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1.
J Surg Res ; 266: 361-365, 2021 10.
Article in English | MEDLINE | ID: covidwho-1275539

ABSTRACT

BACKGROUND: Tracheostomy improves outcomes for critically ill patients requiring prolonged mechanical ventilation. Data are limited on the use and benefit of tracheostomies for intubated, critically ill coronavirus disease 2019 (COVID-19) patients. During the surge in COVID 19 infections in metropolitan New York/New Jersey, our hospital cared for many COVID-19 patients who required prolonged intubation. This study describes the outcomes in COVID-19 patients who underwent tracheostomy. METHODS: We present a case series of patients with COVID-19 who underwent tracheostomy at a single institution. Tracheostomies were performed on patients with prolonged mechanical ventilation beyond 3 wk. Patient demographics, medical comorbidities, and ventilator settings prior to tracheostomy were reviewed. Primary outcome was in-hospital mortality. Secondary outcomes included time on mechanical ventilation, length of ICU and hospital stay, and discharge disposition. RESULTS: Fifteen COVID-19 patients underwent tracheostomy at an average of 31 d post intubation. Two patients (13%) died. Half of our cohort was liberated from the ventilator (8 patients, 53%), with an average time to liberation of 14 ± 6 d after tracheostomy. Among patients off mechanical ventilation, 5 (63%) had their tracheostomies removed prior to discharge. The average intensive care length of stay was 47 ± 13 d (range 29-74 d) and the average hospital stay was 59 ± 16 d (range 34-103 d). CONCLUSIONS: This study reports promising outcomes in COVID-19 patients with acute respiratory failure and need for prolonged ventilation who undergo tracheostomy during their hospitalization. Further research is warranted to establish appropriate indications for tracheostomy in COVID-19 and confirm outcomes.


Subject(s)
COVID-19/complications , Intubation, Intratracheal/statistics & numerical data , Respiration, Artificial/statistics & numerical data , Respiratory Insufficiency/therapy , Tracheostomy/statistics & numerical data , COVID-19/mortality , COVID-19/therapy , Critical Care/methods , Critical Care/statistics & numerical data , Critical Illness , Female , Hospital Mortality , Humans , Intensive Care Units/statistics & numerical data , Intubation, Intratracheal/adverse effects , Length of Stay/statistics & numerical data , Male , Middle Aged , Prospective Studies , Respiration, Artificial/adverse effects , Respiration, Artificial/methods , Respiratory Insufficiency/etiology , Respiratory Insufficiency/mortality , Retrospective Studies , Time Factors , Time-to-Treatment/statistics & numerical data , Tracheostomy/adverse effects , Treatment Outcome , Ventilator Weaning/statistics & numerical data
2.
Palliat Med ; 34(9): 1228-1234, 2020 10.
Article in English | MEDLINE | ID: covidwho-653470

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has a substantial mortality risk with increased rates in the elderly. We hypothesized that age is not sufficient, and that frailty measured by preadmission Palliative Performance Scale would be a predictor of outcomes. Improved ability to identify high-risk patients will improve clinicians' ability to provide appropriate palliative care, including engaging in shared decision-making about life-sustaining therapies. AIM: To evaluate whether preadmission Palliative Performance Scale predicts mortality in hospitalized patients with COVID-19. DESIGN: Retrospective observational cohort study of patients admitted with COVID-19. Palliative Performance Scale was calculated from the chart. Using logistic regression, Palliative Performance Scale was assessed as a predictor of mortality controlling for demographics, comorbidities, palliative care measures and socioeconomic status. SETTING/PARTICIPANTS: Patients older than 18 years of age admitted with COVID-19 to a single urban public hospital in New Jersey, USA. RESULTS: Of 443 admitted patients, we determined the Palliative Performance Scale score for 374. Overall mortality was 31% and 81% in intubated patients. In all, 36% (134) of patients had a low Palliative Performance Scale score. Compared with patients with a high score, patients with a low score were more likely to die, have do not intubate orders and be discharged to a facility. Palliative Performance Scale independently predicts mortality (odds ratio 2.89; 95% confidence interval 1.42-5.85). CONCLUSIONS: Preadmission Palliative Performance Scale independently predicts mortality in patients hospitalized with COVID-19. Improved predictors of mortality can help clinicians caring for patients with COVID-19 to discuss prognosis and provide appropriate palliative care including decisions about life-sustaining therapy.


Subject(s)
Coronavirus Infections/mortality , Coronavirus Infections/therapy , Frail Elderly/statistics & numerical data , Hospital Mortality , Hospitalization/statistics & numerical data , Palliative Care/statistics & numerical data , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Prognosis , Adult , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Cohort Studies , Coronavirus Infections/epidemiology , Female , Humans , Male , Middle Aged , Mortality , New Jersey/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Retrospective Studies , SARS-CoV-2 , Young Adult
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