Outcomes of Tracheostomy in COVID-19 Patients: A Single Centre Experience

Abstract

The rapid emergence of COVID-19 has led to increase in the number of patients requiring prolonged ventilation and tracheostomy. Though global guidelines are evolving, there is a paucity of literature about optimal timing and outcome after tracheostomy in COVID-19 patients. We set out to assess the clinical characteristics and outcome of COVID-19 patients who underwent tracheostomy.This single-center, prospective observational cohort study analyzed all the consecutive tracheostomy performed on COVID-19 patients from April 1 2020 to January 31, 2021. The primary outcome measure was the 30-day mortality rate following tracheostomy and association with various prognostic risk factors. The secondary outcome measures included various tracheostomy-related events, perioperative complications, and decannulation rate.The study included 51 patients with a median age of 52 years and the majority were male (62.74%). 62.74% (32 of 51) tracheostomies were done early (within 10 days of intubation) and the mean duration from endotracheal intubation to tracheostomy was 10.27 days. The 30-day mortality rate was 66.66% (34 of 51) with no tracheostomy-related mortality and the mean duration between tracheostomy and death was 8.29 days. The presence of sepsis was associated with a higher rate of mortality (p = 0.002) while the timing of tracheostomy was not related to increased mortality (p = 0.365). The most common perioperative complication was tracheostoma bleeding (16.64%). At a median follow-up of 7.5 months, only four patients were decannulated.Though associated with a higher rate of 30-day mortality rate, tracheostomy among COVID-19 patients is a safe and an effective weaning tool.

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

“…Figure 1 shows the flow diagram of study selection process. A total of 14 studies [21][22][23][31][32][33][34][35][36][37][38][39][40][41] 8 retrospectively conducted; 8 single-center studies and 6 multicenter studies) from Asia, Europe and America, involving 2371 tracheostomized COVID-19 patients (938 in the ET group vs. 1433 in the LT group), were incorporated in our meta-analysis. The majority of the studies were conducted during the first wave of COVID-19 pandemic.…”

Tracheotomy Outcomes in 71 COVID-19 Patients: A Multi-Centric Study in Saudi Arabia

“…In our study, the mean period of intubation before a tracheostomy was 9.97 ± 2.72 days. A recent study by Chandran A et al reported a mean of 10.27 days from intubation to tracheostomy [ 20 ]. Another study by Chao TN et al reported an average time of intubation before a tracheostomy of 19.7 ± 6.9 days, with a range of 8–42 days [ 9 ].…”

“…The mortality among COVID-19 patients who underwent tracheostomy in previous published studies ranged from 7% to 41% [ 9 , 21 ]. Moreover, a study by Chandran A et al had an overall 30-day mortality of 66.66% [ 20 ]. In this study, the overall 30-day mortality rate was 38.4%, which is an acceptable rate in comparison to the previously reported cases.…”

“…Multiple medical comorbidities, such as hypertension, diabetes, lung disease and obesity (BMI > 30), were associated with poor outcomes. Previous studies found that the presence of sepsis, older age and coexisting neurological diseases were associated with poor outcomes [ 20 , 22 ]. Moreover, a study by Chandran A et al found an overall 30-day mortality rate of 66.66% [ 20 ].…”

“…Previous studies found that the presence of sepsis, older age and coexisting neurological diseases were associated with poor outcomes [ 20 , 22 ]. Moreover, a study by Chandran A et al found an overall 30-day mortality rate of 66.66% [ 20 ]. In this study, the overall 30-day mortality rate was 38.4%, which is acceptable in comparison to previously reported cases.…”