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Hernandez G, Ramos FJ, Añon JM, Ortiz R, Colinas L, Masclans JR, De Haro C, Ortega A, Peñuelas O, Cruz-Delgado MDM, Canabal A, Plans O, Vaquero C, Rialp G, Gordo F, Lesmes A, Martinez M, Figueira JC, Gomez-Carranza A, Corrales R, Castellvi A, Castiñeiras B, Frutos-Vivar F, Prada J, De Pablo R, Naharro A, Montejo JC, Diaz C, Santos-Peral A, Padilla R, Marin-Corral J, Rodriguez-Solis C, Sanchez-Giralt JA, Jimenez J, Cuena R, Perez-Hoyos S, Roca O. Early Tracheostomy for Managing ICU Capacity During the COVID-19 Outbreak: A Propensity-Matched Cohort Study. Chest 2022; 161:121-129. [PMID: 34147502 PMCID: PMC8361308 DOI: 10.1016/j.chest.2021.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND During the first wave of the COVID-19 pandemic, shortages of ventilators and ICU beds overwhelmed health care systems. Whether early tracheostomy reduces the duration of mechanical ventilation and ICU stay is controversial. RESEARCH QUESTION Can failure-free day outcomes focused on ICU resources help to decide the optimal timing of tracheostomy in overburdened health care systems during viral epidemics? STUDY DESIGN AND METHODS This retrospective cohort study included consecutive patients with COVID-19 pneumonia who had undergone tracheostomy in 15 Spanish ICUs during the surge, when ICU occupancy modified clinician criteria to perform tracheostomy in Patients with COVID-19. We compared ventilator-free days at 28 and 60 days and ICU- and hospital bed-free days at 28 and 60 days in propensity score-matched cohorts who underwent tracheostomy at different timings (≤ 7 days, 8-10 days, and 11-14 days after intubation). RESULTS Of 1,939 patients admitted with COVID-19 pneumonia, 682 (35.2%) underwent tracheostomy, 382 (56%) within 14 days. Earlier tracheostomy was associated with more ventilator-free days at 28 days (≤ 7 days vs > 7 days [116 patients included in the analysis]: median, 9 days [interquartile range (IQR), 0-15 days] vs 3 days [IQR, 0-7 days]; difference between groups, 4.5 days; 95% CI, 2.3-6.7 days; 8-10 days vs > 10 days [222 patients analyzed]: 6 days [IQR, 0-10 days] vs 0 days [IQR, 0-6 days]; difference, 3.1 days; 95% CI, 1.7-4.5 days; 11-14 days vs > 14 days [318 patients analyzed]: 4 days [IQR, 0-9 days] vs 0 days [IQR, 0-2 days]; difference, 3 days; 95% CI, 2.1-3.9 days). Except hospital bed-free days at 28 days, all other end points were better with early tracheostomy. INTERPRETATION Optimal timing of tracheostomy may improve patient outcomes and may alleviate ICU capacity strain during the COVID-19 pandemic without increasing mortality. Tracheostomy within the first work on a ventilator in particular may improve ICU availability.
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Affiliation(s)
- Gonzalo Hernandez
- Intensive Care Unit, University Hospital Virgen de la Salud, Toledo, Spain.
| | | | - José Manuel Añon
- Intensive Care Unit, La Paz University Hospital, Madrid, Spain; Ciber Enfermedades Respiratorias (CIBERES), Health Institute Carlos III, Madrid, Spain
| | - Ramón Ortiz
- Intensive Care Unit, Ciudad Real University Hospital, Ciudad Real, Sabadell, Spain
| | - Laura Colinas
- Intensive Care Unit, University Hospital Virgen de la Salud, Toledo, Spain
| | - Joan Ramón Masclans
- Intensive Care Unit, Del Mar University Hospital, Barcelona, Spain; Mar Medical Research Institute, UPF, Departament de Ciències Experimentals i de la Salut-DCEXS, Barcelona, Spain
| | | | - Alfonso Ortega
- Intensive Care Unit, Puerta de Hierro University Hospital, Madrid, Spain
| | - Oscar Peñuelas
- Intensive Care Unit, Getafe University Hospital, Madrid, Spain
| | | | - Alfonso Canabal
- Intensive Care Unit, La Princesa University Hospital, Madrid, Spain
| | - Oriol Plans
- Intensive Care Unit, Joan XXIII University Hospital, Tarragona, Spain
| | | | - Gemma Rialp
- Intensive Care Unit, Son Llatzer University Hospital, Mallorca, Spain
| | - Federico Gordo
- Intensive Care Unit, Henares University Hospital, Madrid, Spain; Universidad Francisco de Vitoria, Madrid, Spain
| | - Amanda Lesmes
- Intensive Care Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - María Martinez
- Intensive Care Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | - Rocio Corrales
- Department of Otolaryngology-Head and Neck Surgery, University Hospital Virgen de la Salud, Toledo, Spain
| | - Andrea Castellvi
- Intensive Care Unit, Del Mar University Hospital, Barcelona, Spain
| | | | | | - Jorge Prada
- Department of Otolaryngology-Head and Neck Surgery, La Princesa University Hospital, Madrid, Spain
| | - Raul De Pablo
- Intensive Care Unit, Ramón y Cajal University Hospital, Madrid, Spain; Critical Care Department, Alcala de Henares University, Alcala de Henares, Spain
| | - Antonio Naharro
- Intensive Care Unit, Henares University Hospital, Madrid, Spain
| | | | - Claudia Diaz
- Intensive Care Unit, La Paz University Hospital, Madrid, Spain
| | - Alfonso Santos-Peral
- Intensive Care Unit, Ciudad Real University Hospital, Ciudad Real, Sabadell, Spain
| | - Rebeca Padilla
- Intensive Care Unit, University Hospital Virgen de la Salud, Toledo, Spain
| | | | | | | | - Jorge Jimenez
- Intensive Care Unit, Getafe University Hospital, Madrid, Spain
| | | | - Santiago Perez-Hoyos
- Statistics and Bioinformatics Unit, Vall d'Hebron Research Institute, Barcelona, Spain; IDIBAPS, the Genetics, Microbiology and Statistics Department, University of Barcelona, Barcelona, Spain
| | - Oriol Roca
- Intensive Care Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Ciber Enfermedades Respiratorias (CIBERES), Health Institute Carlos III, Madrid, Spain
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