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Tracheotomy in COVID-19 patients: Optimizing patient selection and identifying prognostic indicators.
Stubington, Thomas J; Mallick, Ali S; Garas, Georgios; Stubington, Emma; Reddy, Chetan; Mansuri, Mohammed S.
  • Stubington TJ; Department of Otorhinolaryngology-Head and Neck Surgery, Royal Derby Hospital, Derby, UK.
  • Mallick AS; Department of Otorhinolaryngology-Head and Neck Surgery, Royal Derby Hospital, Derby, UK.
  • Garas G; Department of Otorhinolaryngology-Head and Neck Surgery, Nottingham University Hospitals NHS Trust, Queens Medical Center Campus, Nottingham, UK.
  • Stubington E; Centre for Doctoral Training, Lancaster University, Lancaster, UK.
  • Reddy C; Department of Anaesthesia, Royal Derby Hospital, Derby, UK.
  • Mansuri MS; Department of Otorhinolaryngology-Head and Neck Surgery, Royal Derby Hospital, Derby, UK.
Head Neck ; 42(7): 1386-1391, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-342843
ABSTRACT

BACKGROUND:

Tracheotomy, through its ability to wean patients off ventilation, can shorten ICU length of stay and in doing so increase ICU bed capacity, crucial for saving lives during the COVID-19 pandemic. To date, there is a paucity of patient selection criteria and prognosticators to facilitate decision making and enhance precious ICU capacity.

METHODS:

Prospective study of COVID-19 patients undergoing tracheotomy (n = 12) over a 4-week period (March-April 2020). Association between preoperative and postoperative ventilation requirements and outcomes (ICU stay, time to decannulation, and death) were examined.

RESULTS:

Patients who sustained FiO2 ≤ 50% and PEEP ≤ 8 cm H2 O in the 24 hours pretracheotomy exhibited a favorable outcome. Those whose requirements remained below these thresholds post-tracheotomy could be safely stepped down after 48 hours.

CONCLUSION:

Sustained FiO2 ≤ 50% and PEEP ≤ 8 cm H2 O in the 48 hours post-tracheotomy are strong predictive factors for a good outcome, raising the potential for these patients to be stepped down early, thus increasing ICU capacity.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Respiration, Artificial / Tracheotomy / Coronavirus Infections / Pandemics / Intensive Care Units / Length of Stay Type of study: Cohort study / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Head Neck Journal subject: Neoplasms Year: 2020 Document Type: Article Affiliation country: Hed.26280

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Respiration, Artificial / Tracheotomy / Coronavirus Infections / Pandemics / Intensive Care Units / Length of Stay Type of study: Cohort study / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: English Journal: Head Neck Journal subject: Neoplasms Year: 2020 Document Type: Article Affiliation country: Hed.26280