ABSTRACT
T1 Figure 1ConclusionsOverall, this largest paediatric single cell COVID-19 study to date showed significant differences in response to SARS-CoV-2 between children and adults, reflecting the changes of the immune landscape over developmental time, which in children are dominated by naïve and innate responses.
ABSTRACT
Rationale: Patients with severe respiratory failure from SARS-CoV-2 often require prolonged mechanical ventilation. Tracheostomy has been described in these patients, but data are limited regarding the outcomes of patients with SARS-CoV-2 who require tracheostomy. Methods: We performed a retrospective review of patients with severe SARS-CoV-2 intubated at our tertiary care center from March to November 2020. We included those who had percutaneous tracheostomy for prolonged respiratory failure. We catalogued demographics and outcomes. Non-parametric data were compared using unpaired, two-tailed Mann-Whitney tests. Results: We identified 50 patients with prolonged respiratory failure from SARS-CoV-2 who had percutaneous tracheostomy. Median age was 65.5 (interquartile range, IQR 56 - 71) years, 64% were male, and median BMI was 28 (25 - 35). Median time to last follow-up was 61 (IQR 14 - 136) days, and 70% of patients were alive at last follow-up. Median time from intubation to tracheostomy was 19 (IQR 15 - 24) days. The majority of tube sizes were extended length Shiley size 6 (64%). Median time from tracheostomy to end of mechanical ventilation was 13 (IQR 8 - 20) days, and median time to decannulation was 24 (19 - 38) days. Seventeen patients (34%) were decannulated by hospital discharge, and 33 patients (66%) were decannulated by last follow-up;94% of survivors were decannulated by last follow-up. Two patients (4%) developed tracheal stenosis after decannulation. Patients who were decannulated were younger (56 (37 - 64) vs 69 (64 - 74) years, p<0.01). Providers involved in the tracheostomy procedures reported no SARS-CoV-2 infections amongst themselves. Conclusions: In this limited cohort of patients who had tracheostomy for prolonged respiratory failure from SARS-CoV-2, there was a high rate of decannulation. The majority of patients were decannulated by last followup, and almost all survivors were decannulated. This appears to be a unique feature of SARS-CoV-2, as the incidence of decannulation for other types of ARDS are lower. Continued study is needed to understand the long-term outcomes of survivors of SARS-CoV-2. .