Tracheotomy in COVID-19 Patients: A Retrospective Study on Complications and Timing

Overview

Journal Laryngoscope Investig Otolaryngol

Publisher Wiley

Specialty Otorhinolaryngology

Date 2021 Jul 1

PMID 34195366

Citations 5

Authors

Nina Pauli

Mans Eeg-Olofsson

Henrik Bergquist

Affiliations

Soon will be listed here.

Abstract

Objectives: The aim of this study was to analyze the timing of tracheotomy and the duration of mechanical ventilation and stay in the intensive care unit (ICU) in patients with COVID-19 infection. Furthermore, we aimed to investigate tracheotomy complications and mortality.

Methods: Consecutive patients with COVID-19 infection admitted to the Department of Infectious Diseases in Gothenburg, Sweden were identified. Medical records were retrieved and retrospectively assessed.

Results: One hundred eighty-eight patients with COVID-19 infection requiring hospital care were identified. Of these, 116 patients were critically ill and intubated, and 55 patients underwent tracheotomy. The mean time from endotracheal intubation to tracheotomy was 12 days (range 5-28 days). There was a correlation between the timing of tracheotomy and the duration of mechanical ventilation, where a shorter time between intubation and tracheotomy was correlated with a shorter duration of mechanical ventilation ( .58, < .001), and a correlation was identified between the timing of tracheotomy and the duration of ICU stay ( .52, < .001). Perioperative hypoxemia was registered in 9% of tracheotomies performed, whereas postoperative bleeding was observed in 27% of cases, the majority of which were minor.

Conclusions: This retrospective cohort study indicates that early tracheotomy is related to a reduced need for mechanical ventilation and a shorter duration of stay in the ICU in severe cases of COVID-19 disease. Complications during and after tracheotomy in this specific cohort included risk perioperative hypoxia and postoperative bleeding. Prospective randomized controlled trials would be of value to confirm these findings.

Level Of Evidence: 4, Case series.

Citing Articles

Early versus late tracheostomy in critically ill COVID-19 patients.

Szafran A, Dahms K, Ansems K, Skoetz N, Monsef I, Breuer T Cochrane Database Syst Rev. 2023; 11:CD015532.

PMID: 37982427 PMC: 10658650. DOI: 10.1002/14651858.CD015532.

Quality tracheotomy care can be maintained for non-COVID patients during the COVID-19 pandemic.

Tucker J, Ruszkay N, Goyal N, Gniady J, Goldenberg D Laryngoscope Investig Otolaryngol. 2022; .

PMID: 36249086 PMC: 9538406. DOI: 10.1002/lio2.885.

Predictors of Mortality in Patients With COVID-19 Undergoing Tracheotomy.

Mitton T, Atwood C, Kenee P, Wynings E, Tibbetts K Ann Otol Rhinol Laryngol. 2022; 132(7):763-769.

PMID: 35923104 PMC: 10258651. DOI: 10.1177/00034894221115752.

TTCOV19: timing of tracheotomy in SARS-CoV-2-infected patients: a multicentre, single-blinded, randomized, controlled trial.

Eeg-Olofsson M, Pauli N, Hafsten L, Jacobsson J, Lundborg C, Brink M Crit Care. 2022; 26(1):142.

PMID: 35585614 PMC: 9115544. DOI: 10.1186/s13054-022-04005-0.

Tracheotomy in COVID-19 patients: A retrospective study on complications and timing.

Pauli N, Eeg-Olofsson M, Bergquist H Laryngoscope Investig Otolaryngol. 2021; 6(3):446-452.

PMID: 34195366 PMC: 8223451. DOI: 10.1002/lio2.560.

References

Siempos I, Ntaidou T, Filippidis F, Choi A . Effect of early versus late or no tracheostomy on mortality and pneumonia of critically ill patients receiving mechanical ventilation: a systematic review and meta-analysis. Lancet Respir Med. 2015; 3(2):150-158. DOI: 10.1016/S2213-2600(15)00007-7. View

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J . A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020; 382(8):727-733. PMC: 7092803. DOI: 10.1056/NEJMoa2001017. View

Aviles-Jurado F, Prieto-Alhambra D, Gonzalez-Sanchez N, de Osso J, Arancibia C, Rojas-Lechuga M . Timing, Complications, and Safety of Tracheotomy in Critically Ill Patients With COVID-19. JAMA Otolaryngol Head Neck Surg. 2020; . PMC: 7545345. DOI: 10.1001/jamaoto.2020.3641. View

Bier-Laning C, Cramer J, Roy S, Palmieri P, Amin A, Anon J . Tracheostomy During the COVID-19 Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries. Otolaryngol Head Neck Surg. 2020; 164(6):1136-1147. DOI: 10.1177/0194599820961985. View

McGrath B, Brenner M, Warrillow S, Pandian V, Arora A, Cameron T . Tracheostomy in the COVID-19 era: global and multidisciplinary guidance. Lancet Respir Med. 2020; 8(7):717-725. PMC: 7228735. DOI: 10.1016/S2213-2600(20)30230-7. View

Whited R . A prospective study of laryngotracheal sequelae in long-term intubation. Laryngoscope. 1984; 94(3):367-77. DOI: 10.1288/00005537-198403000-00014. View

Wang R, Pan C, Wang X, Xu F, Jiang S, Li M . The impact of tracheotomy timing in critically ill patients undergoing mechanical ventilation: A meta-analysis of randomized controlled clinical trials with trial sequential analysis. Heart Lung. 2018; 48(1):46-54. DOI: 10.1016/j.hrtlng.2018.09.005. View

Chan N, Weitz J . COVID-19 coagulopathy, thrombosis, and bleeding. Blood. 2020; 136(4):381-383. PMC: 7378461. DOI: 10.1182/blood.2020007335. View

Liu X, Wang H, Xing Y, He Y, Zhang Z, Wang T . The effect of early and late tracheotomy on outcomes in patients: a systematic review and cumulative meta-analysis. Otolaryngol Head Neck Surg. 2014; 151(6):916-22. DOI: 10.1177/0194599814552415. View

10.

McGrath B, Pelosi P, Schultz M, Brenner M . Preoperative apnea trial and considerations regarding timing of tracheostomy in anesthetic planning for patient with COVID-19 disease. J Clin Anesth. 2020; 67:110013. PMC: 7386306. DOI: 10.1016/j.jclinane.2020.110013. View

11.

Wang F, Wu Y, Bo L, Lou J, Zhu J, Chen F . The timing of tracheotomy in critically ill patients undergoing mechanical ventilation: a systematic review and meta-analysis of randomized controlled trials. Chest. 2011; 140(6):1456-1465. DOI: 10.1378/chest.11-2024. View

12.

Jacob T, Walker A, Mantelakis A, Gibbins N, Keane O . A framework for open tracheostomy in COVID-19 patients. Clin Otolaryngol. 2020; 45(4):649-651. PMC: 7262328. DOI: 10.1111/coa.13549. View

13.

Pauli N, Eeg-Olofsson M, Bergquist H . Tracheotomy in COVID-19 patients: A retrospective study on complications and timing. Laryngoscope Investig Otolaryngol. 2021; 6(3):446-452. PMC: 8223451. DOI: 10.1002/lio2.560. View

14.

Chao T, Harbison S, Braslow B, Hutchinson C, Rajasekaran K, Go B . Outcomes After Tracheostomy in COVID-19 Patients. Ann Surg. 2020; 272(3):e181-e186. PMC: 7467054. DOI: 10.1097/SLA.0000000000004166. View

15.

Richardson S, Hirsch J, Narasimhan M, Crawford J, McGinn T, Davidson K . Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020; 323(20):2052-2059. PMC: 7177629. DOI: 10.1001/jama.2020.6775. View

16.

Ackermann M, Verleden S, Kuehnel M, Haverich A, Welte T, Laenger F . Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N Engl J Med. 2020; 383(2):120-128. PMC: 7412750. DOI: 10.1056/NEJMoa2015432. View

17.

Dong E, Du H, Gardner L . An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020; 20(5):533-534. PMC: 7159018. DOI: 10.1016/S1473-3099(20)30120-1. View

18.

Stubington T, Mallick A, Garas G, Stubington E, Reddy C, Mansuri M . Tracheotomy in COVID-19 patients: Optimizing patient selection and identifying prognostic indicators. Head Neck. 2020; 42(7):1386-1391. PMC: 7280616. DOI: 10.1002/hed.26280. View

19.

Ahmed Y, Cao A, Thal A, Shah S, Kinkhabwala C, Liao D . Tracheotomy Outcomes in 64 Ventilated COVID-19 Patients at a High-Volume Center in Bronx, NY. Laryngoscope. 2021; 131(6):E1797-E1804. DOI: 10.1002/lary.29391. View

20.

Fox S, Akmatbekov A, Harbert J, Li G, Brown J, Vander Heide R . Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans. Lancet Respir Med. 2020; 8(7):681-686. PMC: 7255143. DOI: 10.1016/S2213-2600(20)30243-5. View