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Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals: A Systematic Review and Meta-analysis.
Staibano, Phillip; Levin, Marc; McHugh, Tobial; Gupta, Michael; Sommer, Doron D.
  • Staibano P; Department of Surgery, Otolaryngology-Head and Neck Division, McMaster University, Hamilton, Ontario, Canada.
  • Levin M; Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
  • McHugh T; Department of Surgery, Otolaryngology-Head and Neck Division, McMaster University, Hamilton, Ontario, Canada.
  • Gupta M; Department of Surgery, Otolaryngology-Head and Neck Division, McMaster University, Hamilton, Ontario, Canada.
  • Sommer DD; Department of Surgery, Otolaryngology-Head and Neck Division, McMaster University, Hamilton, Ontario, Canada.
JAMA Otolaryngol Head Neck Surg ; 147(7): 646-655, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1245338
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. Tracheostomy procedure ADMINISTERED_TO Patients
Subject
Tracheostomy procedure
Predicate
ADMINISTERED_TO
Object
Patients
5. Invasive mechanical ventilation NOS ADMINISTERED_TO Patients
Subject
Invasive mechanical ventilation NOS
Predicate
ADMINISTERED_TO
Object
Patients
6. Weaning PROCESS_OF Patients
Subject
Weaning
Predicate
PROCESS_OF
Object
Patients
7. Discharg PROCESS_OF C0030705
Subject
Discharg
Predicate
PROCESS_OF
Object
C0030705
8. COVID-19 PROCESS_OF Health Personnel
Subject
COVID-19
Predicate
PROCESS_OF
Object
Health Personnel
9. Discharg NEG_COEXISTS_WITH C0043084
Subject
Discharg
Predicate
NEG_COEXISTS_WITH
Object
C0043084
10. Tracheostomy procedure TREATS COVID-19
Subject
Tracheostomy procedure
Predicate
TREATS
Object
COVID-19
11. Tracheostomy procedure TREATS Patients
Subject
Tracheostomy procedure
Predicate
TREATS
Object
Patients
12. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
13. Tracheostomy procedure ADMINISTERED_TO Patients
Subject
Tracheostomy procedure
Predicate
ADMINISTERED_TO
Object
Patients
14. Invasive mechanical ventilation NOS ADMINISTERED_TO Patients
Subject
Invasive mechanical ventilation NOS
Predicate
ADMINISTERED_TO
Object
Patients
15. Weaning PROCESS_OF Patients
Subject
Weaning
Predicate
PROCESS_OF
Object
Patients
16. Discharge, body substance PROCESS_OF Patients
Subject
Discharge, body substance
Predicate
PROCESS_OF
Object
Patients
17. COVID-19 PROCESS_OF Health Personnel
Subject
COVID-19
Predicate
PROCESS_OF
Object
Health Personnel
18. Discharge, body substance NEG_COEXISTS_WITH Weaning
Subject
Discharge, body substance
Predicate
NEG_COEXISTS_WITH
Object
Weaning
ABSTRACT
Importance Approximately 5% to 15% of patients with COVID-19 require invasive mechanical ventilation (IMV) and, at times, tracheostomy. Details regarding the safety and use of tracheostomy in treating COVID-19 continue to evolve.

Objective:

To evaluate the association of tracheostomy with COVID-19 patient outcomes and the risk of SARS-CoV-2 transmission among health care professionals (HCPs). Data Sources EMBASE (Ovid), Medline (Ovid), and Web of Science from January 1, 2020, to March 4, 2021. Study Selection English-language studies investigating patients with COVID-19 who were receiving IMV and undergoing tracheostomy. Observational and randomized clinical trials were eligible (no randomized clinical trials were found in the search). All screening was performed by 2 reviewers (P.S. and M.L.). Overall, 156 studies underwent full-text review. Data Extraction and

Synthesis:

We performed data extraction in accordance with Meta-analysis of Observational Studies in Epidemiology guidelines. We used a random-effects model, and ROBINS-I was used for the risk-of-bias analysis. Main Outcomes and

Measures:

SARS-CoV-2 transmission between HCPs and levels of personal protective equipment, in addition to complications, time to decannulation, ventilation weaning, and intensive care unit (ICU) discharge in patients with COVID-19 who underwent tracheostomy.

Results:

Of the 156 studies that underwent full-text review, only 69 were included in the qualitative synthesis, and 14 of these 69 studies (20.3%) were included in the meta-analysis. A total of 4669 patients were included in the 69 studies, and the mean (range) patient age across studies was 60.7 (49.1-68.8) years (43 studies [62.3%] with 1856 patients). We found that in all studies, 1854 patients (73.8%) were men and 658 (26.2%) were women. We found that 28 studies (40.6%) investigated either surgical tracheostomy or percutaneous dilatational tracheostomy. Overall, 3 of 58 studies (5.17%) identified a small subset of HCPs who developed COVID-19 that was associated with tracheostomy. Studies did not consistently report the number of HCPs involved in tracheostomy. Among the patients, early tracheostomy was associated with faster ICU discharge (mean difference, 6.17 days; 95% CI, -11.30 to -1.30), but no change in IMV weaning (mean difference, -2.99 days; 95% CI, -8.32 to 2.33) or decannulation (mean difference, -3.12 days; 95% CI, -7.35 to 1.12). There was no association between mortality or perioperative complications and type of tracheostomy. A risk-of-bias evaluation that used ROBINS-I demonstrated notable bias in the confounder and patient selection domains because of a lack of randomization and cohort matching. There was notable heterogeneity in study reporting. Conclusions and Relevance The findings of this systematic review and meta-analysis indicate that enhanced personal protective equipment is associated with low rates of SARS-CoV-2 transmission during tracheostomy. Early tracheostomy in patients with COVID-19 may reduce ICU stay, but this finding is limited by the observational nature of the included studies.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Tracheostomy / Infectious Disease Transmission, Patient-to-Professional / COVID-19 Type of study: Controlled clinical trial / Clinical Practice Guide / Prognostic study / Qualitative research / Randomized controlled trials / Reviews / Risk factors / Systematic review Limits: Humans Language: English Journal: JAMA Otolaryngol Head Neck Surg Year: 2021 Document Type: Article Affiliation country: Jamaoto.2021.0930

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Tracheostomy / Infectious Disease Transmission, Patient-to-Professional / COVID-19 Type of study: Controlled clinical trial / Clinical Practice Guide / Prognostic study / Qualitative research / Randomized controlled trials / Reviews / Risk factors / Systematic review Limits: Humans Language: English Journal: JAMA Otolaryngol Head Neck Surg Year: 2021 Document Type: Article Affiliation country: Jamaoto.2021.0930