Tracheostomy for COVID-19 Respiratory Failure Multidisciplinary, Multicenter Data on Timing, Technique, and Outcomes

• Type of Material: Article
• Authors: Kamran Mahmood, Duke University; George Z Cheng, University of California San Diego; Keriann Van Nostrand, Emory University; Samira Shojaee, Virginia Commonwealth University; Max T Wayne, University of Michigan; Matthew Abbott, Duke University; Darrell Nettlow, University of California San Diego; Alice Parish, Duke University; Cynthia L Green, Duke University; Javeryah Safi, Virginia Commonwealth University; Michael J Brenner, University of Michigan; Jose De Cardenas, University of Michigan
• Language: English
• Date: 2021-08-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Final Published Version
• Copyright Statement: © 2021 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/SLA.0000000000004955
• Title of Journal or Parent Work: ANNALS OF SURGERY
• Volume: 274
• Issue: 2
• Start Page: 234
• End Page: 239
• Keywords: Science & Technology; patient safety; timing; tracheostomy; aerosol generating procedure; tracheotomy; ICU; RECEIVING MECHANICAL VENTILATION; TRACHEOTOMY; critical care; ventilation; multidisciplinary teams; PNEUMONIA; multi-institutional; pandemic; anesthesia; personal protective equipment; mortality; Life Sciences & Biomedicine; surgical technique; Coronavirus; COVID-19; PPE; resource allocation; Surgery; ARDS; airway; SARS-CoV-2; acute respiratory distress syndrome; respiratory failure; multicenter
• Research Categories: Biology, Biostatistics; Health Sciences, Medicine and Surgery

Abstract

Objective To assess the outcomes of tracheostomy in patients with COVID-19 respiratory failure. Summary Background Data Tracheostomy has an essential role in managing COVID-19 patients with respiratory failure who require prolonged mechanical ventilation. However, limited data are available on how tracheostomy affects COVID19 outcomes, and uncertainty surrounding risk of infectious transmission has led to divergent recommendations and practices. Methods It is a multicenter, retrospective study; data were collected on all tracheostomies performed in COVID-19 patients at seven hospitals in five tertiary academic medical systems through September 2020. Results Tracheotomy was performed in 118 patients with median time from intubation to tracheostomy of 22 days (Q1-Q3: 18-25). All tracheostomies were performed employing measures to minimize aerosol generation, 78.0% by percutaneous technique, and 95.8% at bedside in negative pressure rooms. Seventy-eight (66.1%) patients were weaned from the ventilator and 18 (15.3%) patients died from causes unrelated to tracheostomy. No major procedural complications occurred. Early tracheostomy (≤14 days) was associated with decreased ventilator days; median ventilator days [Q1-Q3] among patients weaned from the ventilator in the early, middle and late groups were 21 [21-31], 34 [26.5-42] and 37 [32-41] days, respectively with p=0.030. Compared to surgical tracheostomy, percutaneous technique was associated with faster weaning for patients weaned off the ventilator (median [Q1-Q3]: 34 [29-39] vs. 39 [34-51] days, p=0.038); decreased ventilator-associated pneumonia (58.7% vs. 80.8%, p=0.039); and among patients who were discharged, shorter intensive care unit duration (median [Q1-Q3]: 33 [27-42] vs. 47 [33-64] days, p=0.009); and shorter hospital length of stay (median [Q1-Q3]: 46 [33-59] vs. 59.5 [48-80] days, p=0.001). Conclusions Early, percutaneous tracheostomy was associated with improved outcomes compared to surgical tracheostomy in a multi-institutional series of ventilated patients with COVID-19.