Early vs. late tracheostomy in ventilated COVID-19 patients – A retrospective study

Livneh, Nir; Mansour, Jobran; Lerner, Reut Kassif; Feinmesser, Gilad; Alon, Eran E.

doi:10.1016/j.amjoto.2021.103102

Cited by 24 publications

(23 citation statements)

References 22 publications

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“…Comparing our results with the ones found in the literature, Livneh et al 20 reported 38 tracheostomies performed on a series of cases, similar with our study, in the same period of time, with a male gender dominance of 87% versus 80.65% in our case, while in Reis et al 21 study, performed between 2020-2021 on 42 patients with SARS-CoV-2, 71% of the patients were males. The mean age of the patients included in these two studies was 57.1±13,395 years (range 56-72) in Livneh et al and 68.4±11.1 years (range 47-90) in Reis et al study 20,21 . With respect to the time of IOT, in our series it was of 20.52±6.722 days (range 11-43), higher compared to the time reported by Livneh et al with 16 days 20 , but similar to the results of Reis et al of 22.9±6.5 days 21 .…”

Section: Discussionsupporting

confidence: 91%

“…The mean age of the patients included in these two studies was 57.1±13,395 years (range 56-72) in Livneh et al and 68.4±11.1 years (range 47-90) in Reis et al study 20,21 . With respect to the time of IOT, in our series it was of 20.52±6.722 days (range 11-43), higher compared to the time reported by Livneh et al with 16 days 20 , but similar to the results of Reis et al of 22.9±6.5 days 21 . Among the factors associated with death, some comorbidities such as heart disease and age over 60 years are described.…”

Section: Discussionmentioning

confidence: 82%

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Impact of tracheostomy in patients with severe acute respiratory syndrome due to coronavirus infection

Lugo-Machado¹,

Guerrero-Paz²,

Fuentes³

et al. 2022

Romanian Journal of Rhinology

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OBJECTIVE. To estimate the effect of tracheostomy on ventilation in patients with COVID-19. MATERIAL AND METHODS. An observational, retrospective, analytical, longitudinal study of a consecutive series of cases was carried out between April 2020 and March 2021. The study included data about different variables, such as age, sex, comorbidities, time of orotracheal intubation, place of surgery, complications and death, ventilatory parameters, blood gas and time of the weaning after tracheostomy. Descriptive statistics were used with measures of central tendency, measures of dispersion and the Wilcoxon test to see differences in the ventilatory parameters. RESULTS. The study was performed on 130 patients admitted to the ICU with intubation to manage their critical condition. From these patients, the study group included 31 who underwent tracheostomy, 25 males (80.64%) with a mean age of 57.1±13.395 years and with 20.52±6.722 days in orotracheal intubation. Among the most frequent comorbidities, we encountered: arterial hypertension (51.6%), obesity (35.4%), diabetes mellitus (22.5%), hypothyroidism (6.4%), asthma (3.2%), pregnancy (3.2%), chronic obstructive pulmonary disease (3.2%) and obstructive sleep apnea syndrome (3.2%). The main complications were bleeding (12.9%) and decannulation (3.2%). The survival rate was 90.32%. Comparing the pre-surgical and postoperative outcomes of the ventilatory parameters and blood gas, statistically significant differences were found only in case of PEEP (p = 0.033), FiO2 (p = 0.001) and O2 saturation (p = 0.001). The average removal of the ventilator was 4.3±2.437 days. CONCLUSION. There were no significant changes in the ventilatory parameters, however, they were sufficient to wean the patients from the ventilation team and discharge them to the internal medicine department to continue their management outside the intensive care unit.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 82%

Impact of tracheostomy in patients with severe acute respiratory syndrome due to coronavirus infection

Lugo-Machado¹,

Guerrero-Paz²,

Fuentes³

et al. 2022

Romanian Journal of Rhinology

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“…Thirteen studies [ 21 – 23 , 31 – 33 , 35 – 41 ] provided data on overall mortality. Mortality was reported at 30 days following tracheostomy [ 33 ], at 30 days following ICU admission [ 32 , 35 ], at 60 days following intubation [ 39 ], at ICU [ 21 , 40 , 41 ] and hospital discharge [ 23 , 31 , 36 , 38 ] and at an undefined time point [ 22 , 37 ]. Moderate statistical heterogeneity was detected ( I 2 = 41%).…”

Section: Resultsmentioning

confidence: 99%

“…Six studies [ 21 , 23 , 32 , 36 – 38 ] provided data on time from tracheostomy to ventilator weaning. Ventilator weaning was not defined in two studies [ 23 , 37 ] and was defined in four studies as discontinuation of mechanical ventilation [ 21 , 32 , 36 , 38 ]. Low statistical heterogeneity was detected ( I 2 = 30%).…”

Section: Resultsmentioning

confidence: 99%

Tracheostomy timing and clinical outcomes in ventilated COVID-19 patients: a systematic review and meta-analysis

Fang²,

Cheng

et al. 2022

Crit Care

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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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“…These findings are consistent with data reported from previous studies [ 18 , 32 , 33 ]. The optimal timing for tracheostomy provided conflicting evidence [ 13 , 14 , 15 , 16 , 21 , 34 , 35 ]. In our study, longer ICU stay was found in the TS group.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Different Ventilatory Strategies on Clinical Outcomes in Patients with COVID-19 Pneumonia

Rocans

Ozoliņa

Battaglini

et al. 2022

JCM

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Introduction: The aim was to investigate the impact of different ventilator strategies (non-invasive ventilation (NIV); invasive MV with tracheal tube (TT) and with tracheostomy (TS) on outcomes (mortality and intensive care unit (ICU) length of stay) in patients with COVID-19. We also assessed the impact of timing of percutaneous tracheostomy and other risk factors on mortality. Methods: The retrospective cohort included 868 patients with severe COVID-19. Demographics, MV parameters and duration, and ICU mortality were collected. Results: MV was provided in 530 (61.1%) patients, divided into three groups: NIV (n = 139), TT (n = 313), and TS (n = 78). Prevalence of tracheostomy was 14.7%, and ICU mortality was 90.4%, 60.2%, and 30.2% in TT, TS, and NIV groups, respectively (p < 0.001). Tracheostomy increased the chances of survival and being discharged from ICU (OR 6.3, p < 0.001) despite prolonging ICU stay compared to the TT group (22.2 days vs. 10.7 days, p < 0.001) without differences in survival rates between early and late tracheostomy. Patients who only received invasive MV had higher odds of survival compared to those receiving NIV in ICU prior to invasive MV (OR 2.7, p = 0.001). The odds of death increased with age (OR 1.032, p < 0.001), obesity (1.58, p = 0.041), chronic renal disease (1.57, p = 0.019), sepsis (2.8, p < 0.001), acute kidney injury (1.7, p = 0.049), multiple organ dysfunction (3.2, p < 0.001), and ARDS (3.3, p < 0.001). Conclusions: Percutaneous tracheostomy compared to MV via TT significantly increased survival and the rate of discharge from ICU, without differences between early or late tracheostomy.

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Early vs. late tracheostomy in ventilated COVID-19 patients – A retrospective study

Cited by 24 publications

References 22 publications

Impact of tracheostomy in patients with severe acute respiratory syndrome due to coronavirus infection

Impact of tracheostomy in patients with severe acute respiratory syndrome due to coronavirus infection

Tracheostomy timing and clinical outcomes in ventilated COVID-19 patients: a systematic review and meta-analysis

The Impact of Different Ventilatory Strategies on Clinical Outcomes in Patients with COVID-19 Pneumonia

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