Open versus percutaneous tracheostomy in COVID-19: a multicentre comparison and recommendation for future resource utilisation.
Eur Arch Otorhinolaryngol
; 278(6): 2107-2114, 2021 Jun.
Article
in English
| MEDLINE | ID: covidwho-1014131
ABSTRACT
PURPOSE:
The COVID-19 pandemic placed an unprecedented demand on critical care services for the provision of mechanical ventilation. Tracheostomy formation facilitates liberation from mechanical ventilation with advantages for both the patient and wider critical care resource, and can be performed using both percutaneous dilatational and surgical techniques. We compared outcomes in those patients undergoing percutaneous dilatational tracheostomy to those undergoing surgical tracheostomy and make recommendations for provision of tracheostomy services in any future surge.METHODS:
Multicentre multidisciplinary retrospective observational cohort study including 201 patients with COVID-19 pneumonitis admitted to an ICU in one of five NHS Trusts within the South London Adult Critical Care Network who required mechanical ventilation and subsequent tracheostomy.RESULTS:
Percutaneous dilatational tracheostomy was performed in 124 (62%) of patients, and surgical tracheostomy in 77 (38%) of patients. There was no difference between percutaneous dilatational tracheostomy and surgical tracheostomy in either the rate of peri-operative complications (16.9 vs. 22.1%, p = 0.46), median [IQR(range)] time to decannulation [19.0 (15.0-30.2 (5.0-65.0)] vs. 21.0 [15.5-36.0 (5.0-70.0) days] or mortality (13.7% vs. 15.6%, p = 0.84). Of the 172 patients that were alive at follow-up, two remained ventilated and 163 were decannulated.CONCLUSION:
In patients with COVID-19 pneumonitis that require tracheostomy to facilitate weaning from mechanical ventilation, there was no difference in outcomes between those patients that had percutaneous dilatational tracheostomy compared with those that had surgical tracheostomy. Planning for future surges in COVID-19-related critical care demands should utilise all available resource and expertise.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Tracheostomy
/
COVID-19
Type of study:
Cohort study
/
Observational study
/
Prognostic study
Limits:
Adult
/
Humans
Country/Region as subject:
Europa
Language:
English
Journal:
Eur Arch Otorhinolaryngol
Journal subject:
Otolaryngology
Year:
2021
Document Type:
Article
Affiliation country:
S00405-020-06597-1
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