW, Fjølner J, Leaver S, Beil M, Sviri S, Bruno RR, Wernly B, Artigas A, Pinto BB, Schefold JC, Studzińska D, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Cecconi M, Jung C, Szczeklik W. Association between tracheostomy timing and outcomes for older critically ill COVID-19 patients: prospective observational study in European intensive care units. Br J Anaesth 2022; 128:482-490. [PMID: 34955167 PMCID: PMC8627864 DOI: 10.1016/j.bja.2021.11.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/20/2021] [Accepted: 11/20/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Tracheostomy is performed in patients expected to require prolonged mechanical ventilation, but to date optimal timing of tracheostomy has not been established. The evidence concerning tracheostomy in COVID-19 patients is particularly scarce. We aimed to describe the relationship between early tracheostomy (≤10 days since intubation) and outcomes for patients with COVID-19. METHODS This was a prospective cohort study performed in 152 centres across 16 European countries from February to December 2020. We included patients aged ≥70 yr with confirmed COVID-19 infection admitted to an intensive care unit, requiring invasive mechanical ventilation. Multivariable analyses were performed to evaluate the association between early tracheostomy and clinical outcomes including 3-month mortality, intensive care length of stay, and duration of mechanical ventilation. RESULTS The final analysis included 1740 patients with a mean age of 74 yr. Tracheostomy was performed in 461 (26.5%) patients. The tracheostomy rate varied across countries, from 8.3% to 52.9%. Early tracheostomy was performed in 135 (29.3%) patients. There was no difference in 3-month mortality between early and late tracheostomy in either our primary analysis (hazard ratio [HR]=0.96; 95% confidence interval [CI], 0.70-1.33) or a secondary landmark analysis (HR=0.78; 95% CI, 0.57-1.06). CONCLUSIONS There is a wide variation across Europe in the timing of tracheostomy for critically ill patients with COVID-19. However, we found no evidence that early tracheostomy is associated with any effect on survival amongst older critically ill patients with COVID-19. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT04321265.
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Affiliation(s)
- Kamil Polok
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Fronczek
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Peter Vernon van Heerden
- Department of Anesthesia, Intensive Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Dylan W. De Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, the Netherlands
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Susannah Leaver
- Research Lead Critical Care Directorate St George's Hospital, London, UK
| | - Michael Beil
- Medical Intensive Care Unit, Hadassah Medical Center, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Dusseldorf, Germany
| | - Bernhard Wernly
- Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria,Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Antonio Artigas
- Critical Care Department, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain
| | - Bernardo Bollen Pinto
- Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Joerg C. Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dorota Studzińska
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Brian Marsh
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Finn H. Andersen
- Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa (Nova Médical School), Lisbon, Portugal
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center – IRCCS, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Rozzano, Milan, Italy
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Dusseldorf, Germany
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
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13
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Ji Y, Fang Y, Cheng B, Li L, Fang X. Tracheostomy timing and clinical outcomes in ventilated COVID-19 patients: a systematic review and meta-analysis. Crit Care 2022; 26:40. [PMID: 35135597 PMCID: PMC8822732 DOI: 10.1186/s13054-022-03904-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/26/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The association of tracheostomy timing and clinical outcomes in ventilated COVID-19 patients remains controversial. We performed a meta-analysis to evaluate the impact of early tracheostomy compared to late tracheostomy on COVID-19 patients' outcomes. METHODS We searched Medline, Embase, Cochrane, and Scopus database, along with medRxiv, bioRxiv, and Research Square, from December 1, 2019, to August 24, 2021. Early tracheostomy was defined as a tracheostomy conducted 14 days or less after initiation of invasive mechanical ventilation (IMV). Late tracheostomy was any time thereafter. Duration of IMV, duration of ICU stay, and overall mortality were the primary outcomes of the meta-analysis. Pooled odds ratios (OR) or the mean differences (MD) with 95%CIs were calculated using a random-effects model. RESULTS Fourteen studies with a cumulative 2371 tracheostomized COVID-19 patients were included in this review. Early tracheostomy was associated with significant reductions in duration of IMV (2098 patients; MD - 9.08 days, 95% CI - 10.91 to - 7.26 days, p < 0.01) and duration of ICU stay (1224 patients; MD - 9.41 days, 95% CI - 12.36 to - 6.46 days, p < 0.01). Mortality was reported for 2343 patients and was comparable between groups (OR 1.09, 95% CI 0.79-1.51, p = 0.59). CONCLUSIONS The results of this meta-analysis suggest that, compared with late tracheostomy, early tracheostomy in COVID-19 patients was associated with shorter duration of IMV and ICU stay without modifying the mortality rate. These findings may have important implications to improve ICU availability during the COVID-19 pandemic. Trial registration The protocol was registered at INPLASY (INPLASY202180088).
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Affiliation(s)
- Yun Ji
- Department of Surgical Intensive Care Unit, the Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, Zhejiang, China
| | - Yumin Fang
- Department of Intensive Care Unit, Suichang People's Hospital, Lishui, Zhejiang, China
| | - Baoli Cheng
- Department of Anesthesiology and Intensive Care, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Libin Li
- Department of Surgical Intensive Care Unit, the Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, Zhejiang, China
| | - Xiangming Fang
- Department of Anesthesiology and Intensive Care, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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14
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Navaratnam AV, Gray WK, Wall J, Takhar A, Day J, Tatla T, Batchelor A, Swart M, Snowden C, Marshall A, Briggs TW. Utilisation of tracheostomy in patients with COVID‐19 in England: patient characteristics, timing and outcomes. Clin Otolaryngol 2022; 47:424-432. [DOI: 10.1111/coa.13913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/15/2022] [Indexed: 11/25/2022]
Affiliation(s)
| | - William K Gray
- Getting It Right First Time programme NHS England and NHS Improvement London UK
| | - Josh Wall
- Getting It Right First Time programme NHS England and NHS Improvement London UK
| | - Arun Takhar
- Guy's and St Thomas' NHS Foundation Trust London UK
| | - Jamie Day
- Getting It Right First Time programme NHS England and NHS Improvement London UK
| | | | - Anna Batchelor
- Getting It Right First Time programme NHS England and NHS Improvement London UK
| | - Michael Swart
- Getting It Right First Time programme NHS England and NHS Improvement London UK
| | - Christopher Snowden
- Getting It Right First Time programme NHS England and NHS Improvement London UK
| | - Andrew Marshall
- Getting It Right First Time programme NHS England and NHS Improvement London UK
| | - Tim W.R. Briggs
- Getting It Right First Time programme NHS England and NHS Improvement London UK
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15
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Revised recommendations from the CSO-HNS taskforce on performance of tracheotomy during the COVID-19 pandemic - what a difference a year makes. J Otolaryngol Head Neck Surg 2021; 50:59. [PMID: 34670607 PMCID: PMC8527441 DOI: 10.1186/s40463-021-00531-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background During the early part of the COVID-19 pandemic, the Canadian Society of Otolaryngology - Head & Neck Surgery (CSO-HNS) task force published recommendations on performance of tracheotomy. Since then, our understanding of the virus has evolved with ongoing intensive research efforts. New literature has helped us better understand various aspects including patient outcomes and health care worker (HCW) risks associated with tracheotomy during the COVID-19 pandemic. Accordingly, the task force has re-evaluated and revised some of the previous recommendations. Main body Based on recent evidence, a negative reverse transcription polymerase chain reaction (RT-PCR) COVID-19 swab status is no longer the main deciding factor in the timing of tracheotomy. Instead, tracheotomy may be considered as soon as COVID-19 swab positive patients are greater than 20 days beyond initial symptoms and 2 weeks of mechanical ventilation. Furthermore, both open and percutaneous surgical techniques may be considered with both techniques showing similar safety and outcome profiles. Additional recommendations with discussion of current evidence are presented. Conclusion These revised recommendations apply new evidence in optimizing patient and health care system outcomes as well as minimizing risks of COVID-19 transmission during aerosol-generating tracheotomy procedures. As previously noted, additional evidence may lead to further evolution of these and other similar recommendations. Graphical abstract ![]()
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