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Tracheotomies in COVID-19 Patients: Protocols and Outcomes.
Carlson, Eric R; Heidel, R Eric; Houston, Kyle; Vahdani, Soheil; Winstead, Michael.
  • Carlson ER; Professor and Kelly L. Krahwinkel Chairman, Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN. Electronic address: ecarlson@utmck.edu.
  • Heidel RE; Associate Professor of Biostatistics, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN.
  • Houston K; Chief Resident, Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN.
  • Vahdani S; Fellow, Oral/Head and Neck Oncologic Surgery, Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN.
  • Winstead M; Chief Resident, Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN.
J Oral Maxillofac Surg ; 79(8): 1629-1642, 2021 08.
Article in English | MEDLINE | ID: covidwho-1248986
Semantic information from SemMedBD (by NLM)
1. Tracheotomy procedure TREATS COVID-19
Subject
Tracheotomy procedure
Predicate
TREATS
Object
COVID-19
2. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
3. Tracheotomy procedure TREATS Patients
Subject
Tracheotomy procedure
Predicate
TREATS
Object
Patients
4. Tracheostomy procedure TREATS Cohort
Subject
Tracheostomy procedure
Predicate
TREATS
Object
Cohort
5. Tracheostomy procedure TREATS COVID-19
Subject
Tracheostomy procedure
Predicate
TREATS
Object
COVID-19
6. Tracheostomy procedure TREATS Patients
Subject
Tracheostomy procedure
Predicate
TREATS
Object
Patients
7. Performance PROCESS_OF Patients
Subject
Performance
Predicate
PROCESS_OF
Object
Patients
8. Household composition PROCESS_OF Patients
Subject
Household composition
Predicate
PROCESS_OF
Object
Patients
9. Tracheostomy procedure PRECEDES Mechanical ventilation
Subject
Tracheostomy procedure
Predicate
PRECEDES
Object
Mechanical ventilation
10. Interventional procedure TREATS Patients
Subject
Interventional procedure
Predicate
TREATS
Object
Patients
11. Toxic Epidermal Necrolysis PROCESS_OF Patients
Subject
Toxic Epidermal Necrolysis
Predicate
PROCESS_OF
Object
Patients
12. Tracheostomy procedure TREATS Toxic Epidermal Necrolysis
Subject
Tracheostomy procedure
Predicate
TREATS
Object
Toxic Epidermal Necrolysis
13. Tracheotomy procedure ADMINISTERED_TO Patients
Subject
Tracheotomy procedure
Predicate
ADMINISTERED_TO
Object
Patients
14. NCKIPSD gene|NCKIPSD PART_OF Family
Subject
NCKIPSD gene|NCKIPSD
Predicate
PART_OF
Object
Family
15. Tracheotomy procedure TREATS COVID-19
Subject
Tracheotomy procedure
Predicate
TREATS
Object
COVID-19
16. COVID-19 PROCESS_OF Patients
Subject
COVID-19
Predicate
PROCESS_OF
Object
Patients
17. Tracheotomy procedure TREATS Patients
Subject
Tracheotomy procedure
Predicate
TREATS
Object
Patients
18. Tracheostomy procedure TREATS Cohort
Subject
Tracheostomy procedure
Predicate
TREATS
Object
Cohort
19. Tracheostomy procedure TREATS COVID-19
Subject
Tracheostomy procedure
Predicate
TREATS
Object
COVID-19
20. Tracheostomy procedure TREATS Patients
Subject
Tracheostomy procedure
Predicate
TREATS
Object
Patients
21. Performance PROCESS_OF Patients
Subject
Performance
Predicate
PROCESS_OF
Object
Patients
22. Household composition PROCESS_OF Patients
Subject
Household composition
Predicate
PROCESS_OF
Object
Patients
23. Tracheostomy procedure PRECEDES Mechanical ventilation
Subject
Tracheostomy procedure
Predicate
PRECEDES
Object
Mechanical ventilation
24. Interventional procedure TREATS Patients
Subject
Interventional procedure
Predicate
TREATS
Object
Patients
25. Toxic Epidermal Necrolysis PROCESS_OF Patients
Subject
Toxic Epidermal Necrolysis
Predicate
PROCESS_OF
Object
Patients
26. Tracheostomy procedure TREATS Toxic Epidermal Necrolysis
Subject
Tracheostomy procedure
Predicate
TREATS
Object
Toxic Epidermal Necrolysis
27. Tracheotomy procedure ADMINISTERED_TO Patients
Subject
Tracheotomy procedure
Predicate
ADMINISTERED_TO
Object
Patients
28. NCKIPSD gene|NCKIPSD PART_OF Family
Subject
NCKIPSD gene|NCKIPSD
Predicate
PART_OF
Object
Family
ABSTRACT

PURPOSE:

Approximately 3-15% of COVID-19 patients will require prolonged mechanical ventilation thereby requiring consideration for tracheotomy. Guidelines for tracheotomy in this cohort of patients are therefore required with assessed outcomes of tracheotomies. PATIENTS AND

METHODS:

A retrospective chart review was performed of COVID-19 patients undergoing tracheotomy. Inclusion criteria were the performance of a tracheotomy in COVID-19 positive patients between March 11 and December 31, 2020. Exclusion criteria were lack of consent, extubation prior to the performance of a tracheotomy, death prior to the performance of the tracheotomy, and COVID-19 patients undergoing tracheotomy who tested negative twice after medical treatment. The primary predictor variable was the performance of a tracheotomy in COVID-19 positive patients and the primary outcome variable was the time to cessation of mechanical ventilation with the institution of supplemental oxygen via trach mask.

RESULTS:

Seventeen tracheotomies were performed between 4-25 days following intubation (mean = 17 days). Seven patients died between 4 and 16 days (mean = 8.7 days) following tracheotomy and 10 living patients realized cessation of mechanical ventilation from 4 hours to 61 days following tracheotomy (mean = 19.3 days). These patients underwent tracheotomy between 4 and 22 days following intubation (mean = 14 days). The 7 patients who died following tracheotomy underwent the procedure between 7 and 25 days following intubation (mean = 18.2 days). Seven patients underwent tracheotomy on or after 20 days of intubation and 3 survived (43%). Ten patients underwent tracheotomy before 20 days of intubation and 7 patients survived (70%). Significant differences between the mortality groups were detected for age (P = .006), and for P/F ratio at time of consult (P = .047) and the time of tracheotomy (P = .03).

CONCLUSIONS:

Tracheotomies are safely performed in COVID-19 patients with a standardized protocol. The timing of tracheotomy in COVID-19 patients is based on ventilator parameters, P/F ratio, patient prognosis, patient advanced directives, and family wishes.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Tracheotomy / COVID-19 Type of study: Clinical Practice Guide / Observational study / Prognostic study / Randomized controlled trials / Risk factors Limits: Humans Language: English Journal: J Oral Maxillofac Surg Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Tracheotomy / COVID-19 Type of study: Clinical Practice Guide / Observational study / Prognostic study / Randomized controlled trials / Risk factors Limits: Humans Language: English Journal: J Oral Maxillofac Surg Year: 2021 Document Type: Article