Early Versus Late Tracheostomy in Mechanically Ventilated COVID-19 Patients: A Comparative Study
-
Samrand Fattah Ghazi
,
Nima Nazari
,
Mohammad Taghi Beigmohammadi
,
Masoud Ramezani
,
Mohammadreza Salehi
,
Yeganeh Abedipour
Abstract
The decision to perform tracheostomy during the COVID-19 pandemic has been based mainly on practical and empirical standards. Also, the amount of scientific evidence to determine the exact timing of tracheostomy in patients with severe COVID-19 on mechanical ventilation is not significant. We conducted a retrospective cohort study on mechanically ventilated COVID-19 patients from April 25, 2021 to January 25, 2022 in intensive care units of Imam Khomeini Hospital Complex, Tehran, Iran. The 30-day survival of patients was calculated and compared between patients under tracheostomy and those without tracheostomy. A number of 135 COVID-19 cases (75 patients in the intubated group and 60 patients in the tracheostomy group) were included in this study. The mean age of the population was 53.6±12.4. The overall mortality rate was 101 (74.8%). The 30-day mortality rate was significantly higher in the intubated group (90.6%) than in the tracheostomy group (55%) (P< 0.001). The mortality rate was 60% in the early (≤ 7 days) tracheostomy group and 50% in the late (>7 days) group. This difference was not statistically significant (P> 0.05). Tracheostomy is a preferred method in airway management of severe COVID-19 patients under mechanical ventilation; however, early tracheostomy during the first week of intubation may not be superior to late tracheostomy in decreasing the mortality rate.
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21. Chao TN, Harbison SP, Braslow BM, Hutchinson CT, Rajasekaran K, Go BC, et al. Outcomes after tracheostomy in COVID-19 patients. Ann Surg 2020;272:e181-6.
22. Frost EA. Rhinology, Laryngology. Tracing the tracheostomy. Ann Otol Rhinol Laryngol 1976;85:618-24.
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27. Fan H, Zhang L, Huang B, Zhu M, Zhou Y, Zhang H, et al. Retrospective analysis of clinical features in 101 death cases with COVID-19. MedRxiv 2020.
28. Zhang L, Huang B, Xia H, Fan H, Zhu M, Zhu L, et al. Retrospective analysis of clinical features in 134 coronavirus disease 2019 cases. Epidemiol Infect 2020;148:e199.
29. Bier-Laning C, Cramer JD, Roy S, Palmieri PA, Amin A, Añon JM, et al. Tracheostomy During the COVID-19 Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries. Otolaryngol Head Neck Surg 2021;164:1136-47.
30. Liu CC, Livingstone D, Dixon E, Dort JCJOH. Early versus late tracheostomy: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 2015;152:219-27.
31. Griffiths J, Barber VS, Morgan L, Young JD. Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ 2005;330:1243.
32. Hosokawa K, Nishimura M, Egi M, Vincent JL. Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials. Crit Care 2015;19:424.
33. Koshkareva Y, Gaughan JP, Soliman AM. Rhinology, Laryngology. Risk factors for adult laryngotracheal stenosis: a review of 74 cases. Ann Otol Rhinol Laryngol 2007;116:206-10.
34. Chao TN, Braslow BM, Martin ND, Chalian AA, Atkins J, Haas AR, et al. Tracheotomy in ventilated patients with COVID-19. Ann Surg 2020;272:e30-2.
35. Wang J, Zhou M, Liu F. Reasons for healthcare workers becoming infected with novel coronavirus disease 2019 (COVID-19) in China. J Hosp Infect 2020;105:100-1.
36. Chu J, Yang N, Wei Y, Yue H, Zhang F, Zhao J, et al. Clinical characteristics of 54 medical staff with COVID‐19: a retrospective study in a single center in Wuhan, China. J Med Virol 2020;92:807-13.
37. Jacob T, Walker A, Mantelakis A, Gibbins N, Keane O. A framework for open tracheostomy in COVID‐19 patients. Clin Otolaryngol 2020;45:649-51.
38. Pichi B, Mazzola F, Bonsembiante A, Petruzzi G, Zocchi J, Moretto S, et al. CORONA-steps for tracheotomy in COVID-19 patients: a staff-safe method for airway management. Oral Oncol 2020;105:104682.
39. Adly A, Youssef TA, El-Begermy MM, Younis HM. Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review. Eur Arch Otorhinolaryngol 2018;275:679-90.
40. Andriolo BN, Andriolo RB, Saconato H, Atallah ÁN, Valente O. Early versus late tracheostomy for critically ill patients. Cochrane Database Syst Rev 2015;1:CD007271.
41. Tang Y, Wu Y, Zhu F, Yang X, Huang C, Hou G, et al. Tracheostomy in 80 COVID-19 Patients: A Multicenter, Retrospective, Observational Study. Front Med (Lausanne) 2020;7:615845.
42. Avilés-Jurado FX, Prieto-Alhambra D, González-Sánchez N, de Ossó J, Arancibia C, Rojas-Lechuga MJ, et al. Timing, Complications, and Safety of Tracheotomy in Critically Ill Patients With COVID-19. JAMA Otolaryngol Head Neck Surg 2020;147:1-8.
2. Hasöksüz M, Kilic S, Saraç F. Coronaviruses and sars-cov-2. Turk J Med Sci 2020;50:549-56.
3. Azhar EI, Hui DS, Memish ZA, Drosten C, Zumla A. The middle east respiratory syndrome (MERS). Infect Dis Clin North Am 2019;33:891-905.
4. Baharoon S, Memish ZA. MERS-CoV as an emerging respiratory illness: a review of prevention methods. Travel Med Infect Dis 2019;32:101520.
5. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
6. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020;395:565-74.
7. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med 2020;382:727-33.
8. WHO COJRtCSoC-RWC-CT. World health organization, 2020. (Accessed at https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019).)
9. Mohapatra RK, Pintilie L, Kandi V, Sarangi AK, Das D, Sahu R, et al. The recent challenges of highly contagious COVID‐19, causing respiratory infections: Symptoms, diagnosis, transmission, possible vaccines, animal models, and immunotherapy. Chem Biol Drug Des 2020;96:1187-208.
10. Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A review. Clin Immunol 2020;215:108427.
11. Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, et al. Covid-19 in critically ill patients in the Seattle region—case series. N Engl J Med 2020;382:2012-22.
12. Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA 2020;323:1612-4.
13. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.
14. Allameh SF, Nemati S, Ghalehtaki R, Mohammadnejad E, Aghili SM, Khajavirad N, et al. Clinical characteristics and outcomes of 905 COVID-19 patients admitted to Imam Khomeini hospital complex in the capital city of Tehran, Iran. Arch Iran Med 2020;23:766-75.
15. Goyal P, Choi JJ, Pinheiro LC, Schenck EJ, Chen R, Jabri A, et al. Clinical characteristics of Covid-19 in New York city. N Engl J Med 2020;382:2372-4.
16. Wunsch H. Mechanical ventilation in COVID-19: interpreting the current epidemiology. Am J Respir Crit Care Med 2020;202:1-4.
17. McGrath BA, Brenner MJ, Warrillow SJ, Pandian V, Arora A, Cameron TS, et al. Tracheostomy in the COVID-19 era: global and multidisciplinary guidance. Lancet Respir Med 2020;8:717-25.
18. Pandian V, Morris LL, Brodsky MB, Lynch J, Walsh B, Rushton C, et al. Critical care guidance for tracheostomy care during the COVID-19 pandemic: a global, multidisciplinary approach. Am J Crit Care 2020;29:e116-e27.
19. Vargas M, Sutherasan Y, Brunetti I, Micalizzi C, Insorsi A, Ball L, et al. Mortality and long-term quality of life after percutaneous tracheotomy in Intensive Care Unit: a prospective observational study. Minerva Anestesiol 2018;84:1024-31.
20. McGrath BA, Wallace S, Goswamy J. Laryngeal oedema associated with COVID-19 complicating airway management. Anaesthesia 2020;75:972.
21. Chao TN, Harbison SP, Braslow BM, Hutchinson CT, Rajasekaran K, Go BC, et al. Outcomes after tracheostomy in COVID-19 patients. Ann Surg 2020;272:e181-6.
22. Frost EA. Rhinology, Laryngology. Tracing the tracheostomy. Ann Otol Rhinol Laryngol 1976;85:618-24.
23. Al-Ansari MA, Hijazi MH. Clinical review: percutaneous dilatational tracheostomy. Crit Care 2006;10:202.
24. Yang X, Yu Y, Xu J, Shu H, Liu H, Wu Y, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;8:475-81.
25. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054-62.
26. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020;323:2052-9.
27. Fan H, Zhang L, Huang B, Zhu M, Zhou Y, Zhang H, et al. Retrospective analysis of clinical features in 101 death cases with COVID-19. MedRxiv 2020.
28. Zhang L, Huang B, Xia H, Fan H, Zhu M, Zhu L, et al. Retrospective analysis of clinical features in 134 coronavirus disease 2019 cases. Epidemiol Infect 2020;148:e199.
29. Bier-Laning C, Cramer JD, Roy S, Palmieri PA, Amin A, Añon JM, et al. Tracheostomy During the COVID-19 Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries. Otolaryngol Head Neck Surg 2021;164:1136-47.
30. Liu CC, Livingstone D, Dixon E, Dort JCJOH. Early versus late tracheostomy: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 2015;152:219-27.
31. Griffiths J, Barber VS, Morgan L, Young JD. Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ 2005;330:1243.
32. Hosokawa K, Nishimura M, Egi M, Vincent JL. Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials. Crit Care 2015;19:424.
33. Koshkareva Y, Gaughan JP, Soliman AM. Rhinology, Laryngology. Risk factors for adult laryngotracheal stenosis: a review of 74 cases. Ann Otol Rhinol Laryngol 2007;116:206-10.
34. Chao TN, Braslow BM, Martin ND, Chalian AA, Atkins J, Haas AR, et al. Tracheotomy in ventilated patients with COVID-19. Ann Surg 2020;272:e30-2.
35. Wang J, Zhou M, Liu F. Reasons for healthcare workers becoming infected with novel coronavirus disease 2019 (COVID-19) in China. J Hosp Infect 2020;105:100-1.
36. Chu J, Yang N, Wei Y, Yue H, Zhang F, Zhao J, et al. Clinical characteristics of 54 medical staff with COVID‐19: a retrospective study in a single center in Wuhan, China. J Med Virol 2020;92:807-13.
37. Jacob T, Walker A, Mantelakis A, Gibbins N, Keane O. A framework for open tracheostomy in COVID‐19 patients. Clin Otolaryngol 2020;45:649-51.
38. Pichi B, Mazzola F, Bonsembiante A, Petruzzi G, Zocchi J, Moretto S, et al. CORONA-steps for tracheotomy in COVID-19 patients: a staff-safe method for airway management. Oral Oncol 2020;105:104682.
39. Adly A, Youssef TA, El-Begermy MM, Younis HM. Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review. Eur Arch Otorhinolaryngol 2018;275:679-90.
40. Andriolo BN, Andriolo RB, Saconato H, Atallah ÁN, Valente O. Early versus late tracheostomy for critically ill patients. Cochrane Database Syst Rev 2015;1:CD007271.
41. Tang Y, Wu Y, Zhu F, Yang X, Huang C, Hou G, et al. Tracheostomy in 80 COVID-19 Patients: A Multicenter, Retrospective, Observational Study. Front Med (Lausanne) 2020;7:615845.
42. Avilés-Jurado FX, Prieto-Alhambra D, González-Sánchez N, de Ossó J, Arancibia C, Rojas-Lechuga MJ, et al. Timing, Complications, and Safety of Tracheotomy in Critically Ill Patients With COVID-19. JAMA Otolaryngol Head Neck Surg 2020;147:1-8.
| Files | ||
| Issue | Vol 61 No 6 (2023) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v61i6.13831 | |
| Keywords | ||
| Coronavirus disease 2019 (COVID-19) Late tracheostomy Early tracheostomy Airway management | ||
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How to Cite
1.
Fattah Ghazi S, Nazari N, Beigmohammadi MT, Ramezani M, Salehi M, Abedipour Y. Early Versus Late Tracheostomy in Mechanically Ventilated COVID-19 Patients: A Comparative Study. Acta Med Iran. 2023;61(6):323-328.
