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COVID-19 Tracheostomy Outcomes.
Molin, Nicole; Myers, Keith; Soliman, Ahmed M S; Schmalbach, Cecelia E.
  • Molin N; Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
  • Myers K; Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
  • Soliman AMS; Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
  • Schmalbach CE; Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
Otolaryngol Head Neck Surg ; : 1945998221075610, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-2138550
ABSTRACT

OBJECTIVES:

(1) Assess overall COVID-19 mortality in ventilated patients with and without tracheostomy. (2) Determine the impact of tracheostomy on mechanical ventilation duration, overall length of stay (LOS), and intensive care unit (ICU) LOS for patients with COVID-19. STUDY

DESIGN:

Case series with planned chart review.

SETTING:

Single-institution tertiary care center.

METHODS:

Patients with COVID-19 who were ≥18 years old and requiring invasive positive pressure ventilation (IPPV) met inclusion criteria. Patients were stratified into 2 cohorts IPPV with tracheostomy and IPPV with intubation only. Cohorts were analyzed for the following primary outcome

measures:

mortality, LOS, ICU LOS, and IPPV duration.

RESULTS:

An overall 258 patients with IPPV met inclusion criteria 46 (18%) with tracheostomy and 212 (82%) without (66% male; median age, 63 years [interquartile range, 18.75]). Average LOS, time in ICU, and time receiving IPPV were longer in the tracheostomy cohort (P < .01). Ability to wean from IPPV was similar between cohorts (P > .05). The number of deaths in the nontracheostomy cohort (54%) was significantly higher than the tracheostomy cohort (29%, P < .01).

CONCLUSIONS:

While tracheostomy placement in patients with COVID-19 did not shorten overall LOS, mechanical ventilation duration, or ICU LOS, patients with a tracheostomy experienced a significantly lower number of deaths vs those without. One goal for tracheostomy is improved pulmonary toilet with associated shortened IPPV requirements. Our study did not identify this advantage among the COVID-19 population. However, this study demonstrates that the need for tracheostomy in the COVID-19 setting does not portent a poor prognostic factor, as patients with a tracheostomy experienced a significantly higher survival rate than their nontracheostomy counterparts.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: Otolaryngol Head Neck Surg Journal subject: Otolaryngology Year: 2022 Document Type: Article Affiliation country: 01945998221075610

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: Otolaryngol Head Neck Surg Journal subject: Otolaryngology Year: 2022 Document Type: Article Affiliation country: 01945998221075610