Tracheostomy, ventilatory wean, and decannulation in COVID-19 patients.
Eur Arch Otorhinolaryngol
; 278(5): 1595-1604, 2021 May.
Article
in English
| MEDLINE | ID: covidwho-692740
ABSTRACT
PURPOSE:
COVID-19 patients requiring mechanical ventilation can overwhelm existing bed capacity. We aimed to better understand the factors that influence the trajectory of tracheostomy care in this population to facilitate capacity planning and improve outcomes.METHODS:
We conducted an observational cohort study of patients in a high-volume centre in the worst-affected region of the UK including all patients that underwent tracheostomy for COVID-19 pneumonitis ventilatory wean from 1st March 2020 to 10th May 2020. The primary outcome was time from insertion to decannulation. The analysis utilised Cox regression to account for patients that are still progressing through their tracheostomy pathway.RESULTS:
At the point of analysis, a median 21 days (IQR 15-28) post-tracheostomy and 39 days (IQR 32-45) post-intubation, 35/69 (57.4%) patients had been decannulated a median of 17 days (IQR 12-20.5) post-insertion. The overall median age was 55 (IQR 48-61) with a male-to-female ratio of 21. In Cox regression analysis, FiO2 at tracheostomy ≥ 0.4 (HR 1.80; 95% CI 0.89-3.60; p = 0.048) and last pre-tracheostomy peak cough flow (HR 2.27; 95% CI 1.78-4.45; p = 0.001) were independent variables associated with prolonged time to decannulation.CONCLUSION:
Higher FiO2 at tracheostomy and higher pre-tracheostomy peak cough flow are associated with increased delay in COVID-19 tracheostomy patient decannulation. These finding comprise the most comprehensive report of COVID-19 tracheostomy decannulation to date and will assist service planning for future peaks of this pandemic.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Tracheostomy
/
COVID-19
Type of study:
Cohort study
/
Observational study
/
Prognostic study
Limits:
Female
/
Humans
/
Male
/
Middle aged
Language:
English
Journal:
Eur Arch Otorhinolaryngol
Journal subject:
Otolaryngology
Year:
2021
Document Type:
Article
Affiliation country:
S00405-020-06187-1
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