Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study

• Type of Material: Article
• Authors: Constance S Harrell Shreckengost, Emory University; Jorge Esteban Foianini, Clínica Ángel Foianini; Karen M Moron Encinas, Clínica Ángel Foianini; Huho Tola Guarachi, Clínica Ángel Foianini; Katrina Abril, Emory University; Dina Amin, Emory University; David Berkowitz, Emory University; Christine Castater, Emory University; April Grant, Emory University; Miller J Douglas, Emory University School of Medicine; Onkar Khullar, Emory University; Andrea Nichole Lane, Emory University; Alice Lin, Emory University; Abesh Rashied, Emory University; Abesh Niroula, Emory University; Azhar Nizam, Emory University; Ammar Rashied, Emory University; Alexandra Reitz, Emory University; Steven Roser, Emory University; Julia Spychalski, Emory University; Sérgio Samir Arap, Universidade de São Paulo; Ricardo F Bento, Universidade de São Paulo; Pedro Prosperi Desenzi Ciaralo, Universidade de São Paulo; Rui Imamura, Universidade de São Paulo; Luiz P Kowalski, Universidade de São Paulo; Ali Mahmoud, Universidade de São Paulo; Alessandro Wasum Mariani, Universidade de São Paulo; Carlos Augusto Metidieri Menegozzo, Universidade de São Paulo; Hélio Minamoto, Universidade de São Paulo; Fábio Luiz M Montenegro, Universidade de São Paulo; Paulo M Pêgo-Fernandes, Universidade de São Paulo; Jones Santos, Universidade de São Paulo; Edivaldo M Utiyama, Universidade de São Paulo; Jithin K Sreedharan, Prince Sultan Military College of Health Sciences - Dhahran; Or Kalchiem-Dekel, Memorial Sloan-Kettering Cancer Center; Jonathan Nguyen, Emory University; Rohan K Dhamsania, Georgia Campus - Philadelphia College of Osteopathic Medicine; Kerianne Allen, Riverside Health System; Adrian Modzik, Riverside Health System; Vikas Pathak, Riverside Health System; Cheryl White, Riverside Health System; Juan Blas, Hospital Royo Villanova; Issa Talal El-Abur, Hospital Royo Villanova; Gabriel Tirado, Hospital Royo Villanova; Carlos Yánez Benítez, Hospital Royo Villanova; Thomas G Weiser, Stanford University; Mark Barry, University of California, San Francisco; Marissa Boeck, University of California, San Francisco; Michael Farrell, University of California, San Francisco; Anya Greenberg, UCSF School of Medicine; Phoebe Miller, University of California, San Francisco; Paul Park, UCSF School of Medicine; Maraya Camazine, University of Missouri; Deidre Dillon, University of Missouri; Randi Smith, Emory University
• Language: English
• Date: 2022-11-21
• Publisher: Wolters Kluwer Health, Inc.
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/CCE.0000000000000796
• Title of Journal or Parent Work: Critical Care Explorations
• Volume: 4
• Issue: 11
• Start Page: E0796
• End Page: E0796
• Grant/Funding Information: Supported, in part, by an Emory University School of Medicine “Imagine, Innovate, Inspire” Nexus Award and the Fogarty International Center of the National Institutes of Health (D43 TW009337). Use of Research Electronic Data Capture (REDCap) was supported by the Library Information Technology Services grant (UL1 TR000424) for REDCap.
• Keywords: airway management; survival; pandemics; mechanical ventilators; length of stay
• Research Categories: Health Sciences, Medicine and Surgery; Biology, Biostatistics

Abstract

OBJECTIVES: Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient outcomes and alleviate resource shortages. This study compares outcomes in a diverse population of hospitalized COVID-19 patients who underwent tracheostomy either "early"(within 14 d of intubation) or "late"(more than 14 d after intubation). DESIGN: International multi-institute retrospective cohort study. SETTING: Thirteen hospitals in Bolivia, Brazil, Spain, and the United States. PATIENTS: Hospitalized patients with COVID-19 undergoing early or late tracheostomy between March 1, 2020, and March 31, 2021. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: A total of 549 patients from 13 hospitals in four countries were included in the final analysis. Multivariable regression analysis showed that early tracheostomy was associated with a 12-day decrease in time on mechanical ventilation (95% CI, -16 to -8; p < 0.001). Further, ICU and hospital lengths of stay in patients undergoing early tracheostomy were 15 days (95% CI, -23 to -9 d; p < 0.001) and 22 days (95% CI, -31 to -12 d) shorter, respectively. In contrast, early tracheostomy patients experienced lower risk-adjusted survival at 30-day post-admission (hazard ratio, 3.0; 95% CI, 1.8-5.2). Differences in 90-day post-admission survival were not identified. CONCLUSIONS: COVID-19 patients undergoing tracheostomy within 14 days of intubation have reduced ventilator dependence as well as reduced lengths of stay. However, early tracheostomy patients experienced lower 30-day survival. Future efforts should identify patients most likely to benefit from early tracheostomy while accounting for location-specific capacity.