ABSTRACT
Objective: The aim of this study was to investigate the effect of percutaneous tracheotomy on mortality and length of stay in the intensive care unit (ICU) for patients with COVID-19-associated acute respiratory distress syndrome (ARDS). Materials and Methods: This study included patients with coronavirus disease-19 (COVID-19-associated) acute respiratory distress syndrome who were treated with invasive mechanical ventilation in a pandemic intensive care unit. Patients admitted to the pandemic intensive care unit between March and July 2021 were retrospectively reviewed. Patients who underwent percutaneous tracheotomy and did not have a tracheotomy during the follow-up were statistically compared in terms of laboratory and clinical characteristics such as mortality and length of stay in the intensive care unit. Results: The study included 102 orotracheally intubated patients diagnosed with COVID-19 acute respiratory distress syndrome. The number of tracheotomized and not-tracheotomized patients was 34 and 68, respectively. The mean age of the patients was 60.39 +/- 14.10 years. The mean time to perform percutaneous tracheotomy was 7.94 +/- 6.11 days. There was no significant difference in mortality rate between the two groups (p=0.298). However, patients who underwent tracheotomy had a longer length of stay in the intensive care unit compared to those who did not (35.00 +/- 24.60 days vs 13.20 +/- 11.69 days, p<0.001). Conclusion: Our study found no statistically significant difference in mortality rate between the two groups in our study. Additionally, the length of stay in the intensive care unit was not better in tracheotomized patients. While tracheotomy has some advantages in other severe lung diseases, its effect on mortality in patients with severe lung disease associated with COVID-19 should be evaluated further in randomized controlled trials.
ABSTRACT
Background: Acute phase reactants and inflammation biomarkers such as ferritin, procalcitonin, C-reactive protein (CRP), and complete blood count parameters (White blood cell, platelet count) are usually used to evaluate and monitor the disease severity and treatment response of systemic inflammatory diseases. In addition to these parameters, Immature granulocytes (IG) that increase during systemic infection, hematological malignancy, and drug treatments (such as chemotherapy and glucocorticoids) are important parameters for evaluating systemic inflammation. The sensitivity and specificity of IG are as high as the abovementioned inflammatory biomarkers for monitoring disease severity and treatment response. Aim: The aim of the study is to evaluate the relationship between IG count and the need for mechanical ventilation and mortality in patients hospitalized in the intensive care unit (ICU) due to coronavirus disease 2019 (COVID-19). Patients and Methods: The medical records of the 401 patients who were followed up in the ICU due to COVID-19-related acute respiratory distress syndrome between October 2020 and February 2021 were retrospectively reviewed. On the day of admission to the ICU complete blood count (CBC), arterial blood gas analysis, coagulation parameters (fibrinogen, D-dimer) are recorded. CRP, procalcitonin, and ferritin levels are also recorded at the day of admission. During the follow-up period, the survival status and mechanical ventilation status of the patients were recorded and the relation between IG count and these parameters was evaluated. Results: The mean IG at the admission was 0.2 ± 0.4 109/L. The IG level of the intubated patients at the time of intubation was 0.3 ± 0.5 109/L. There was a significant positive correlation between mortality and IG levels at admission and at the time of intubation (IG admission; P = 0.001, r = 0.347 and IG at intubation; P = 0.001, r = 0.228). Conclusion: IG levels in CBC data could be a potential practical biomarker. This issue requires further research and the development of therapies targeting IG cells is needed.