Background The question of an optimal strategy and outcomes in COVID-19 tracheostomy has not been answered yet. The critical focus in our case study is to evaluate the outcomes of tracheostomy on intubated COVID-19 patients. Methods A multicentric prospective observational study of 1890 COVID-19 patients undergoing tracheostomy across 120 hospitals was conducted over 7 weeks in Spain (March 28 to May 15, 2020). Data were collected with an innovative approach: instant messaging via WhatsApp. Outcome measurements: complications, achieved weaning and decannulation and survival. Results We performed 1,461 surgical (81.3%) and 429 percutaneous tracheostomies. Median timing of tracheostomy was 12 days (4-42 days) since orotracheal intubation. A close follow-up of 1616/1890 (85.5%) patients at the cutoff time of 1-month follow-up showed that in 842 (52.1%) patients, weaning was achieved, while 391 (24.2%) were still under mechanical ventilation and 383 (23.7%) patients had died from COVID-19. Decannulation among those in whom weaning was successful (n = 842) was achieved in 683 (81%) patients. Conclusion To the best of our knowledge, this is the largest cohort of COVID-19 patients undergoing tracheostomy. The critical focus is the unprecedented amount of tracheostomies: 1890 in 7 weeks. Weaning could be achieved in over half of the patients with follow-up. Almost one out of four tracheotomized patients died from COVID-19.

OBJECTIVE:Th e objective of this study was to evaluate the diagnostic reliability of home respiratory polygraphy (HRP) in children with a clinical suspicion of OSA-hypopnea syndrome (OSAS). METHODS:A prospective blind evaluation was performed. Children between the ages of 2 to 14 years with clinical suspicion of OSAS who were referred to the Sleep Unit were included. An initial HRP followed by a later date , same night, in-laboratory overnight respiratory polygraphy and polysomnography (PSG) in the sleep laboratory were performed. Th e apneahypopnea index (AHI)-HRP was compared with AHI-PSG, and therapeutic decisions based on AHI-HRP and AHI-PSG were analyzed using intraclass correlation coeffi cients, BlandAltman plots, and receiver operator curves (ROCs). RESULTS:Twenty-seven boys and 23 girls, with a mean age of 5.3 Ϯ 2.5 years, were studied, and 66% were diagnosed with OSAS based on a PSG-defi ned obstructive respiratory disturbance index Ն 3/h total sleep time. Based on the availability of concurrent HRP-PSG recordings, the optimal AHI-HRP corresponding to the PSG-defi ned OSAS criterion was established as Ն 5.6/h Th e latter exhibited a sensitivity of 90.9% (95% CI, 79.6%-100%) and a specifi city of 94.1% (95% CI, 80%-100%).CONCLUSIONS: HRP recordings emerge as a potentially useful and reliable approach for the diagnosis of OSAS in children. However, more research is required for the diagnosis of mild OSAS using HRP in children. ENT 5 ear, nose, and throat; HRP 5 home respiratory polygraphy; ICC 5 interclass correlation coeffi cient; LRP 5 in-laboratory respiratory polygraphy; OAHI 5 obstructive apnea-hypopnea index; ORDI 5 obstructive respiratory disturbance index; OSAS 5 OSAhypopnea syndrome; PSG 5 polysomnography; RDI 5 respiratory disturbance index; ROC 5 receiver operating characteristic; RP 5 respiratory polygraphy; Sp o 2 5 oxygen saturation using pulse oximetry; SU 5 Sleep Unit AFFILIATIONS: From the Sleep Unit (Drs Alonso-Álvarez, Terán-Santos, Ordax Carbajo, Cordero-Guevara, and Navazo-Egüia), the CIBER of Respiratory Diseases (Drs Alonso-Álvarez and Terán-Santos), Instituto Carlos III, CIBERES, and the

The first line of treatment of obstructive sleep apnoea syndrome (OSAS) in children consists of adenotonsillectomy (T&A). The aim of the present study was to evaluate treatment outcomes of OSAS among obese children recruited from the community.A cross-sectional, prospective, multicentre study of Spanish obese children aged 3-14 years, with four groups available for follow-up: group 1: non-OSAS with no treatment; group 2: dietary treatment; group 3: surgical treatment; and group 4: continuous positive airway pressure treatment.117 obese children (60 boys, 57 girls) with a mean age of 11.3±2.9 years completed the initial (T0) and follow-up (T1) assessments. Their mean body mass index (BMI) at T1 was 27.6±4.7 kg·m −2 , corresponding to a BMI Z-score of 1.34±0.59. Mean respiratory disturbance index (RDI) at follow-up was 3.3±3.9 events·h −1 . Among group 1 children, 21.2% had an RDI ⩾3 events·h −1 at T1, the latter being present in 50% of group 2, and 43.5% in group 3. In the binary logistic regression model, age emerged as a significant risk factor for residual OSAS (odds ratio 1.49, 95% confidence interval 1.01-2.23; p<0.05) in obese children surgically treated, and RDI at T0 as well as an increase in BMI emerged as significant risk factors for persistent OSAS in obese children with dietary treatment (OR 1.82,).Age, RDI at diagnosis and obesity are risk factors for relatively unfavourable OSAS treatment outcomes at follow-up. @ERSpublications Age, RDI and obesity are risk factors for unfavourable OSAS treatment outcomes at follow-up

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