Long-term Outcomes After Tracheostomy for COVID-19

Taboada, Manuel; Moreno, E.; Leal, Sonsoles; Pita-Romero, Rafael; Sanduende, Yolanda; Rama, P.; Cid, Milagros; Seoane-Pillado, Teresa

doi:10.1016/j.arbres.2021.01.014

Cited by 7 publications

(4 citation statements)

References 5 publications

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“…A scientific letter by Taboada et al on the same subject reported a mortality rate of 41%, where 12 of the 29 tracheotomised patients died due to COVID related complications. The number in their case was much less than in the present study; however, the results are comparable [ 10 ].…”

Section: Discussioncontrasting

confidence: 44%

“…The most common complication was bleeding, which occurred in 20.6% of the patients, most of which were mild. In various other studies, bleeding was also the most common complication, ranging from 5 to 30% [ 10 , 12 ]. The most common reason for this could be that all these patients were on blood thinners, which was ideally stopped 24 h before the procedure, though at the present centre, we do stop anticoagulation as per standard protocols.…”

Section: Discussionmentioning

confidence: 99%

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Outcome of Tracheostomy in COVID-19 Patients

Mishra

Jedge

Yadav

et al. 2022

Indian J Otolaryngol Head Neck Surg

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Introduction Since the start of the COVID-19 pandemic 2019, quite a few patients became critical and needed ICU admission with ventilator assistance. Tracheostomy, which was initially performed late during the course of patient on ventilator, has now been considered a procedure that can be performed relatively early as this leads to early weaning of patients and overcomes the shortage of critical beds. Objective This study aims to focus on the outcomes of tracheotomised COVID-19 patients in terms of survival and any tracheostomy related morbidity. Methods A prospective study was performed on COVID-19 patients undergoing tracheostomy at this tertiary care teaching hospital, which also was a dedicated centre for treating COVID-19 patients. The duration of this study was from April 2020 to September 2021. Following tracheostomy, all patients were followed up regularly and clinical changes were recorded. Points that were specifically noted were timing of the tracheostomy, change in ventilator settings, tracheostomy related complications, requirement of oxygen, days needed to wean the patient, decanulation, and, if death, the cause of death. Results A total of 136 surgical open tracheostomies were performed on COVID-19 patients over the study period. The mean duration of intubation (timing of tracheostomy) was 12 days. A total of 73 out of 136 (53.6%) patients survived. 51 patients (37.5%) got decannulated during the course of the hospital stay. 9 patients were decanulated during the follow up visits and 13 patients were lost to follow up. 63 out of 136 (46.3%) patients died due to COVID pneumonia. Most of the patients who died had gone into multi-organ failure. Air leak syndromes (pneumothorax and pneumomediastinum) were common findings. 10 patients already had surgical emphysema before taking up for tracheostomy and 6 developed 2–3 days after tracheostomy. The most common complication was bleeding, which was seen in 28 out of 136 patients. The Median weaning of period of patients who survived was 5 days. Conclusion Performing tracheostomy early in COVID-19 patients helps in early weaning of the patient from the ventilator and makes nursing care easier and increases the availability of ICU beds. The mortality rate was 46% amongst the 136 tracheostomies done in COVID-19 patients. Local site bleeding was the most common complication and surgical emphysema was also seen more than routine tracheostomies. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-022-03248-1.

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Section: Discussioncontrasting

confidence: 44%

Section: Discussionmentioning

confidence: 99%

Outcome of Tracheostomy in COVID-19 Patients

Mishra

Jedge

Yadav

et al. 2022

Indian J Otolaryngol Head Neck Surg

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“…There is a clear decrement in HRQoL in adult patients with tracheostomies as measured with generic measures including the EQ-5D-3L/5L [ 29 – 32 ], SF-36 [ 33 , 34 ] and tracheostomy-specific questionnaires [ 35 – 37 ]. Most studies in children dependent on technology for breathing have studied the impact of caregiver or family burden with decrements in HRQoL shown on the PedsQL family impact module [ 25 – 27 ] as well as caregiver HRQoL on the SF-36 [ 38 , 39 ], HUI [ 4 ] and the PTHSI [ 24 , 38 , 40 ].…”

Section: Introductionmentioning

confidence: 99%

Fighting to Breathe and Fighting for Health-Related Quality of Life: Measuring the Impact of Being Dependent on Technology for Breathing on the Child and Their Caregiver

Verstraete,

Booth,

Booth

et al. 2023

Patient

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Background and Objective Medical advancement has enabled children to survive congenital airway anomalies, rare diseases and critical illnesses with medical technology including tracheostomies and long-term ventilation to support breathing. This study aimed to assess (1) the validity of the EQ-TIPS and EQ-5D-Y-3L in children dependent on technology and (2) the impact of caring for these children on the EQ-5D-5L and CarerQoL. Methods Caregivers of children aged 1 month to 18 years completed the EQ-TIPS or EQ-5D-Y-3L, Pediatric Quality of Life Inventory (PedsQL) and Paediatric Tracheostomy Health Status Instrument (PTHSI) to reflect the child’s health. In addition, caregivers self-completed the EQ-5D-5L and CarerQoL. Reports of problems on EQ dimensions were compared across age groups with the Fisher’s exact test. Spearman and Pearson’s correlation coefficients and Kruskal–Wallis H-test were used to explore the association between caregiver and child scores, concurrent validity, and known-group validity of the EQ-TIPS and EQ-5D-Y-3L. Results Responses from 144 caregivers were collected, 66 for children aged 1 month to 4 years completing EQ-TIPS and 78 for children aged 5–18 years completing EQ-5D-Y-3L. The EQ-TIPS showed a higher report of no problems for social interaction for children aged 1–12 months ( p = 0.040) than the older age groups, there were however no differences in the level sum score (LSS) or EQ Visual Analogue Scale scores between the age groups. The EQ-5D-Y-3L showed a significantly less report of problems for mobility ( p = 0.013) and usual activities ( p = 0.006) for children aged 5–7 years compared with children aged 8–12 and children aged 13–18 years. Similarly, the 5–7 years of age group had a significantly lower EQ-5D-Y-3L LSS compared with the older groups (H = 12.08, p = 0.002). The EQ-TIPS and EQ-5D-Y-3L showed moderate-to-strong associations with the PedsQL. EQ-TIPS median LSS was able to differentiate between groups on the clinical prognosis with a better health-related quality of life (HRQoL) in those where weaning from technology is possible compared with those where weaning is not possible (H = 18.98, p = 0.011). The EQ-5D-Y-3L can discriminate between breathing technology, where those with only a tracheostomy reported better HRQoL (H = 8.92, p = 0.012), and between mild and moderate clinical severity (H = 19.42, p < 0.001). Neither the PedsQL nor the PTHSI was able to discriminate between these groups across the age range. Caregiver and child HRQoL scores showed moderate-to-strong associations. Conclusions The EQ-TIPS and EQ-5D-Y-3L showed good validity in children dependent on the technology for breathing. The EQ-TIPS and EQ-5D-Y-3L LSS were all able to differentiate between children with known ...

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“…A significant proportion of these patients survive but require tracheostomy placement and prolonged convalescence. There are few studies published to date evaluating the outcomes of patients recovering from COVID-19 and resulting in the need for tracheostomy, with no published studies that reported, to our knowledge, long-term outcomes beyond 90 days (5)(6)(7). Unfortunately, the short horizon of follow-up may under-represent important (and less favorable) outcomes occurring in the following months.…”

mentioning

confidence: 99%

One-Year Outcomes of Patients Requiring Tracheostomy Placement Due to Severe Acute Respiratory Syndrome Coronavirus 2 Infection

Abunasser

Pérez

Wang

et al. 2023

Critical Care Explorations

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BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease it causes (COVID-19) have resulted in an increase in critical illness and in the prevalence of acute respiratory failure with the need for tracheostomy. The characteristics and long-term outcomes of this patient cohort are not well identified. RESEARCH QUESTION: What are the characteristics of patients who develop the need for tracheostomy due to SARS-CoV-2 with acute respiratory distress syndrome (ARDS)? What is their 90-day and 1-year survival and are there any identifiable risk factors for mortality and ventilator dependency? STUDY DESIGN AND METHODS: Retrospective, follow-up cohort study of adult patients with COVID-19 infection and ARDS who required tracheostomy placement in a large healthcare system. RESULTS: One hundred sixty-four consecutive patients with SARS-CoV-2 admitted to ICUs for ARDS who required tracheostomy placement between March 2020 and March 2021 were identified. One hundred nine (66.5%) were male. Average age was 63.5 years. The most common comorbidities were obesity, hypertension, diabetes mellitus, congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease (COPD), atrial fibrillation, and asthma. The most common complications during hospitalization were delirium, secondary infections, acute kidney injury, pneumothorax, and venous thromboembolism. Ninety-day and 1-year mortality were 29.9% and 44.5%, respectively. Ninety-six patients (58.5%) were liberated from the ventilator, and 84 (51.2%) had the tracheostomy tube decannulated. Asthma, COPD, atrial fibrillation, and renal replacement therapy requirement in the ICU correlated with increased risk of ventilator dependency. Among survivors at 1 year, 71 patients (43.3%) were residing at home and 20 patients (12.2%) remained in a skilled nursing facility. INTERPRETATION: COVID-19 has resulted in a significant burden of acute critical illness and acute respiratory failure with the need for tracheostomy. A significant percentage of patients with SARS-CoV-2 requiring tracheostomy were alive and at home 1 year after tracheostomy placement. Long-term care support, including tracheostomy, beyond 90 days appears to be beneficial in this patient population and warrants further investigation.

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Long-term Outcomes After Tracheostomy for COVID-19

Cited by 7 publications

References 5 publications

Outcome of Tracheostomy in COVID-19 Patients

Outcome of Tracheostomy in COVID-19 Patients

Fighting to Breathe and Fighting for Health-Related Quality of Life: Measuring the Impact of Being Dependent on Technology for Breathing on the Child and Their Caregiver

One-Year Outcomes of Patients Requiring Tracheostomy Placement Due to Severe Acute Respiratory Syndrome Coronavirus 2 Infection

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