Tracheostomy for COVID-19 Respiratory Failure: Multidisciplinary, Multicenter Data on Timing, Technique, and Outcomes.
| dc.contributor.author | Mahmood, Kamran | |
| dc.contributor.author | Cheng, George Z | |
| dc.contributor.author | Van Nostrand, Keriann | |
| dc.contributor.author | Shojaee, Samira | |
| dc.contributor.author | Wayne, Max T | |
| dc.contributor.author | Abbott, Matthew | |
| dc.contributor.author | Nettlow, Darrell | |
| dc.contributor.author | Parish, Alice | |
| dc.contributor.author | Green, Cynthia L | |
| dc.contributor.author | Safi, Javeryah | |
| dc.contributor.author | Brenner, Michael J | |
| dc.contributor.author | De Cardenas, Jose | |
| dc.date.accessioned | 2021-08-09T22:45:56Z | |
| dc.date.available | 2021-08-09T22:45:56Z | |
| dc.date.issued | 2021-08 | |
| dc.date.updated | 2021-08-09T22:45:55Z | |
| dc.description.abstract | ObjectiveThe aim of this study was to assess the outcomes of tracheostomy in patients with COVID-19 respiratory failure.Summary background dataTracheostomy 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.MethodsIt 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.ResultTracheotomy 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].ConclusionEarly, percutaneous tracheostomy was associated with improved outcomes compared to surgical tracheostomy in a multi-institutional series of ventilated patients with COVID-19. | |
| dc.identifier | 00000658-900000000-93543 | |
| dc.identifier.issn | 0003-4932 | |
| dc.identifier.issn | 1528-1140 | |
| dc.identifier.uri | ||
| dc.language | eng | |
| dc.publisher | Ovid Technologies (Wolters Kluwer Health) | |
| dc.relation.ispartof | Annals of surgery | |
| dc.relation.isversionof | 10.1097/sla.0000000000004955 | |
| dc.subject | Humans | |
| dc.subject | Cross Infection | |
| dc.subject | Pneumonia, Viral | |
| dc.subject | Respiratory Insufficiency | |
| dc.subject | Respiration, Artificial | |
| dc.subject | Tracheostomy | |
| dc.subject | Tracheotomy | |
| dc.subject | Retrospective Studies | |
| dc.subject | Adult | |
| dc.subject | Aged | |
| dc.subject | Middle Aged | |
| dc.subject | United States | |
| dc.subject | Female | |
| dc.subject | Male | |
| dc.subject | COVID-19 | |
| dc.subject | SARS-CoV-2 | |
| dc.title | Tracheostomy for COVID-19 Respiratory Failure: Multidisciplinary, Multicenter Data on Timing, Technique, and Outcomes. | |
| dc.type | Journal article | |
| duke.contributor.orcid | Green, Cynthia L|0000-0002-0186-5191 | |
| pubs.begin-page | 234 | |
| pubs.end-page | 239 | |
| pubs.issue | 2 | |
| pubs.organisational-group | School of Medicine | |
| pubs.organisational-group | Duke Clinical Research Institute | |
| pubs.organisational-group | Biostatistics & Bioinformatics | |
| pubs.organisational-group | Duke | |
| pubs.organisational-group | Institutes and Centers | |
| pubs.organisational-group | Basic Science Departments | |
| pubs.organisational-group | Duke Cancer Institute | |
| pubs.organisational-group | Medicine, Pulmonary, Allergy, and Critical Care Medicine | |
| pubs.organisational-group | Medicine | |
| pubs.organisational-group | Clinical Science Departments | |
| pubs.publication-status | Accepted | |
| pubs.volume | 274 |
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