Tracheostomy for COVID-19 Respiratory Failure: Multidisciplinary, Multicenter Data on Timing, Technique, and Outcomes.
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2021-08
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Abstract
Objective
The aim of this study was to assess the outcomes of tracheostomy in patients with COVID-19 respiratory failure.Summary background data
Tracheostomy has an essential role in managing COVID-19 patients with respiratory failure who require prolonged mechanical ventilation. However, limited data are available on how tracheostomy affects COVID-19 outcomes, and uncertainty surrounding risk of infectious transmission has led to divergent recommendations and practices.Methods
It is a multicenter, retrospective study; data were collected on all tracheostomies performed in COVID-19 patients at 7 hospitals in 5 tertiary academic medical systems from February 1, 2020 to September 4, 2020.Result
Tracheotomy was performed in 118 patients with median time from intubation to tracheostomy of 22 days (Q1-Q3: 18-25). All tracheostomies were performed employing measures to minimize aerosol generation, 78.0% by percutaneous technique, and 95.8% at bedside in negative pressure rooms. Seventy-eight (66.1%) patients were weaned from the ventilator and 18 (15.3%) patients died from causes unrelated to tracheostomy. No major procedural complications occurred. Early tracheostomy (≤14 days) was associated with decreased ventilator days; median ventilator days (Q1-Q3) among patients weaned from the ventilator in the early, middle and late groups were 21 (21-31), 34 (26.5-42), and 37 (32-41) days, respectively with P = 0.030. Compared to surgical tracheostomy, percutaneous technique was associated with faster weaning for patients weaned off the ventilator [median (Q1-Q3): 34 (29-39) vs 39 (34-51) days, P = 0.038]; decreased ventilator-associated pneumonia (58.7% vs 80.8%, P = 0.039); and among patients who were discharged, shorter intensive care unit duration [median (Q1-Q3): 33 (27-42) vs 47 (33-64) days, P = 0.009]; and shorter hospital length of stay [median (Q1-Q3): 46 (33-59) vs 59.5 (48-80) days, P = 0.001].Conclusion
Early, percutaneous tracheostomy was associated with improved outcomes compared to surgical tracheostomy in a multi-institutional series of ventilated patients with COVID-19.Type
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Mahmood, Kamran, George Z Cheng, Keriann Van Nostrand, Samira Shojaee, Max T Wayne, Matthew Abbott, Darrell Nettlow, Alice Parish, et al. (2021). Tracheostomy for COVID-19 Respiratory Failure: Multidisciplinary, Multicenter Data on Timing, Technique, and Outcomes. Annals of surgery, 274(2). pp. 234–239. 10.1097/sla.0000000000004955 Retrieved from https://hdl.handle.net/10161/23581.
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Scholars@Duke
Alice Parish
Education: Master of Science in Public Health, Biostatistics- Emory University Rollins School of Public Health.
Overview: Alice collaborates with researchers and clinicians with the Division of Gastroenterology on many observational studies using data from EHR as well as large national databases such as HCUP, UNOS, and Medicare 5% LDS. Additionally, Alice collaborates with the Division of Pulmonary on palliative care RCTs and various retrospective studies. Alice works with the Pharmacy residents on their PGY1 studies. In the past Alice has had the opportunity to work with investigators in Heart Center and Epicenter. Alice has experience working with zero inflated count outcomes, among many other statistical methodologies.
Cynthia Lea Green
Survival Analysis
Longitudinal Data Analysis
Logistic Regression
Missing Data
Clinical Trial Methods
Maximum Likelihood Methods
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