Tracheostomy In COVID-19 Patients Research Articles

Early tracheostomy in ventilated COVID-19 patients reduces incidence of ventilator-associated pneumonia

Tracheostomy can reduce mechanical ventilation (MV) duration, ICU and hospital length of stay (LOS), and ventilator-associated pneumonia (VAP) risk in critically ill patients. The timing of tracheostomy in COVID-19 patients has been studied, but its impact on VAP incidence has rarely been analyzed. This study investigated tracheostomy timing’s impact on VAP incidence, ventilation time, ICU and hospital LOS, and mortality in critically ill COVID-19 patients. It was conducted at the University Hospital in Wroclaw, Poland, from October 1, 2020, to June 30, 2021. Of 60 tracheostomized patients, 21 (35%) developed VAP. Early tracheostomy (≤ 13 days) resulted in 8/42 (19%) VAP cases, while late tracheostomy (> 13 days) had 13/18 (72%) VAP cases, showing a significantly lower VAP risk in the early group (p < 0.05). VAP incidence rates were 7.9 and 22.8 per 1000 patient-days for early and late groups, respectively. Early tracheostomy patients had shorter median MV duration (18 vs. 33 days, p < 0.05), ICU LOS (20 vs. 31 days, p < 0.05) and hospital LOS (25 vs. 47 days, p < 0.05). Early tracheostomy in critically ill COVID-19 patients significantly reduced VAP risk, MV duration, ICU, and hospital LOS.

Tracheostomy in Critically Ill Covid 19 Patients: A Review of Outcome

The novel human coronavirus disease (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which can result in serious respiratory illness requiring endotracheal intubation, mechanical ventilation, and tracheostomy. Resources on the indication, ideal timing and outcomes for tracheostomy in COVID-19 patients are still limited. Tracheostomy is an aerosol generating procedure with risk of transmission of airborne disease to healthcare workers (HCWs)1. However, tracheostomy aids in ventilation liberation2 for mechanical ventilated patient in general but resources on overall outcome for tracheostomy in COVID-19 patients are not well reported. Thus, a trained surgeon, adequate safety equipment and measures are essential to reduce timing of exposure through this aerosol-generating procedures and reduce risk of complications.

Tracheostomy in COVID-19 Patients in India\'s Largest COVID Hospital: Our Experience

Tracheostomy in COVID-19 Patients in India\'s Largest COVID Hospital: Our Experience

Bedside open tracheostomy in COVID-19 patients - a safe and swift approach.

Tracheostomy can be performed as an open surgical procedure, percutaneous, or hybrid and forms an important step in the management of patients infected with coronavirus disease 2019 (COVID-19) requiring weaning from mechanical ventilation. The purpose of this article is to share our experience to performing bedside surgical tracheostomy in COVID-19 patients in a safe and effective manner, whilst minimising the risk of viral transmission, to optimise patient outcomes and reduce risk to healthcare professionals. As recommended by ENT UK, we prospectively established a COVID Airway Team within the ENT department at Birmingham Heartlands Hospital, consisting of four head and neck consultant surgeons to perform either open-bedside, open-theatre or percutaneous tracheostomy in COVID-19 patients. A specific stepwise method for bedside open surgical tracheostomy was based on ENT UK and British Laryngological Society recommendations. Thirty patients underwent tracheostomy during the study period (14 bedside-open, 5 open-theatre, 11 percutaneous). Mean duration of mechanical intubation prior to bedside-open tracheostomy was 14.5 days. The average time for open-bedside tracheostomy was 9 minutes compared to 31 minutes for open-theatre. There were no significant tracheostomy related complications with bedside-open tracheostomy. No healthcare professional involved reported acute COVID-19 infection. We describe our effective, safe and swift approach to bedside open tracheostomy during the COVID-19 pandemic. Our experience demonstrated a short mean procedural time, with no tracheostomy-related complications and no reported viral transmission amongst the healthcare members involved.

Tracheostomy in COVID-19 patients and its effect on laboratory parameters: a retrospective case series

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim &amp;lt;br /&amp;gt;&amp;lt;/strong&amp;gt;To evaluate characteristics of COVID-19 tracheostomy and its effect on laboratory parameters.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;Demographic parameters, duration indicators, and laboratory parameters before and after tracheostomy were analysed in&amp;lt;br /&amp;gt;a series of 17 patients with COVID-19 patients.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;Of the 17 patients, four were males and 13 females with a mean age of 59 years. The average length of total hospitalization was 12 days, the length of stay in intensive care was 10 days, the length of endotracheal intubation was 9 days; tracheostomy was mostly performed on the seventh day. There was a significant correlation between comorbidities and outcomes; however, laboratory parameters did not show statistical significance. &amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion&amp;lt;/strong&amp;gt; &amp;lt;br /&amp;gt;Open surgical tracheostomy is recommended in all COVID-19 critically ill patients within 1 or 2 weeks after endotracheal intubation; it can be performed in terms of renal laboratory parameters, lactate and D-dimer. These patients had a lower&amp;lt;br /&amp;gt;possibility of weaning from mechanical ventilation.&amp;lt;/p&amp;gt;

Tracheostomy in the Era of COVID-19 Pandemic

Since COVID-19 pandemic, extreme care must be taken to not only tracheotomy, but also subsequent tube management so that medical staff and other patients can be protected from infectious aerosols from the patient. Numerous studies have been reported worldwide on the timing and indications for tracheotomy in COVID-19 patients since 2019. In this paper, we describe the issues to be considered not only during tracheostomy but also before and after procedure in COVID-19 patients with the literatures review.

Elective Tracheostomy During Covid-19 Pandemic- A Tertiary Care Centre Experience.

: The aim of our study was to present an experience of elective tracheostomy in COVID-19 patients at our institute. The present prospective study was conducted, after approval by Institutional Ethics Committee, in the Department of ENT, SMGS Hospital, GMC Jammu from May 2020 to March 2021 over 60 patients having need for prolonged mechanical ventilation and having tested positive for COVID-19 with nasopharyngeal swab on rtPCR assay testing. Detailed information regarding following aspects was gathered :Age, Gender, Comorbidities (Diabetes, Cardiovascular disease, Pulmonary disease, Malignancy), time of endotracheal intubation to tracheostomy, time to wean sedation after tracheostomy, time to wean mechanical ventilation after tracheostomy, surgical complications, mortality, any health care worker in operating team getting infected by SARS-CoV-2. All 60 patients underwent Elective Open Tracheostomy Bed-side in the ICU section of our institute. The mean age of presentation was 55.9 ± 2.34 years, with male preponderance. The most common indication for tracheostomy was ARDS (Acute Respiratory Distress Syndrome) (56.6%). Out of 60 patients, co-morbidities were present in 44 patients (73.3%). The mean time between endotracheal intubation and tracheostomy was 12.2 ± 4.9 days. The mean time to wean mechanical ventilation after tracheostomy was 10.4 ± 2.31 days. The mean time to wean sedation was 2.2 ± 0.83 days. There were no deaths during the procedure. Out of 60 patients, 5 patients (8.3%) died due to complications of COVID-19. Our study provides important clinical data (such as timing of tracheostomy, pre-operative evaluation of patients, recommendations during procedure, outcomes of tracheostomy and postoperative care) on this threatening issue of tracheostomy in COVID-19 patients and might be of immense help to various Otorhinolaryngologists who are dealing with the same situation.

PERCUTANEOUS DILATATIONAL TRACHEOSTOMY IN COVID-19 PATIENTS IN THE COVID HOSPITAL INTENSIVE CARE UNIT: THE UNIVERSITY CLINICAL CENTER OF VOJVODINA EXPERIENCE.

Patients with acute respiratory distress syndrome due to COVID-19 require intensive care unit (ICU) admission with consecutive endotracheal intubation and invasive mechanical ventilation. In patients with long-term mechanical ventilation, percutaneous dilatational tracheostomy (PDT) may be considered. This retrospective analysis includes clinical data on patients treated at the ICUs of the COVID Hospital of the Clinical Center of Vojvodina in the period from September 3, 2021 to May 1, 2022, and underwent PDT. Patients were predominantly male (n=48; 65.8%). Weaning from mechanical ventilation was achieved in 31 (42.5%) and decannulation in 25 (34.2%) patients. The mean time from polymerase chain reaction SARS CoV-2 positivity until PDT was 15.59±6.85 days. The mean time of endotracheal intubation before the PDT procedure was 7.37±4.89 days. The mean weaning time from mechanical ventilation was 10.45±7.92 days. Twenty-five (34.2%) patients were decannulated at the mean time of 19.60±11.81 days. The complications were tracheostomy related bleeding (2 patients), pneumothorax (4 patients), subcutaneous emphysema (1 patient) and cricoid cartilage injury (1 patient). PDT is a simple, safe, and effective procedure performed in COVID-19 patients in the ICU.

Outcome of Tracheostomy in COVID-19 Patients.

Since the start of the COVID-19 pandemic 2019, quite a few patients became critical and needed ICU admission with ventilator assistance. Tracheostomy, which was initially performed late during the course of patient on ventilator, has now been considered a procedure that can be performed relatively early as this leads to early weaning of patients and overcomes the shortage of critical beds. This study aims to focus on the outcomes of tracheotomised COVID-19 patients in terms of survival and any tracheostomy related morbidity. A prospective study was performed on COVID-19 patients undergoing tracheostomy at this tertiary care teaching hospital, which also was a dedicated centre for treating COVID-19 patients. The duration of this study was from April 2020 to September 2021. Following tracheostomy, all patients were followed up regularly and clinical changes were recorded. Points that were specifically noted were timing of the tracheostomy, change in ventilator settings, tracheostomy related complications, requirement of oxygen, days needed to wean the patient, decanulation, and, if death, the cause of death. A total of 136 surgical open tracheostomies were performed on COVID-19 patients over the study period. The mean duration of intubation (timing of tracheostomy) was 12 days. A total of 73 out of 136 (53.6%) patients survived. 51 patients (37.5%) got decannulated during the course of the hospital stay. 9 patients were decanulated during the follow up visits and 13 patients were lost to follow up. 63 out of 136 (46.3%) patients died due to COVID pneumonia. Most of the patients who died had gone into multi-organ failure. Air leak syndromes (pneumothorax and pneumomediastinum) were common findings. 10 patients already had surgical emphysema before taking up for tracheostomy and 6 developed 2-3 days after tracheostomy. The most common complication was bleeding, which was seen in 28 out of 136 patients. The Median weaning of period of patients who survived was 5 days. Performing tracheostomy early in COVID-19 patients helps in early weaning of the patient from the ventilator and makes nursing care easier and increases the availability of ICU beds. The mortality rate was 46% amongst the 136 tracheostomies done in COVID-19 patients. Local site bleeding was the most common complication and surgical emphysema was also seen more than routine tracheostomies. The online version contains supplementary material available at 10.1007/s12070-022-03248-1.

Bleeding Hazard of Percutaneous Tracheostomy in COVID-19 Patients Supported With Venovenous Extracorporeal Membrane Oxygenation: A Case Series

ObjectivesTracheostomy is usually performed to aid weaning from mechanical ventilation and facilitate rehabilitation and secretion clearance. Little is known about the safety of percutaneous tracheostomy in patients with severe COVID-19 supported on veno-venous extracorporeal membrane oxygenation (VV-ECMO). This study aims to investigate the bleeding risk of bedside percutaneous tracheostomy in patients with COVID-19 infection supported with VV-ECMO.DesignA Retrospective review of electronic data for routine care of patients on ECMO.SettingTertiary, university affiliated national ECMO centre.ParticipantsCOVID-19 patients who underwent percutaneous tracheostomy while on VV-ECMO support.InterventionsNo intervention was conducted during this study. Measurements and Main Results: Electronic medical records of 16 confirmed COVID-19 patients who underwent percutaneous tracheostomy while on VV-ECMO support, including patient demographics, severity of illness, clinical variables, procedural complications, and outcome were compared with 16 non-COVID-19 cases. SPSS statistical software was used for statistical analysis. Demographic data were compared using the chi-square test and normality assumption was test using Shapiro-Wilk test. The indications for tracheostomy in all the cases were prolonged mechanical ventilation and sedation management. None of the patients suffered a life-threatening procedural complication within 48 hours. Moderate to severe bleeding was similar in both groups. There was no difference in 30 and 90-days mortality between both groups. As per routine screening results, none of the staff involved contracted COVID-19 infection.ConclusionsIn this case series percutaneous tracheostomy during VV-ECMO in COVID-19 patients appeared to be safe and did not pose additional risks to patients or healthcare workers.

Association of mortality and early tracheostomy in patients with COVID-19: a retrospective analysis

COVID-19 adds to the complexity of optimal timing for tracheostomy. Over the course of this pandemic, and expanded knowledge of the disease, many centers have changed their operating procedures and performed an early tracheostomy. We studied the data on early and delayed tracheostomy regarding patient outcome such as mortality. We performed a retrospective analysis of all tracheostomies at our institution in patients diagnosed with COVID-19 from March 2020 to June 2021. Time from intubation to tracheostomy and mortality of early (≤ 10 days) vs. late (> 10 days) tracheostomy were the primary objectives of this study. We used mixed cox-regression models to calculate the effect of distinct variables on events. We studied 117 tracheostomies. Intubation to tracheostomy shortened significantly (Spearman’s correlation coefficient; rho = − 0.44, p ≤ 0.001) during the course of this pandemic. Early tracheostomy was associated with a significant increase in mortality in uni- and multivariate analysis (Hazard ratio 1.83, 95% CI 1.07–3.17, p = 0.029). The timing of tracheostomy in COVID-19 patients has a potentially critical impact on mortality. The timing of tracheostomy has changed during this pandemic tending to be performed earlier. Future prospective research is necessary to substantiate these results.

P84: Advantages of Early Tracheostomy in COVID-19 Patients Supported with ECMO

P84: Advantages of Early Tracheostomy in COVID-19 Patients Supported with ECMO

The surgical airway in the COVID-19 era

The aim is to summarize the guidelines for tracheostomy management during the COVID-19 pandemic. This is a comparative study analysis and literature review using articles found in the PubMed/MEDLINE database. Here we summarize published work on tracheostomy timing, technique, outcomes, mortality, and decannulation rates during the COVID-19 pandemic, with a focus on expertise from our own institution. Among 12 studies, 2,692 tracheostomies were performed at an average of 17.5 days from intubation. 66.4% were performed open, and 33.6% percutaneously. A total of 85.6% were performed bedside, and 14.4% in the operating room. 19.5% experienced all-cause mortality, and 43.4% were decannulated. In these studies, only 1 proceduralist became infected with COVID-19. Early COVID-19 recommendations advocated for tracheostomy a minimum of 14 days from intubation. Currently, tracheostomy is performed more closely to prepandemic criteria. Bedside tracheostomy comprised most procedures during the pandemic. Tracheostomy in COVID-19 patients, when performed with techniques to minimize aerosolization, is safe and poses minimal risk of infection to providers performing the procedure.

Timing to perform bed-side surgical tracheostomy in COVID-19 patients in intensive care unit

Background: Tracheostomy is an important surgical procedure in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) pandemic, particularly those patients undergoing prolonged tracheal intubation. The timing and indications for tracheostomy in COVID-19 patients with ventilators are still controversial. Methods: We prospectively studied the best timing for performing surgical tracheostomy in COVID-19 patients (n = 22) from April 2020 to May 2021 in the COVID-19 ICU attached to our COVID-19 hospital. The tracheotomised patients were followed up and the number and timing of the death were documented. Results: There were 14 males (male:female = 1.75:1). The mean duration of endotracheal intubation to tracheostomy was 14.4 days (range 10-22 days). The mean time for tracheostomy was 18.45 min (range 12–25 min). Five patients (22.7%) died after tracheostomy. The median time between tracheostomy and death was 4 days. Conclusions: Surgical tracheostomy has to be performed in a proper time with safe manner for benefit of the patients with COVID-19 and the health care professionals managing the patient.

Tracheostomy timing and clinical outcomes in ventilated COVID-19 patients: a systematic review and meta-analysis

BackgroundThe association of tracheostomy timing and clinical outcomes in ventilated COVID-19 patients remains controversial. We performed a meta-analysis to evaluate the impact of early tracheostomy compared to late tracheostomy on COVID-19 patients’ outcomes.MethodsWe searched Medline, Embase, Cochrane, and Scopus database, along with medRxiv, bioRxiv, and Research Square, from December 1, 2019, to August 24, 2021. Early tracheostomy was defined as a tracheostomy conducted 14 days or less after initiation of invasive mechanical ventilation (IMV). Late tracheostomy was any time thereafter. Duration of IMV, duration of ICU stay, and overall mortality were the primary outcomes of the meta-analysis. Pooled odds ratios (OR) or the mean differences (MD) with 95%CIs were calculated using a random-effects model.ResultsFourteen studies with a cumulative 2371 tracheostomized COVID-19 patients were included in this review. Early tracheostomy was associated with significant reductions in duration of IMV (2098 patients; MD − 9.08 days, 95% CI − 10.91 to − 7.26 days, p < 0.01) and duration of ICU stay (1224 patients; MD − 9.41 days, 95% CI − 12.36 to − 6.46 days, p < 0.01). Mortality was reported for 2343 patients and was comparable between groups (OR 1.09, 95% CI 0.79–1.51, p = 0.59).ConclusionsThe results of this meta-analysis suggest that, compared with late tracheostomy, early tracheostomy in COVID-19 patients was associated with shorter duration of IMV and ICU stay without modifying the mortality rate. These findings may have important implications to improve ICU availability during the COVID-19 pandemic.Trial registration The protocol was registered at INPLASY (INPLASY202180088).

Use of Tracheostomy in COVID-19 Patients and it’s Effects on Healthcare Workers

Tracheostomy in COVID-19 patients needs important decision making and surgical planning, especially since it’s an aerosol-generating procedure and poses a threat to the health care personnel involved. Various public health agencies have recognized that some particular health care procedures considerably increase the risk of transmission of respiratory pathogens because they produce aerosols.&#x0D; Severe infection with SARS-CoV-2 [COVID-19] causes respiratory illness resulting in Acute Respiratory Distress Syndrome (ARDS) and respiratory failure that put patients in need of intrusive mechanical ventilation. Because it is linked to longer use of sedatives, narcotics, muscle palsy leading to a longing desire for invasive central catheters, and the patient's stationary position inflicting line infection and pressure injuries to the skin, prolonged invasive mechanical ventilation usually results in ventilator-associated pneumonia and other complications.&#x0D; If patients are projected to be ventilator-dependent for a lengthy period of time, surgical treatment is considered once every 7–10 days for automatically ventilated patients. However, due to the risk faced by the health care workers, it has been recommended by organizations such as WHO, that health personnel must take appropriate measures so as to minimize the risk of contracting the deadly virus. This includes wearing personal protective equipment [PPE] while performing the procedure. An N-95[or above] face mask, face shield, latex gloves, full-body disposable cover, foot covers are some of the contents of personal protective equipment [PPE].&#x0D; Our goal is to provide authoritative guidance to healthcare providers and healthcare systems and to highlight the possible effects of the accumulating experiences, currently available evidence, and historical lessons, tracheostomy decisions during the current COVID19 epidemic. Because incubated patients have a poor prognosis and there is a danger of transfer to providers through this highly aerosolizing procedure, the pathway of tracheostomy placement has changed.

Fuzzy Decision Tree Based Method in Decision-Making of COVID-19 Patients’ Treatment

A new method in decision-making of timing of tracheostomy in COVID-19 patients is developed and discussed in this paper. Tracheostomy is performed in critically ill coronavirus disease (COVID-19) patients. The timing of tracheostomy is important for anticipated prolonged ventilatory wean when levels of respiratory support were favorable. The analysis of this timing has been implemented based on classification method. One of principal conditions for the developed classifiers in decision-making of timing of tracheostomy in COVID-19 patients was a good interpretation of result. Therefore, the proposed classifiers have been developed as decision tree based because these classifiers have very good interpretability of result. The possible uncertainty of initial data has been considered by the application of fuzzy classifiers. Two fuzzy classifiers as Fuzzy Decision Tree (FDT) and Fuzzy Random Forest (FRF) have been developed for the decision-making in tracheostomy timing. The evaluation of proposed classifiers and their comparison with other show the efficiency of the proposed classifiers. FDT has best characteristics in comparison with other classifiers.

Association between tracheostomy timing and outcomes for older critically ill COVID-19 patients: prospective observational study in European intensive care units

BackgroundTracheostomy is performed in patients expected to require prolonged mechanical ventilation, but to date optimal timing of tracheostomy has not been established. The evidence concerning tracheostomy in COVID-19 patients is particularly scarce. We aimed to describe the relationship between early tracheostomy (≤10 days since intubation) and outcomes for patients with COVID-19. MethodsThis was a prospective cohort study performed in 152 centres across 16 European countries from February to December 2020. We included patients aged ≥70 yr with confirmed COVID-19 infection admitted to an intensive care unit, requiring invasive mechanical ventilation. Multivariable analyses were performed to evaluate the association between early tracheostomy and clinical outcomes including 3-month mortality, intensive care length of stay, and duration of mechanical ventilation. ResultsThe final analysis included 1740 patients with a mean age of 74 yr. Tracheostomy was performed in 461 (26.5%) patients. The tracheostomy rate varied across countries, from 8.3% to 52.9%. Early tracheostomy was performed in 135 (29.3%) patients. There was no difference in 3-month mortality between early and late tracheostomy in either our primary analysis (hazard ratio [HR]=0.96; 95% confidence interval [CI], 0.70–1.33) or a secondary landmark analysis (HR=0.78; 95% CI, 0.57–1.06). ConclusionsThere is a wide variation across Europe in the timing of tracheostomy for critically ill patients with COVID-19. However, we found no evidence that early tracheostomy is associated with any effect on survival amongst older critically ill patients with COVID-19. Clinical Trial registrationClinicalTrials.gov NCT 04321265.

Outcomes and survival of tracheostomised patients during the COVID-19 pandemic in a third level hospital.

PurposeAnalyse the evolution and outcomes of COVID-19 tracheostomised patients. Clarify if this cohort presents an increased risk of haemorrhagic complications and verify the correlation between some risk factors with increased mortality.MethodsA retrospective single-centre observational study of a prospective cohort of all COVID-19 patients admitted to our centre between March and April 2020. A control group was obtained from a historical cohort of patients who required tracheostomy due to prolonged invasive mechanical ventilation (IMV) before 2020.ResultsA total of 1768 patients were included: 67 tracheostomised non-COVID-19 patients (historic cohort), 1371 COVID-19 patients that did not require ICU admission, 266 non-tracheostomised COVID-19 patients and 64 tracheostomised COVID-19 patients. Comparing the obesity prevalence, 54.69% of the tracheostomised COVID-19 patients were obese and 10.53% of the non-tracheostomised COVID-19 patients (p < 0.001). The median of ICU admission days was lower (p < 0.001) in the non-tracheostomised cohort (12.5 days) compared with the COVID-19 tracheostomised cohort (34 days). The incidence of haemorrhagic complications was significantly higher in tracheostomised COVID-19 patients (20.31%) compared with tracheostomised non-COVID-19 patients (5.97%) and presented a higher percentage of obesity, hypertension, diabetes and smoking, significantly different from the historic cohort (p < 0.001). A Cox model showed that tracheostomy had no statistically significant effect on mortality in COVID-19 patients.ConclusionObesity and smoking may be risk factors for tracheostomy in COVID-19 patients, tracheostomised COVID-19 patients present a higher risk of bleeding complications than those admitted for other reasons and an elevated LDH and INR on ICU admission may be associated with increased mortality.

Early percutaneous tracheostomy in COVID19 patients with failed intubation: A case series

IntroductionCOVID19 and pulmonary dysfunction leading to acute respiratory distress syndrome (ARDS). Case study presentationHerein we presented the cases of failed intubation that was replaced by early percutaneous dilational tracheostomy. The procedure is safe for the patients, doctors and clinical staff. ConclusionAdditionally, we report mucormycosis after COVID19 treatment that was potentially due to immunosuppressive drugs.