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Percutaneous and Open Tracheostomy in Patients With COVID-19: The Weill Cornell Experience in New York City.
Long, Sallie M; Feit, Noah Z; Chern, Alexander; Cooley, Victoria; Hill, Shanna S; Rajwani, Kapil; Schenck, Edward J; Stiles, Brendon; Tassler, Andrew B.
  • Long SM; Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, U.S.A.
  • Feit NZ; Weill Cornell Medical College, New York, New York, U.S.A.
  • Chern A; Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, U.S.A.
  • Cooley V; Division of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, New York, U.S.A.
  • Hill SS; Department of Anesthesiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, U.S.A.
  • Rajwani K; Division of Pulmonary and Critical Care Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, U.S.A.
  • Schenck EJ; Division of Pulmonary and Critical Care Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, U.S.A.
  • Stiles B; Department of Cardiothoracic Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, U.S.A.
  • Tassler AB; Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, U.S.A.
Laryngoscope ; 131(12): E2849-E2856, 2021 12.
Article in English | MEDLINE | ID: covidwho-1242750
Semantic information from SemMedBD (by NLM)
1. Tracheostomy procedure TREATS COVID-19
Subject
Tracheostomy procedure
Predicate
TREATS
Object
COVID-19
2. Tracheostomy procedure TREATS Patients
Subject
Tracheostomy procedure
Predicate
TREATS
Object
Patients
3. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
4. COVID-19 PROCESS_OF Adult
Subject
COVID-19
Predicate
PROCESS_OF
Object
Adult
5. Sedated state PROCESS_OF Patients
Subject
Sedated state
Predicate
PROCESS_OF
Object
Patients
6. Tracheostomy procedure TREATS COVID-19
Subject
Tracheostomy procedure
Predicate
TREATS
Object
COVID-19
7. Tracheostomy procedure TREATS Patients
Subject
Tracheostomy procedure
Predicate
TREATS
Object
Patients
8. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
9. COVID-19 PROCESS_OF Adult
Subject
COVID-19
Predicate
PROCESS_OF
Object
Adult
10. Sedated state PROCESS_OF Patients
Subject
Sedated state
Predicate
PROCESS_OF
Object
Patients
ABSTRACT

OBJECTIVE:

Report long-term tracheostomy outcomes in patients with COVID-19. STUDY

DESIGN:

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.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Tracheostomy / SARS-CoV-2 / COVID-19 Type of study: Evaluation study / Observational study / Risk factors 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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Full text: Available Collection: International databases Database: MEDLINE Main subject: Tracheostomy / SARS-CoV-2 / COVID-19 Type of study: Evaluation study / Observational study / Risk factors 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