Your browser doesn't support javascript.
Clinical Outcomes of Early Versus Late Tracheostomy in Coronavirus Disease 2019 Patients: A Systematic Review and Meta-Analysis.
Chong, Woon Hean; Tan, Chee Keat.
  • Chong WH; Department of Intensive Care Medicine, 242949Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore.
  • Tan CK; Department of Intensive Care Medicine, 242949Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore.
J Intensive Care Med ; : 8850666221098930, 2022 May 04.
Article in English | MEDLINE | ID: covidwho-1820051
ABSTRACT

BACKGROUND:

A significant proportion of Coronavirus Disease 2019 (COVID-19) patients require admission to the intensive care unit (ICU) and invasive mechanical ventilation (IMV). Tracheostomy is increasingly performed when a prolonged course of IMV is anticipated.

OBJECTIVES:

To determine clinical and resource utilization benefits of early versus late tracheostomy among COVID-19 patients.

METHODS:

Pubmed, Cochrane Library, Scopus, and Embase were used to identify relevant studies comparing outcomes of COVID-19 patients undergoing early and late tracheostomy from January 1, 2020, to December 1, 2021.

RESULTS:

Twelve studies were selected, and 2222 critically ill COVID-19 patients hospitalized between January to December 2020 were included. Among the included patients, 34.5% and 65.5% underwent early and late tracheostomy, respectively. Among the included studies, 58.3% and 41.7% defined early tracheostomy using cutoffs of 14 and 10 days, respectively. All-cause in-hospital mortality was not different between the early and late tracheostomy groups (32.9% vs. 33.1%; OR = 1.00; P = 0.98). Sensitivity analysis demonstrated a similar mortality rate in studies using a cutoff of 10 days (34.6% vs. 35.5%; OR = 0.97; P = 0.89) or 14 days (31.2% vs. 27.7%; OR = 1.05; P = 0.78). The early tracheostomy group had shorter ICU length of stay (LOS) (mean 23.18 vs. 30.51 days; P < 0.001) and IMV duration (mean 20.49 vs. 28.94 days; P < 0.001) than the late tracheostomy group. The time from tracheostomy to decannulation was longer (mean 23.36 vs. 16.24 days; P = 0.02) in the early tracheostomy group than in the late tracheostomy group, but the time from tracheostomy to IMV weaning was similar in both groups. Other clinical characteristics, including age, were similar in both groups.

CONCLUSIONS:

Early tracheostomy reduced the ICU LOS and IMV duration among COVID-19 patients compared with late tracheostomy, but the mortality rate was similar in both groups. The findings have important implications for the treatment of COVID-19 patients, especially in a resource-limited setting.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Prognostic study / Randomized controlled trials / Reviews / Systematic review Topics: Long Covid Language: English Journal: J Intensive Care Med Journal subject: Critical Care Year: 2022 Document Type: Article Affiliation country: 08850666221098930

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Type of study: Prognostic study / Randomized controlled trials / Reviews / Systematic review Topics: Long Covid Language: English Journal: J Intensive Care Med Journal subject: Critical Care Year: 2022 Document Type: Article Affiliation country: 08850666221098930