Tracheotomy in a High‐Volume Center During the COVID‐19 Pandemic: Evaluating the Surgeon’s Risk

Thal, Arielle; Schiff, Bradley A.; Ahmed, Yasmina; Cao, Angela; Mo, Allen; Mehta, Vikas; Smith, Richard V.; Cohen, Hillel W.; Ow, Thomas J.

doi:10.1177/0194599820955174

Cited by 16 publications

(18 citation statements)

References 16 publications

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“…Additionally, the PAPR, which was advised by several recommendations (1,12,21), was used in more than half of the procedures in our study. Other principles, including limiting the number of personnel present, ensuring complete paralysis, adequate sedation, and minimizing suction during the procedure, also help to improve protection for health care workers from SARS-CoV-2 (22).…”

Section: Discussionmentioning

confidence: 99%

Tracheostomy in 80 COVID-19 Patients: A Multicenter, Retrospective, Observational Study

Tang

Zhu

et al. 2020

Front. Med.

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Background: The outbreak of coronavirus disease 2019 (COVID-19) has led to a large and increasing number of patients requiring prolonged mechanical ventilation and tracheostomy. The indication and optimal timing of tracheostomy in COVID-19 patients are still unclear, and the outcomes about tracheostomy have not been extensively reported. We aimed to describe the clinical characteristics and outcomes of patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia who underwent elective tracheostomies.Methods: The multi-center, retrospective, observational study investigated all the COVID-19 patients who underwent elective tracheostomies in intensive care units (ICUs) of 23 hospitals in Hubei province, China, from January 8, 2020 to March 25, 2020. Demographic information, clinical characteristics, treatment, details of the tracheostomy procedure, successful weaning after tracheostomy, and living status were collected and analyzed. Data were compared between early tracheostomy patients (tracheostomy performed within 14 days of intubation) and late tracheostomy patients (tracheostomy performed after 14 days).Results: A total of 80 patients were included. The median duration from endotracheal intubation to tracheostomy was 17.5 [IQR 11.3–27.0] days. Most tracheotomies were performed by ICU physician [62 (77.5%)], and using percutaneous techniques [63 (78.8%)] at the ICU bedside [76 (95.0%)]. The most common complication was tracheostoma bleeding [14 (17.5%)], and major bleeding occurred in 4 (5.0%) patients. At 60 days after intubation, 31 (38.8%) patients experienced successful weaning from ventilator, 17 (21.2%) patients discharged from ICU, and 43 (53.8%) patients had died. Higher 60 day mortality [22 (73.3%) vs. 21 (42.0%)] were identified in patients who underwent early tracheostomy.Conclusions: In patients with SARS-CoV-2 pneumonia, tracheostomies were feasible to conduct by ICU physician at bedside with few major complications. Compared with tracheostomies conducted after 14 days of intubation, tracheostomies within 14 days were associated with an increased mortality rate.

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Section: Discussionmentioning

confidence: 99%

Tracheostomy in 80 COVID-19 Patients: A Multicenter, Retrospective, Observational Study

Tang

Zhu

et al. 2020

Front. Med.

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“…Although tracheostomy confers benefit for carefully selected COVID-19 mechanically ventilated patients, we defer the procedure in patients who require high ventilator requirements with high fractions of inspired oxygen (> 80%), significant medical comorbidities leading to poor survival, severe ARDS with a low chance of recovery. The mortality in patients with COVID-19 undergoing tracheostomy had been reported to vary from 7 to 41% in the previously published outcome studies [ 16 , 30 ]. The overall 30-day mortality in our study was 66.66%, mirroring the results of other studies that reported > 50% mortality rate for COVID-19 patients who required prolonged ventilation culminating in a tracheostomy [ 8 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

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

Chandran

Kumar

Kanodia

et al. 2021

Indian J Otolaryngol Head Neck Surg

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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.

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“…It is worth noting that none of the Otolaryngology surgeons performing tracheotomies in this study developed SARS-CoV-2-related symptoms or positive antibody seroconversion. 24…”

Section: Tracheotomy Outcomesmentioning

confidence: 99%

Tracheotomy Outcomes in 64 Ventilated COVID‐19 Patients at a High‐Volume Center in Bronx, NY

et al. 2021

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Objectives/Hypothesis: The COVID-19 pandemic has resulted in a dramatic increase in the number of patients requiring prolonged mechanical ventilation. Few studies have reported COVID-19 specific tracheotomy outcomes, and the optimal timing and patient selection criteria for tracheotomy remains undetermined. We delineate our outcomes for tracheotomies performed on COVID-19 patients during the peak of the pandemic at a major epicenter in the United States.Methods: This is a retrospective observational cohort study. Mortality, ventilation liberation rate, complication rate, and decannulation rate were analyzed.Results: Sixty-four patients with COVID-19 underwent tracheotomy between April 1, 2020 and May 19, 2020 at two tertiary care hospitals in Bronx, New York. The average duration of intubation prior to tracheotomy was 20 days ((interquartile range [IQR] 16.5-26.0). The mortality rate was 33% (n = 21), the ventilation liberation rate was 47% (n = 30), the decannulation rate was 28% (n = 18), and the complication rate was 19% (n = 12). Tracheotomies performed by Otolaryngology were associated with significantly improved survival (P < .05) with 60% of patients alive at the conclusion of the study compared to 9%, 12%, and 19% of patients undergoing tracheotomy performed by Critical Care, General Surgery, and Pulmonology, respectively.Conclusions: So far, this is the second largest study describing tracheotomy outcomes in COVID-19 patients in the United States. Our early outcomes demonstrate successful ventilation liberation and decannulation in COVID-19 patients. Further inquiry is necessary to determine the optimal timing and identification of patient risk factors predictive of improved survival in COVID-19 patients undergoing tracheotomy.

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Tracheotomy in a High‐Volume Center During the COVID‐19 Pandemic: Evaluating the Surgeon’s Risk

Cited by 16 publications

References 16 publications

Tracheostomy in 80 COVID-19 Patients: A Multicenter, Retrospective, Observational Study

Tracheostomy in 80 COVID-19 Patients: A Multicenter, Retrospective, Observational Study

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

Tracheotomy Outcomes in 64 Ventilated COVID‐19 Patients at a High‐Volume Center in Bronx, NY

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