Early Percutaneous Tracheostomy in Coronavirus Disease 2019: Association With Hospital Mortality and Factors Associated With Removal of Tracheostomy Tube at ICU Discharge. A Cohort Study on 121 Patients*

Abstract

Objectives: Early tracheotomy, defined as a procedure performed within 10 days from intubation, is associated with more ventilator free days, shorter ICU stay, and lower mortality than late tracheotomy. During the coronavirus disease 2019 pandemic, it was especially important to save operating room resources and to have a shorter ICU stay for patients, when ICUs had insufficient beds. In this context of limited resources, early percutaneous tracheostomy could be an effective way to manage mechanically ventilated patients. Nevertheless, current recommendations suggest delaying or avoiding the tracheotomy in coronavirus disease 2019 patients. Aim of the study was to analyze the hospital mortality of coronavirus disease 2019 patients who had received early percutaneous tracheostomy and factors associated with removal of tracheostomy cannula at ICU discharge. Design: Cohort study. Setting: Coronavirus disease 2019 ICU. Patients: Adult patients with coronavirus disease 2019 3 days after ICU admission. Interventions: None. Measurements and Main Results: Three days after ICU admission, 164 patients were present in ICU and included in the analysis. One-hundred and twenty-one patients (74%) were tracheostomized, whereas the other 43 (26%) were managed with translaryngeal intubation only. In multivariable analysis, early percutaneous tracheostomy was associated with lower hospital mortality. Sixty-six of tracheostomized patients (55%) were discharged alive from the hospital. Age and male sex were the only characteristics that were independently associated with mortality in the tracheostomized patients (45.5% and 62.8% in tracheostomized and nontracheostomized patients, respectively; p = 0.009). Tracheostomy tube was removed in 47 of the tracheostomized patients (71%). The only variable independently associated with weaning from tracheostomy at ICU discharge was a faster start of spontaneous breathing after tracheotomy was performed. Conclusions: Early percutaneous tracheostomy was safe and effective in coronavirus disease 2019 patients, giving a good chance of survival and of weaning from tracheostomy cannula at ICU discharge.

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

“…The majority of studies were performed in the United States (US), accounting for 33.3% of all included studies. The United Kingdom (UK) provided 9 studies 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , Spain 7 studies 32 , 33 , 34 , 35 , 36 , 37 , 38 , Italy 6 studies 39 , 40 , 41 , 42 , 43 , 44 , China 3 studies 45 , 46 , 47 , and India 1 study 48 .…”

“…SD, standard deviation; BMI, body-mass index; PEEP, positive end-expiratory pressure; APACHE II, Acute Physiology and Chronic Health Evaluation II. Characteristic Value References Count n(%) Total patients 3929 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 3929 (100) Sex n (%) Female Male 437 (27.01) 1181 (72.99) 23 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , ...…”

“…37 studies included mortality data, irrespective of subgrouping. Of the 3876 patients included across these 37 studies, 824 patients had died by the time of follow-up 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 41 , 42 , 43 , 45 – 62 . Only 14 studies explicitly reported a mean follow-up duration, giving a combined weighted mean of 42.03 days (SD 26.43) 24 , 26 , 27 , 30 , 33 , 37 , 42 , 43 , 48 , 50 , 52 , 56 , 59 , 60 .…”

“…28 studies reported outcomes related to decannulation. Of a total of 3326 tracheostomies performed across these 28 studies, 1416 patients were successfully decannulated at the time of follow-up 24 , 25 , 26 , 27 , 28 , 29 , 31 , 32 , 33 , 35 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 48 – 52 , 55 , 56 , 57 , 59 , 60 , 61 . Analysis of pooled data identified a cumulative incidence of decannulation of 44.2% [95% CI 33.96%-54.67%].…”

“…2 ). Mean time to decannulation was reported in 19 of the 39 studies, identifying an overall weighted mean time from intubation to decannulation of 17.70 days (SD 11.31) 25 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 38 , 39 , 41 , 43 , 46 , 48 , 49 , 51 , 52 , 55 , 56 , 57 , 60 .…”