ABSTRACT
Introduction: At the height of the COVID-19 pandemic, our institution instituted a safe tracheostomy aftercare taskforce (STAT) team to care for the influx of patients undergoing tracheostomies. This review was undertaken to quantify and understand this team's benefits on the outcomes of tracheostomy care. Method: Retrospective data were collected from patients undergoing tracheostomies at our institution from February to June 2019, prior to creation of the STAT team, and was compared with prospectively collected data from tracheostomies performed from February to June 2020 while the STAT team was in place. The primary endpoint was decannulation before discharge. Secondary endpoints included downsizing and outpatient follow-up. Results: Prior to the STAT team, 92 patients underwent tracheostomy from February to June 2019, including 59 males (64%) and 33 females (36%). Following implementation of the STAT team, 170 patients underwent tracheostomy from February to June 2020, including 106 males (62%) and 64 females (38%). Mean time from tracheostomy to discharge was 43.7 days (range, 1-174;standard deviation [SD] 45.5) in 2019 and 39.7 days (range, 2-205;SD 30.3) in 2020. Twenty (22%) and 26 patients (15%) expired in the 2019 and 2020 cohorts, respectively. Of the surviving patients, 22% of patients in 2019 compared with 60% of patients in 2020 were decannulated before discharge (P < .00001). With the STAT team, decannulation rates before discharge increased absolutely by 40% and relatively by 178%. In the 2020 cohort, 59% of patients had documented downsizes during admission compared with just 20% of patients in 2019 (P < .0001). In 2020 the STAT team remained in contact to advise further tracheostomy care for 86% of discharged patients. Conclusion: The STAT team significantly increased decannulation rates, documentation of downsizing, and improved follow-up for tracheostomy care. It is possible that the STAT team's positive impact was related to improved documentation of significant tracheostomy care events. Nevertheless, this type of care team provides significant benefit to hospitals and improves the overall care of patients with tracheostomies.
ABSTRACT
Introduction: Tracheostomies have been performed in patients with prolonged intubation due to COVID-19, but the optimal timing, patient selection, and long-term outcomes largely remain unknown. Method: A prospectively collected database of patients with COVID-19 undergoing open tracheostomy at a major medical center in New York City between March 2020 and April 2020 was reviewed. Primary endpoints were weaning from the ventilator and sedation and time to decannulation. Secondary endpoints included both immediate and long-term complication rates as well as intensive care unit and hospital discharge. Results: In total, 61 patients underwent tracheostomy. There were 38 men (62.3%) and 28 women (37.7%) with an average age of 62 years (SD 13.7;range 23-91 years). Patients were intubated for a median time of 26 days prior to tracheostomy (interquartile range [IQR] 23-30 days). The median time to weaning from ventilatory support after tracheostomy was 18 days (IQR 10-27 days). Of those sedated at the time of tracheostomy, the median time to discontinuation of sedation was 5 days (IQR 3-9 days). Of patients who survived, 35 patients (60.3%) were decannulated. Of those decannulated (n = 33) before discharge, the median time to decannulation was 36 days following tracheostomy (IQR 27-48 days). Time from ventilator liberation to decannulation was 14 days (IQR 7-18 days). Fourteen patients (23.0%) had minor bleeding managed with packing. Two patients (3.3%) had bleeding requiring neck exploration. The all-use mortality rate was 9.4%. No patients died of procedural uses. No attending surgeons contracted COVID-19. Conclusion: Open tracheostomies were successfully and safely performed at our institution in the peak of the COVID- 19 pandemic. Most patients were successfully weaned from the ventilator and sedation. Approximately 60% of patients were decannulated prior to hospital discharge.