Systematic review of international guidelines for tracheostomy in COVID-19 patients

Chiesa‐Estomba, Carlos Miguel; Lechien, J; Calvo‐Henríquez, Christian; Fakhry, Nicolas; Karkos, Petros D.; Peer, Shazia; Sistiaga-Suárez, Jon Alexander; González-García, José Ángel; Cammaroto, Giovanni; Mayo‐Yáñez, Miguel; Parente‐Arias, Pablo; Saussez, Sven; Ayad, Tareck

doi:10.1016/j.oraloncology.2020.104844

Cited by 79 publications

(60 citation statements)

References 35 publications

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“… 9 10 Early guidelines recommended deferring tracheostomy in these patients beyond the first weeks of MV due to high early patient mortality and potential risks to proceduralists. 11–14 Consistent with reports from other centers, we observed that many intubated patients with COVID-19 infection require unusually high doses of sedation, increasing the risk of delirium, an independent predictor of longer lengths of stay, higher mortality, greater cost of care, and acquired dementia in ICU survivors. 15–19 Increased sedation requirements may contribute to failure to liberate patients with COVID-19 infection from ventilator support successfully.…”

Section: Introductionsupporting

confidence: 91%

Early ventilator liberation and decreased sedation needs after tracheostomy in patients with COVID-19 infection

Carmichael¹,

Wright

McIntyre

et al. 2021

Trauma Surg Acute Care Open

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BackgroundSince the outset of the coronavirus disease 2019 (COVID-19) pandemic, published tracheostomy guidelines have generally recommended deferral of the procedure beyond the initial weeks of intubation given high mortality as well as concerns about transmission of the infection to providers. It is unclear whether tracheostomy in patients with COVID-19 infection facilitates ventilator weaning, and long-term outcomes are not yet reported in the literature.MethodsThis is a retrospective study of tracheostomy outcomes in patients with COVID-19 infection at a single-center academic tertiary referral intensive care unit. Patients underwent percutaneous tracheostomy at the bedside; the procedure was performed with limited staffing to reduce risk of disease transmission.ResultsBetween March 1 and June 30, 2020, a total of 206 patients with COVID-19 infection required mechanical ventilation and 26 underwent tracheostomy at a mean of 25±5 days after initial intubation. Overall, 81% of tracheostomy patients were liberated from the ventilator at a mean of 9±6 days postprocedure, and 54% were decannulated prior to hospital discharge at a mean of 21±10 days postprocedure. Sedation and pain medication requirements decreased significantly in the week after the procedure. In-hospital mortality was 15%. Among tracheostomy survivors, 68% were discharged to a facility.DiscussionThe management of patients with COVID-19 related respiratory failure can be challenging due to prolonged ventilator dependency. In our initial experience, outcomes post-tracheostomy in this population are encouraging, with short time to liberation from the ventilator, a high rate of decannulation prior to hospital discharge, and similar mortality to tracheostomy performed for other indications. Barriers to weaning ventilation in this cohort may be high sedation needs and ventilator dyssynchrony.Level of evidenceLevel V—Therapeutic/care management.

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Section: Introductionsupporting

confidence: 91%

Early ventilator liberation and decreased sedation needs after tracheostomy in patients with COVID-19 infection

Carmichael¹,

Wright

McIntyre

et al. 2021

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

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“…Performing tracheostomy in the COVID-19 era exemplifies how a previously straightforward clinical decision for an essential-elective procedure has been reimagined when the safety of more than just the patient must be considered. The balance of anticipated benefits and risks for major stakeholders (patient, health care system, and HCW) will vary between different locations during various stages of the COVID-19 pandemic as evidenced by a multitude of available guidelines 5 ( Table 4 ). A multidisciplinary team is essential in developing a center-specific protocol for COVID-19 tracheostomy with an indispensable role for simulation and team rehearsal.…”

Section: Discussionmentioning

confidence: 99%

Coronavirus disease 2019 (COVID-19): Team preparation and approach to tracheostomy

Bribriesco¹,

Sudarshan²,

Gillespie³

et al. 2021

JTCVS Techniques

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“…Tracheostomy insertion and routine tracheostomy care are aerosol generating procedures and therefore high risk for COVID-19 transmission, particularly to health care workers (55). Most of the literature on tracheostomy insertion and care during the COVID-19 pandemic is in adults and from high income settings.…”

Section: Tracheostomiesmentioning

confidence: 99%

COVID-19 and Pediatric Lung Disease: A South African Tertiary Center Experience

et al. 2021

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The COVID-19 pandemic led to rapid global spread with far-reaching impacts on health-care systems. Whilst pediatric data consistently shown a milder disease course, chronic lung disease has been identified as a risk factor for hospitalization and severe disease. In Africa, comprised predominantly of low middle-income countries (LMIC), the additional burden of HIV, tuberculosis, malnutrition and overcrowding is high and further impacts health risk. This paper reviewed the literature on COVID-19 and chronic lung disease in children and provides our experience from an African pediatric pulmonary center in Cape Town, South Africa. South African epidemiological data confirms a low burden of severe disease with children <18 years comprising 8% of all diagnosed cases and 3% of all COVID-19 admissions. A decrease in hospital admission for other viral lower respiratory tract infections was found. While the pulmonology service manages children with a wide range of chronic respiratory conditions including bronchiectasis, cystic fibrosis, asthma, interstitial lung disease and children with tracheostomies, no significant increase in COVID-19 admissions were noted and in those who developed COVID-19, the disease course was not severe. Current evidence suggests that pre-existing respiratory disease in children does not appear to be a significant risk factor for severe COVID-19. Longitudinal data are still needed to assess risk in children with immunosuppression and interstitial lung diseases. The indirect impacts of the pandemic response on child respiratory health are notable and still likely to be fully realized and quantified. Ensuring children have access to full preventive and care services during this time is priority.

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Systematic review of international guidelines for tracheostomy in COVID-19 patients

Cited by 79 publications

References 35 publications

Early ventilator liberation and decreased sedation needs after tracheostomy in patients with COVID-19 infection

Early ventilator liberation and decreased sedation needs after tracheostomy in patients with COVID-19 infection

Coronavirus disease 2019 (COVID-19): Team preparation and approach to tracheostomy

COVID-19 and Pediatric Lung Disease: A South African Tertiary Center Experience

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