Outcome of Tracheostomy in COVID-19 Patients

Mishra, Prasun; Jedge, Prashant; Yadav, Krutika V.; Galagali, Jeevan; Gaikwad, Viraj; Chethna, R; Kaushik, Maitri

doi:10.1007/s12070-022-03248-1

Cited by 4 publications

(4 citation statements)

References 11 publications

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“…A recent study has shown that air leak syndromes (pneumothorax and pneumomediastinum) were common findings in COVID-19 patients following placement of a tracheostomy. In this study, six out of 136 patients enrolled developed pneumothorax two to three days after tracheostomy, and 10 out of 136 patients had pneumothorax prior to placement of the tracheostomy, but no direct correlations have been established [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Optimal Timing of Tracheostomy in the Setting of COVID-19 and Associated Pneumothorax

Zweerink,

Sang,

Durrani

et al. 2024

Cureus

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Introduction At the beginning of the 2020 pandemic, no criteria were in place regarding the timing of tracheostomy placement in intubated COVID-19 patients, nor were there any data pertaining to pneumothorax incidence in this population. This study examines the timing of tracheostomy placement and its correlation with patient outcomes, along with pneumothorax incidence in COVID-19 patients who underwent a tracheostomy. Methods We performed a multi-institutional retrospective study of intubated COVID-19 patients admitted to intensive care units (ICUs) in North and South Dakota between April 2020 and December 2020. The timing of the tracheostomy was assessed, with primary outcomes being mortality, successful ventilator weaning, discharge to a long-term care facility, and overall length of stay. Patients were grouped by age, gender, ethnicity, and comorbidities. Pre- and post-tracheostomy pneumothorax was extracted from this dataset. Results We identified 85 patients who were intubated with COVID-19 and underwent a tracheostomy. The timing of tracheostomy varied widely, ranging from five to 53 days with an average time to tracheostomy being 17.3 days. Thirty-four of the patients expired, 32 patients were discharged to a long-term care hospital (LTCH), and 11 patients were discharged to an inpatient rehabilitation facility. Only three patients were discharged home. Regression analysis did not reveal statistically significant differences between patients who survived (N = 51) and patients who expired (N = 34) for almost all variables analyzed. Sixteen of the 85 patients were diagnosed with pneumothorax during their hospital stay. Half of these patients were diagnosed after a tracheostomy was placed. Conclusion This study did not demonstrate statistically significant differences in overall mortality or incidence of pneumothorax when it pertains to the timing of placement of tracheostomy. Variation in mortality was identified, in which younger patients were more likely to survive than older patients, a finding that was echoed in other studies. Considering this evidence, we cannot conclude that an association between the timing of tracheostomy and mortality from COVID-19; therefore, tracheostomy in the setting of COVID-19 can be performed at the provider's discretion.

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Section: Discussionmentioning

confidence: 99%

Optimal Timing of Tracheostomy in the Setting of COVID-19 and Associated Pneumothorax

Zweerink,

Sang,

Durrani

et al. 2024

Cureus

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“…They found no significant difference in survival between critically ill COVID-19 patients who received tracheostomy before versus after day 15. However, Mishra et al [ 18 ] reported outcomes of tracheostomy in COVID-19 patients. They found promising outcomes for COVID-19 patients who underwent early tracheostomy defined as within 10 days, with higher rates of ventilator liberation and decannulation.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Early vs. Late Tracheostomy in Ventilated COVID-19 Patients

Alkoheji,

Alabbasi,

Aldoseri

et al. 2024

Cureus

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Background The coronavirus disease 2019 (COVID-19) global pandemic prompted a significant use of intensive care resources for managing hypoxic respiratory failure. A substantial portion of these patients required mechanical ventilation. While intubation is common, its impact on mortality improvement has been questionable. Tracheostomies have become crucial for patients needing prolonged ventilation. However, tracheostomies also risk infections, ranging from early-stage mild cellulitis to later-stage nosocomial pneumonia. Our study evaluates the incidence of bacterial infections in COVID-19 patients who underwent tracheostomy early (within 14 days) versus late (more than 14 days after initiation of mechanical ventilation) during their stay in the intensive care unit (ICU). Methods We conducted a retrospective single-center study at Royal Medical Services Military Hospital. The study included COVID-19 patients who underwent tracheostomy and were admitted to the ICU from March 2020 to March 2022. We analyzed the incidence of ventilator-associated pneumonia, the timing of weaning from mechanical ventilation, and outcomes between early and late tracheostomized patients. Analyzed variables included demographics, comorbidities, use of steroids, tocilizumab, inflammation parameters, tracheostomy timing, incidence of bacterial infections, complications, and outcomes. Results The study comprised 36 patients. We found no statistically significant difference in the incidence of bacterial infections between the early and late tracheostomy groups (P>0.05). Complications and overall outcomes did not show significant statistical associations. Inotropes use was more frequent in the late tracheostomy group (P=0.122). In contrast, continuous renal replacement therapy was higher in the early tracheostomy group, showing no significant association (P>0.05). Mortality was higher in the early tracheostomy group, with nine deaths compared to seven in the late tracheostomy group. Interestingly, infection with Acinetobacter baumannii was associated with a statistically significant lower mortality rate, with 75% survival following tracheostomy. Conclusions Findings suggest that tracheostomy timing does not significantly impact the incidence of bacterial pneumonia or other complications, such as the use of inotropes, continuous renal replacement therapy, or mortality rates. These results support the use of personalized decision-making while conducting tracheostomies. Further research is necessary to determine the impacts of tracheostomy timing on patient outcomes more definitively.

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“…Regarding the procedure's safety, a 2021 study from France found no infections among the surgical team post-tracheostomies, with patient postoperative complications standing at 15% [36]. Similarly, a study in 2022 by Hansson et al reported postoperative complications in 36% of their COVID-19 cohort, highlighting bleeding as a prevalent issue [39,42,43]. Interestingly, a comprehensive 2022 meta-analysis, encompassing data from over 1000 studies, determined a cumulative complication incidence of 14.24%, with hemorrhages constituting 52% of all complications [44].…”

Section: Literature Findingsmentioning

confidence: 99%

The Effect of Comorbidities and Complications on COVID-19 Mortality: A Detailed Retrospective Study in Western Romania

Marc,

Rosca,

Bratosin

et al. 2023

JPM

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COVID-19 continues to impact global health systems even after being declared over, with some patients exhibiting severe complications linked to pre-existing conditions. This study aimed to investigate the association between comorbidities, complications, and survival outcomes among COVID-19 survivors in Western Romania. Our hypothesis posited that comorbidities and complications significantly influence survival rates. We conducted a retrospective analysis of 1948 COVID-19 survivors admitted from January to December 2021, with 192 selected for detailed analysis based on inclusion and exclusion criteria. The severity of COVID-19 was classified according to WHO guidelines, and conditions like hypertension and obesity were defined using criteria from the European Society of Hypertension (ESH), the European Society of Cardiology (ESC), and WHO, respectively. Among the 192 patients, 33 had mild, 62 had moderate, and 97 had severe COVID-19. The median age across the severity groups was 63.2 years. Patients undergoing tracheostomy had a mortality rate of 83.3% versus 22.2% for non-tracheostomy patients (p < 0.001) and presented with significantly higher lung injury, hospitalization duration, and complications. Remarkably, tracheostomized patients were 17.50 times more likely to succumb to the disease (95% CI 4.39–116.91, p < 0.001). Furthermore, pneumothorax increased the mortality risk significantly (OR 22.11, 95% CI 5.72–146.03, p < 0.001). Intriguingly, certain conditions like grade I hypertension and grade II obesity showed a protective effect against mortality, whereas type 2 diabetes mellitus increased mortality risk (univariate OR 2.89, p = 0.001). The presence of certain comorbidities and complications significantly impacts the survival rates of COVID-19 patients in Western Romania. Notably, tracheostomy, pneumothorax, and T2DM were associated with increased mortality. This study underscores the importance of personalized patient care and provides insights for healthcare policymakers in Western Romania to improve clinical management strategies.

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Outcome of Tracheostomy in COVID-19 Patients

Cited by 4 publications

References 11 publications

Optimal Timing of Tracheostomy in the Setting of COVID-19 and Associated Pneumothorax

Optimal Timing of Tracheostomy in the Setting of COVID-19 and Associated Pneumothorax

Clinical Outcomes of Early vs. Late Tracheostomy in Ventilated COVID-19 Patients

The Effect of Comorbidities and Complications on COVID-19 Mortality: A Detailed Retrospective Study in Western Romania

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