Outcomes and survival of tracheostomised patients during the COVID-19 pandemic in a third level hospital

Mesalles-Ruíz, Marta; Hamdan, Miriam; Huguet-Llull, Gabriel; Penella, Anna; Portillo, Alejandro; Bagudà, Eva; Capelleras, Marta; Caballero, José María; Golet, Mireia; Fulla, Marta; Bartel, Ricardo; Cisa, Enric; Cruellas, Francesc; Tornero, Jordi; Lares, Henry; Farré, Anna Freixas; Skufca, Javier; Nogués, Julio J.; Mañós, M.; Gonzàlez-Compta, Xavier

doi:10.1007/s00405-021-07120-w

Cited by 3 publications

(3 citation statements)

References 29 publications

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“…16 The second of these studies found a significantly increased risk of bleeding in Covid-19 patients (20.3 per cent vs 5.97 per cent), but with no difference in length of hospital stay. 17 The final of these studies reported an increased time from intubation to tracheostomy in Covid-19 patients (25.4 days vs 22.9 days). 7…”

Section: Resultsmentioning

confidence: 98%

Coronavirus disease tracheostomy complications: a scoping review

et al. 2022

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Background Coronavirus disease 2019 increased the numbers of patients requiring prolonged mechanical ventilation, with a subsequent increase in tracheostomy procedures. Coronavirus disease 2019 patients are high risk for surgical complications. This review examines open surgical and percutaneous tracheostomy complications in coronavirus disease 2019 patients. Methods Medline and Embase databases were searched (November 2021), and the abstracts of relevant articles were screened. Data were collected regarding tracheostomy technique and complications. Complication rates were compared between percutaneous and open surgical tracheostomy. Results Percutaneous tracheostomy was higher risk for bleeding, pneumothorax and false passage. Surgical tracheostomy was higher risk for peri-operative hypoxia. The most common complication for both techniques was post-operative bleeding. Conclusion Coronavirus disease 2019 patients undergoing tracheostomy are at higher risk of bleeding and peri-operative hypoxia than non-coronavirus disease patients. High doses of anti-coagulants may partially explain this. Reasons for higher bleeding risk in percutaneous over open surgical technique remain unclear. Further research is required to determine the causes of differences found and to establish mitigating strategies.

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Section: Resultsmentioning

confidence: 98%

Coronavirus disease tracheostomy complications: a scoping review

et al. 2022

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“…In the present study, bleeding complications were observed in 7.5% of patients. In a previous retrospective single‐center observational study of a prospective cohort of patients with COVID‐19 in Spain, bleeding complications occurred in 20.31% of 64 patients with tracheostomized COVID‐19 13 . In a retrospective study of 161 COVID‐19 non‐survivors in Turkey, 39% had major bleeding complications.…”

Section: Discussionmentioning

confidence: 97%

Factors associated with bleeding complications in patients with coronavirus disease 2019 admitted to intensive care units: A multicenter retrospective cohort study

Imai

Ushigome

Hamaguchi

et al. 2023

J of Diabetes Invest

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Aims/IntroductionDiabetes is a major risk factor for coronavirus disease 2019 (COVID‐19) severity. We aimed to retrospectively investigate the rates of patients with no diabetes, untreated diabetes, treated diabetes, COVID‐19‐related diabetes and the factors associated with bleeding complications in a cohort of patients with severe COVID‐19.Materials and MethodsThis was a multicenter, retrospective, observational study. Participants were COVID‐19 patients enrolled in the Cross‐sectional ICU Information Search System (CRISIS) from February 2020 to March 2022. Patients were classified into four groups according to diabetes status and treatment status. Hemorrhagic complications were defined as bleeding requiring transfusion of four or more red blood cell units, a drop of hemoglobin of ≥2 g in 24 h and retroperitoneal, airway or intracranial bleeding. Logistic regression analysis was carried out to examine factors associated with bleeding complications.ResultsA total of 1,076 patients were included in the analysis. The rates of patients in the no diabetes, untreated diabetes, treated diabetes and COVID‐19‐related diabetes groups were 17.4, 23.0, 23.9 and 35.7%, respectively. Bleeding complications were observed in 7.5% of all patients. Glycated hemoglobin level and renal failure were significantly correlated with bleeding complications (odds ratio 1.16, 95% confidence interval 1.02–1.33 and 2.77, 95% confidence interval 1.16–6.63, respectively). Patients with diabetes, including those with COVID‐19‐related diabetes, accounted for approximately 83% of all cases.ConclusionsIn patients with severe COVID‐19 with high glycated hemoglobin and renal failure, we recommend additional attention to the course of COVID‐19, given the risk of bleeding complications.

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“…1 A recent study of 1371 patients with COVID-19 found that 64 out of 330 (19.4%) patients admitted to the intensive care unit (ICU) eventually underwent tracheotomy. 2 Though tracheotomy is generally associated with an increase in survival, the high mortality rate of intubated patients with COVID-19 makes predicting which patients will survive beyond the immediate postoperative period challenging. 3,4 Previous studies have explored predictive factors for mortality in patients with COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Mortality in Patients With COVID-19 Undergoing Tracheotomy

Mitton

Atwood

Kenee

et al. 2022

Ann Otol Rhinol Laryngol

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Objective: To identify factors predictive of 30-day mortality following tracheotomy in patients with COVID-19. Methods: A retrospective chart review of patients with COVID-19 who underwent tracheotomy at a tertiary medical center between March 2020 and October 2021 was conducted. Univariate and multivariable analyses of factors correlated with 30-day post-tracheotomy mortality were performed. The outcomes of tracheotomies performed in the operating room and at bedside were compared with t-tests and multivariable analysis. Results: One hundred-twenty patients met inclusion criteria, with 48 female patients (40%). Mean age was 59.8 [12.6] years, and the 30-day mortality rate was 18.3%. On univariate analysis, age (odds ratio (OR) = 1.06; P = .015), FiO2 at the time of tracheotomy (OR = 1.06; P < .001), and bedside tracheotomy (OR = 3.21; P = .019) were associated with increased risk of 30-day mortality. After including control variables, increased FiO2 continued to predict increased odds of 30-day mortality (OR = 1.08; P = .02); specifically, patients with FiO2 > 65% were significantly more likely to pass within 30 days than those with FiO2 ≤ 40% (OR = 28.24; P < .001). There was a significant difference in the 30-day mortality rate of bedside tracheotomies (31%) and OR tracheotomies (12%; P = .02), but this association was eliminated on multivariable analysis (OR = 0.95; P = .96). Conclusion: Intubated patients with COVID-19 undergoing tracheotomy with FiO2 > 65% have 25 times greater odds of 30-day mortality than those with FiO2 ≤ 40%. There were no differences in outcomes between bedside and OR tracheotomies.

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Outcomes and survival of tracheostomised patients during the COVID-19 pandemic in a third level hospital

Cited by 3 publications

References 29 publications

Coronavirus disease tracheostomy complications: a scoping review

Coronavirus disease tracheostomy complications: a scoping review

Factors associated with bleeding complications in patients with coronavirus disease 2019 admitted to intensive care units: A multicenter retrospective cohort study

Predictors of Mortality in Patients With COVID-19 Undergoing Tracheotomy

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