The Safety and Efficacy of Tracheostomy in Patients Diagnosed With COVID-19

Abstract

Objective: To determine the optimal surgical strategy for performing tracheostomy in COVID-19 patients. Background: Many ventilated COVID-19 patients require prolonged ventilation. We do not know if tracheostomy will improve their care. Given the paucity of data on this topic, the optimal surgical approach has yet to be elucidated. Methods: This is a cohort study of 143 ventilator dependent COVID-19 patients undergoing tracheostomy at an academic medical center from April 15th to May 15th, 2020, with follow up until June 1, 2020. We included adult patients admitted to a NYC medical center with COVID-19 who required invasive mechanical ventilation for greater than 2 weeks who were unable to be extubated and determined to have reasonable chance of recovery and fit defined tracheostomy candidate criteria. Patients underwent either a percutaneous tracheostomy (PT) or open surgical tracheostomy (ST) performed by 1 of 3 surgical services. Results: One hundred forty-three patients underwent tracheostomy, 58 (41%) via a ST, and 85 (59%) via a PT. There were no significant differences in patient characteristics between the 2 groups, except that more patients who had a history of extracorporeal membrane oxygenation underwent PT (11% vs 2%, P = 0.049). There were no statistical differences observed between the PT and ST groups with regard to bleeding complications (3.5%vs 10.3%, P = 0.099), tracheostomy related complications (5.9% vs 8.6%, P = 0.528), inpatient death (12% vs 5%, P = 0.178), discharge from hospital (39% vs 36%, P = 0.751) or surgeon illness (0% vs 0%, P = 1). Conclusion and Relevance: The rapid formation of a multi-disciplinary team allows for the efficient evaluation and performance of a large volume of tracheostomies in a resource-limited setting. Bedside tracheostomy in COVID-19 does not cause additional harm to patients if performed after 2 weeks from intubation. It also seems to be safe for proceduralists to perform in this timeframe. The manner of tracheostomy does not change outcomes significantly if it is performed safely and efficiently.

Tracheostomy Practice in Mechanically Ventilated Patients With SARS-CoV-2 Induced Acute Respiratory Distress Syndrome: a Single-center Retrospective Study With Focus on Tracheomalacia

“…The most common comorbidities were hypertension (48%), diabetes mellitus (15%), and chronic obstructive pulmonary disease (12%). At ICU admission, median APACHE and SOFA scores were 23 [21][22][23][24][25][26][27] and 5 [3][4][5][6][7], respectively. List of abbreviations.…”

“…The median duration of antibiotic therapy was 6 [2][3][4][5][6][7][8][9][10][11][12][13][14][15] days. Overall, median ICU and hospital length of stay were 14 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] days and 26 days, respectively. Sixty patients (40%) died in the ICU, mortality increased according to disease severity at admission (25%, 40%, and 58%, p = 0.041, for mild, moderate, and severe ARDS, respectively).…”

“…Mortality in the ICU did not differ between tracheostomized patients and patients treated exclusively with endotracheal intubation (34% vs. 45%, p = 0.243). Patients in whom a tracheostomy was performed had a signi cantly longer duration of mechanical ventilation (25 vs. 8 [5][6][7][8][9][10][11][12] days, p < 0.001) and both ICU (27 vs. 9 [5][6][7][8][9][10][11][12][13][14] days, p < 0.001) and hospital (45 [27-58] vs. 17 [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] days, p < 0.001) length of stay.…”

“…Tracheomalacia was diagnosed in 8 (5%) of studied patients. The diagnosis was performed 27 [21][22][23][24][25][26][27][28][29][30][31][32] days after endotracheal intubation. Compared to the remaining population (Table 2), more patients in whom tracheomalacia was diagnosed were female (75% vs. 20%, p = 0.002;…”

“…All patients diagnosed with tracheomalacia were treated with a tracheostomy for airway management (100% vs. 45%, p = 0.008). No difference was found regarding the use of the surgical approach (87.5% vs. 72.3% p = 0.671 with surgical approach), the timing of tracheostomy (11 [7][8][9][10][11][12][13][14] days vs. 11 [8][9][10][11][12][13][14][15][16][17] days, p = 0.371), and decannulation (35 days vs. 19 [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] p = 0.108) comparing patients that developed tracheomalacia with the remaining population. Conversely, the duration of mechanical ventilation (29 [22][23][24][25][26][27][28][29][30]…”