Jeeyune Bahk, Bridget Dolan, Venus Sharma, Mantej Sehmbhi, Jennifer Y Fung, Young Im Lee
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Clinical characteristics, outcomes, and weaning parameters (first pressure support [PS], tracheostomy collar [TC], speech valve placement, and decannulation) were analyzed.</p><p><strong>Results: </strong>COVID+ve had fewer comorbidities including coronary artery disease, congestive heart failure, malignancy, chronic kidney disease, liver disease, and HIV (<i>p</i> < 0.05). Higher Fio<sub>2</sub> (53% vs 44%), positive end-expiratory pressure (PEEP) (7.15 vs 5.69), Pco<sub>2</sub> (45.8 vs 38.2), and lower pH (7.41 vs 7.43) were observed at the time of tracheostomy in COVID+ve (<i>p</i> < 0.005). There was no statistical difference in post-tracheostomy complication rates. Longer time from intubation to tracheostomy (15.90 vs 13.60 d; <i>p</i> = 0.002), tracheostomy to first PS (2.87 vs 1.80 d; <i>p</i> = 0.005), and TC placement (11.07 vs 4.46 d; <i>p</i> < 0.001) were seen in COVID+ve. However, similar time to speech valve placement, decannulation, and significantly lower 1-year mortality (23.3% vs 36.7%; <i>p</i> = 0.001) with higher number of discharges to long-term acute care hospital (LTACH) (23.8% vs 13.6%; <i>p</i> = 0.015) were seen in COVID+ve.</p><p><strong>Conclusions and relevance: </strong>Patients with COVID-19 required higher Fio<sub>2</sub> and PEEP ventilatory support at the time of tracheostomy, with no observed change in complication rates. Despite longer initial weaning period with PS or TC, similar time to speech valve placement or decannulation with significantly lower mortality and higher LTACH discharges suggest favorable outcome in COVID-19 positive patients. Higher ventilatory support requirements and prolonged weaning should not be a deterrent to pursuing a tracheostomy.</p>","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"5 8","pages":"e0950"},"PeriodicalIF":0.0000,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0d/f4/cc9-5-e0950.PMC10403025.pdf","citationCount":"1","resultStr":"{\"title\":\"Characteristics and Outcomes of Tracheostomized Patients With and Without COVID-19.\",\"authors\":\"Jeeyune Bahk, Bridget Dolan, Venus Sharma, Mantej Sehmbhi, Jennifer Y Fung, Young Im Lee\",\"doi\":\"10.1097/CCE.0000000000000950\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Outcomes of tracheostomized patients with COVID-19 are seldomly investigated with conflicting evidence from the existing literature.</p><p><strong>Objectives: </strong>To create a study evaluating the impact of COVID-19 on tracheostomized patients by comparing clinical outcomes and weaning parameters in COVID-19 positive and negative cohorts.</p><p><strong>Design setting and participants: </strong>A retrospective observational cohort study of 604 tracheostomized patients hospitalized in 16 ICUs in New York City between March 9, 2020, and September 8, 2021.</p><p><strong>Main outcomes and measures: </strong>Patients were stratified into two cohorts: 398 COVID-19 negative (COVID-ve) and 206 COVID-19 positive (COVID+ve) patients. Clinical characteristics, outcomes, and weaning parameters (first pressure support [PS], tracheostomy collar [TC], speech valve placement, and decannulation) were analyzed.</p><p><strong>Results: </strong>COVID+ve had fewer comorbidities including coronary artery disease, congestive heart failure, malignancy, chronic kidney disease, liver disease, and HIV (<i>p</i> < 0.05). Higher Fio<sub>2</sub> (53% vs 44%), positive end-expiratory pressure (PEEP) (7.15 vs 5.69), Pco<sub>2</sub> (45.8 vs 38.2), and lower pH (7.41 vs 7.43) were observed at the time of tracheostomy in COVID+ve (<i>p</i> < 0.005). There was no statistical difference in post-tracheostomy complication rates. Longer time from intubation to tracheostomy (15.90 vs 13.60 d; <i>p</i> = 0.002), tracheostomy to first PS (2.87 vs 1.80 d; <i>p</i> = 0.005), and TC placement (11.07 vs 4.46 d; <i>p</i> < 0.001) were seen in COVID+ve. However, similar time to speech valve placement, decannulation, and significantly lower 1-year mortality (23.3% vs 36.7%; <i>p</i> = 0.001) with higher number of discharges to long-term acute care hospital (LTACH) (23.8% vs 13.6%; <i>p</i> = 0.015) were seen in COVID+ve.</p><p><strong>Conclusions and relevance: </strong>Patients with COVID-19 required higher Fio<sub>2</sub> and PEEP ventilatory support at the time of tracheostomy, with no observed change in complication rates. Despite longer initial weaning period with PS or TC, similar time to speech valve placement or decannulation with significantly lower mortality and higher LTACH discharges suggest favorable outcome in COVID-19 positive patients. 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引用次数: 1
摘要
由于现有文献中存在相互矛盾的证据，很少对经气管造口术的COVID-19患者的预后进行调查。目的:通过比较COVID-19阳性和阴性队列的临床结局和脱机参数，评估COVID-19对气管造口患者的影响。设计背景和参与者:一项回顾性观察队列研究，纳入2020年3月9日至2021年9月8日期间在纽约市16个icu住院的604例气管造口患者。主要结局和措施:患者被分为两组:398例COVID-19阴性(COVID-ve)和206例COVID-19阳性(COVID+ve)患者。分析临床特征、结局和脱机参数(第一压力支持、气管造口领、语音瓣膜置放和脱管)。结果:冠状动脉疾病、充血性心力衰竭、恶性肿瘤、慢性肾脏疾病、肝脏疾病、HIV等合并症较少(p < 0.05)。新冠肺炎患者气管造口时Fio2升高(53% vs 44%)、呼气末正压(PEEP)升高(7.15 vs 5.69)、Pco2升高(45.8 vs 38.2)、pH降低(7.41 vs 7.43) (p < 0.005)。气管切开术后并发症发生率无统计学差异。从插管到气管切开术所需时间更长(15.90 d vs 13.60 d;p = 0.002)，气管造瘘至第一次PS (2.87 vs 1.80;p = 0.005)和TC放置(11.07 vs 4.46 d;p < 0.001)。然而，与语音瓣膜置放、脱脉术时间相近，1年死亡率显著降低(23.3% vs 36.7%;p = 0.001)，长期急性护理医院(LTACH)的出院人数较高(23.8% vs 13.6%;p = 0.015)。结论及相关性:COVID-19患者在气管切开术时需要更高的Fio2和PEEP通气支持，未观察到并发症发生率的变化。尽管PS或TC的初始脱机时间较长，但与语音瓣膜置放或脱管时间相似，死亡率显著降低，LTACH出院率较高，这表明COVID-19阳性患者的预后良好。较高的通气支持要求和较长的脱机时间不应成为气管切开术的障碍。
Characteristics and Outcomes of Tracheostomized Patients With and Without COVID-19.
Outcomes of tracheostomized patients with COVID-19 are seldomly investigated with conflicting evidence from the existing literature.
Objectives: To create a study evaluating the impact of COVID-19 on tracheostomized patients by comparing clinical outcomes and weaning parameters in COVID-19 positive and negative cohorts.
Design setting and participants: A retrospective observational cohort study of 604 tracheostomized patients hospitalized in 16 ICUs in New York City between March 9, 2020, and September 8, 2021.
Main outcomes and measures: Patients were stratified into two cohorts: 398 COVID-19 negative (COVID-ve) and 206 COVID-19 positive (COVID+ve) patients. Clinical characteristics, outcomes, and weaning parameters (first pressure support [PS], tracheostomy collar [TC], speech valve placement, and decannulation) were analyzed.
Results: COVID+ve had fewer comorbidities including coronary artery disease, congestive heart failure, malignancy, chronic kidney disease, liver disease, and HIV (p < 0.05). Higher Fio2 (53% vs 44%), positive end-expiratory pressure (PEEP) (7.15 vs 5.69), Pco2 (45.8 vs 38.2), and lower pH (7.41 vs 7.43) were observed at the time of tracheostomy in COVID+ve (p < 0.005). There was no statistical difference in post-tracheostomy complication rates. Longer time from intubation to tracheostomy (15.90 vs 13.60 d; p = 0.002), tracheostomy to first PS (2.87 vs 1.80 d; p = 0.005), and TC placement (11.07 vs 4.46 d; p < 0.001) were seen in COVID+ve. However, similar time to speech valve placement, decannulation, and significantly lower 1-year mortality (23.3% vs 36.7%; p = 0.001) with higher number of discharges to long-term acute care hospital (LTACH) (23.8% vs 13.6%; p = 0.015) were seen in COVID+ve.
Conclusions and relevance: Patients with COVID-19 required higher Fio2 and PEEP ventilatory support at the time of tracheostomy, with no observed change in complication rates. Despite longer initial weaning period with PS or TC, similar time to speech valve placement or decannulation with significantly lower mortality and higher LTACH discharges suggest favorable outcome in COVID-19 positive patients. Higher ventilatory support requirements and prolonged weaning should not be a deterrent to pursuing a tracheostomy.
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