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Tracheostomy for COVID-19 respiratory failure: timing, ventilatory characteristics, and outcomes.
Farlow, Janice L; Park, Pauline K; Sjoding, Michael W; Kay, Stephen G; Blank, Ross; Malloy, Kelly M; Washer, Laraine; Napolitano, Lena M; Rajajee, Venkatakrishna; Brenner, Michael J; Chinn, Steven B; De Cardenas, Jose.
  • Farlow JL; Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA.
  • Park PK; Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA.
  • Sjoding MW; Division of Pulmonary and Critical Care, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA.
  • Kay SG; Division of Pulmonary and Critical Care, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA.
  • Blank R; Department of Anesthesia, Michigan Medicine, Ann Arbor, MI, USA.
  • Malloy KM; Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA.
  • Washer L; Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA.
  • Napolitano LM; Department of Surgery, Michigan Medicine, Ann Arbor, MI, USA.
  • Rajajee V; Department of Neurosurgery, Michigan Medicine, Ann Arbor, MI, USA.
  • Brenner MJ; Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA.
  • Chinn SB; Global Tracheostomy Collaborative, Raleigh, NC, USA.
  • De Cardenas J; Department of Otolaryngology-Head and Neck Surgery, Michigan Medicine, Ann Arbor, MI, USA.
J Thorac Dis ; 13(7): 4137-4145, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1344631
ABSTRACT

BACKGROUND:

Whereas data from the pre-pandemic era have demonstrated that tracheostomy can accelerate liberation from the ventilator, reduce need for sedation, and facilitate rehabilitation, concerns for healthcare worker safety have led to disagreement on tracheostomy placement in COVID-19 patients. Data on COVID-19 patients undergoing tracheostomy may inform best practices. Thus, we report a retrospective institutional cohort experience with tracheostomy in ventilated patients with COVID-19, examining associations between time to tracheostomy and duration of mechanical ventilation in relation to patient characteristics, clinical course, and survival.

METHODS:

Clinical data were extracted for all COVID-19 tracheostomies performed at a quaternary referral center from April-July 2020. Outcomes studied included mortality, adverse events, duration of mechanical ventilation, and time to decannulation.

RESULTS:

Among 64 COVID-19 tracheostomies (13% of COVID-19 hospitalizations), patients were 64% male and 42% African American, with a median age of 54 (range, 20-89). Median time to tracheostomy was 22 (range, 7-60) days and median duration of mechanical ventilation was 39.4 (range, 20-113) days. Earlier tracheostomy was associated with shortened mechanical ventilation (R2=0.4, P<0.01). Median decannulation time was 35.3 (range, 7-79) days. There was 19% mortality and adverse events in 45%, mostly from bleeding in therapeutically anticoagulated patients.

CONCLUSIONS:

Tracheostomy was associated with swifter liberation from the ventilator and acceptable safety for physicians in this series of critically ill COVID-19 patients. Patient mortality was not increased relative to historical data on acute respiratory distress syndrome (ARDS). Future studies are required to establish conclusions of causality regarding tracheostomy timing with mechanical ventilation, complications, or mortality in COVID-19 patients.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Clinical Practice Guide Language: English Journal: J Thorac Dis Year: 2021 Document Type: Article Affiliation country: Jtd-21-10

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Clinical Practice Guide Language: English Journal: J Thorac Dis Year: 2021 Document Type: Article Affiliation country: Jtd-21-10