Percutaneous and Open Tracheostomy in Patients With COVID-19: The Weill Cornell Experience in New York City.
Laryngoscope
; 131(12): E2849-E2856, 2021 12.
Article
in English
| MEDLINE | ID: covidwho-1242750
ABSTRACT
OBJECTIVE:
Report long-term tracheostomy outcomes in patients with COVID-19. STUDYDESIGN:
Review of prospectively collected data.METHODS:
Prospectively collected data were extracted for adults with COVID-19 undergoing percutaneous or open tracheostomy between April 4, 2020 and June 2, 2020 at a major medical center in New York City. The primary endpoint was weaning from mechanical ventilation. Secondary outcomes included sedation weaning, decannulation, and discharge.RESULTS:
One hundred one patients underwent tracheostomy, including 48 percutaneous (48%) and 53 open (52%), after a median intubation time of 24 days (IQR 20, 31). The most common complication was minor bleeding (n = 18, 18%). The all-cause mortality rate was 15% and no deaths were attributable to the tracheostomy. Eighty-three patients (82%) were weaned off mechanical ventilation, 88 patients (87%) were weaned off sedation, and 72 patients (71%) were decannulated. Censored median times from tracheostomy to sedation and ventilator weaning were 8 (95% CI 6-11) and 18 (95% CI 14-22) days, respectively (uncensored 7 and 15 days). Median time from tracheostomy to decannulation was 36 (95% CI 32-47) days (uncensored 32 days). Of those decannulated, 82% were decannulated during their index admission. There were no differences in outcomes or complication rates between percutaneous and open tracheostomy. Likelihood of discharge from the ICU was inversely related to intubation time, though the clinical relevance of this was small (HR 0.97, 95% CI 0.943-0.998; P = .037).CONCLUSION:
Tracheostomy by either percutaneous or open technique facilitated sedation and ventilator weaning in patients with COVID-19 after prolonged intubation. Additional study on the optimal timing of tracheostomy in patients with COVID-19 is warranted. LEVEL OF EVIDENCE 3 Laryngoscope, 131E2849-E2856, 2021.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Tracheostomy
/
SARS-CoV-2
/
COVID-19
Type of study:
Cohort study
/
Observational study
/
Prognostic study
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
North America
Language:
English
Journal:
Laryngoscope
Journal subject:
Otolaryngology
Year:
2021
Document Type:
Article
Affiliation country:
Lary.29669
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