Tracheostomy in COVID-19 acute respiratory distress syndrome patients and follow-up: A parisian bicentric retrospective cohort

Abstract

Background Tracheostomy has been proposed as an option to help organize the healthcare system to face the unprecedented number of patients hospitalized for a COVID-19-related acute respiratory distress syndrome (ARDS) in intensive care units (ICU). It is, however, considered a particularly high-risk procedure for contamination. This paper aims to provide our experience in performing tracheostomies on COVID-19 critically ill patients during the pandemic and its long-term local complications. Methods We performed a retrospective analysis of prospectively collected data of patients tracheostomized for a COVID-19-related ARDS in two university hospitals in the Paris region between January 27th (date of first COVID-19 admission) and May 18th, 2020 (date of last tracheostomy performed). We focused on tracheostomy technique (percutaneous versus surgical), timing (early versus late) and late complications. Results Forty-eight tracheostomies were performed with an equal division between surgical and percutaneous techniques. There was no difference in patients’ characteristics between surgical and percutaneous groups. Tracheostomy was performed after a median of 17 [12–22] days of mechanical ventilation (MV), with 10 patients in the “early” group (≤ day 10) and 38 patients in the “late” group (> day 10). Survivors required MV for a median of 32 [22–41] days and were ultimately decannulated with a median of 21 [15–34] days spent on cannula. Patients in the early group had shorter ICU and hospital stays (respectively 15 [12–19] versus 35 [25–47] days; p = 0.002, and 21 [16–28] versus 54 [35–72] days; p = 0.002) and spent less time on MV (respectively 17 [14–20] and 35 [27–43] days; p<0.001). Interestingly, patients in the percutaneous group had shorter hospital and rehabilitation center stays (respectively 44 [34–81] versus 92 [61–118] days; p = 0.012, and 24 [11–38] versus 45 [22–71] days; p = 0.045). Of the 30 (67%) patients examined by a head and neck surgeon, 17 (57%) had complications with unilateral laryngeal palsy (n = 5) being the most prevalent. Conclusions Tracheostomy seems to be a safe procedure that could help ICU organization by delegating work to a separate team and favoring patient turnover by allowing faster transfer to step-down units. Following guidelines alone was found sufficient to prevent the risk of aerosolization and contamination of healthcare professionals.

Tracheostomy in Critically Ill Covid 19 Patients: A Review of Outcome

“…A multidisciplinary approach is important in discussing prognosis, risk, benefits and outcome for the patients besides considering organization resources, manpower and risk to healthcare provider [14]. Evrard, Diane, et al suggested that timing of tracheostomy should be assessed on a case-by-case basis rather than depend on a rigid rule [15]. Most of tracheostomies (73.3%) in our center was performed within 21 days.…”

Characteristics and factors associated with mortality in tracheostomized patients with COVID-19: a retrospective cohort study in a hospital in Tacna, Peru

“…Tracheostomy plays a fundamental role in the management of these patients when the intubation and mechanical ventilation time exceeds 14 days (prolonged mechanical ventilation) by allowing better airway management and facilitating the withdrawal of invasive ventilatory support. Tracheostomy has been associated with less need for deep sedation, shorter weaning time from the mechanical ventilator, shorter stay in the intensive care unit (ICU) and shorter hospital stay 5 .…”

“…Los pacientes con síndrome de distrés respiratorio agudo (SDRA) y COVID-19, suelen permanecer intubados durante periodos prolongados 4 , Cuando el tiempo de intubación y ventilación mecánica supera los 14 días (ventilación mecánica prolongada) la traqueostomía desempeña un rol fundamental en el manejo de estos pacientes, al permitir una mejor gestión de la vía aérea y facilitar la retirada del soporte ventilatorio invasivo. La traqueostomía se ha asociado a menor necesidad de sedación profunda, menor tiempo de destete del ventilador mecánico, menor estancia en la unidad de cuidados intensivos (UCI) y menor estancia hospitalaria 5 .…”

Relación entre traqueostomización y supervivencia en pacientes sometidos a ventilación mecánica con sintomatología respiratoria sugestiva de COVID-19 en Cartagena, Colombia

“…Entre estos, los que permanecen bajo intubación endotraqueal y ventilación mecánica por larga duración, pueden ser candidatos para la traqueostomía (5). Esta última tiene como beneficios la disminución de la sedación, la reducción en la estancia en cuidados intensivos y en el tiempo de requerimiento de ventilación mecánica, así como la disminución del riesgo de neumonía asociada al ventilador (6).…”