Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study
Objectives:. Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient ou...
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2022-12-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000000796 |
| _version_ | 1828086656213712896 |
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| author | Constance S. Harrell Shreckengost, MD, PhD Jorge Esteban Foianini, MD Karen Milenka Moron Encinas, MD Hugo Tola Guarachi, MD Katrina Abril, MD, MSc Dina Amin, DDS David Berkowitz, MD Christine Aisha Castater, MD J. Miller Douglas, BS April A. Grant, MD Onkar Vohra Khullar, MD Andrea Nichole Lane, PhD Alice Lin, MPH Abesh Niroula, MD Azhar Nizam, MS Ammar Rashied, MS Alexandra W. Reitz, MD, MPH Steven M. Roser, DMD, MD Julia Spychalski, BS Sérgio Samir Arap, MD, PhD Ricardo Ferreira Bento, MD, PhD Pedro Prosperi Desenzi Ciaralo, MD Rui Imamura, MD, PhD Luiz Paulo Kowalski, MD, PhD Ali Mahmoud, MD Alessandro Wasum Mariani, MD, PhD Carlos Augusto Metidieri Menegozzo, MD Hélio Minamoto, MD, PhD Fábio Luiz M. Montenegro, MD, PhD Paulo Manoel Pêgo-Fernandes, MD, PhD Jones Santos, Jr, MD Edivaldo Massozo Utiyama, MD Jithin K. Sreedharan, BScRT, MScRT Or Kalchiem-Dekel, MD Jonathan Nguyen, DO Rohan K. Dhamsania, MS Kerianne Allen, BA Adrian Modzik, BS Vikas Pathak, MD Cheryl White, RN, BSN Juan Blas, MD, MBBS-MBChB Issa Talal El-Abur, PhD, MSc, MD, MBBS-MBChB Gabriel Tirado, MD, MBBS-MBChB Carlos Yánez Benítez, MD, MSc Thomas G. Weiser, MD, MPH Mark Barry, MD Marissa Boeck, MD, MPH Michael Farrell, MD, MS Anya Greenberg, MBA Phoebe Miller, MS Paul Park, MS Maraya Camazine, MS Deidre Dillon, BS Randi N. Smith, MD, MPH |
| author_facet | Constance S. Harrell Shreckengost, MD, PhD Jorge Esteban Foianini, MD Karen Milenka Moron Encinas, MD Hugo Tola Guarachi, MD Katrina Abril, MD, MSc Dina Amin, DDS David Berkowitz, MD Christine Aisha Castater, MD J. Miller Douglas, BS April A. Grant, MD Onkar Vohra Khullar, MD Andrea Nichole Lane, PhD Alice Lin, MPH Abesh Niroula, MD Azhar Nizam, MS Ammar Rashied, MS Alexandra W. Reitz, MD, MPH Steven M. Roser, DMD, MD Julia Spychalski, BS Sérgio Samir Arap, MD, PhD Ricardo Ferreira Bento, MD, PhD Pedro Prosperi Desenzi Ciaralo, MD Rui Imamura, MD, PhD Luiz Paulo Kowalski, MD, PhD Ali Mahmoud, MD Alessandro Wasum Mariani, MD, PhD Carlos Augusto Metidieri Menegozzo, MD Hélio Minamoto, MD, PhD Fábio Luiz M. Montenegro, MD, PhD Paulo Manoel Pêgo-Fernandes, MD, PhD Jones Santos, Jr, MD Edivaldo Massozo Utiyama, MD Jithin K. Sreedharan, BScRT, MScRT Or Kalchiem-Dekel, MD Jonathan Nguyen, DO Rohan K. Dhamsania, MS Kerianne Allen, BA Adrian Modzik, BS Vikas Pathak, MD Cheryl White, RN, BSN Juan Blas, MD, MBBS-MBChB Issa Talal El-Abur, PhD, MSc, MD, MBBS-MBChB Gabriel Tirado, MD, MBBS-MBChB Carlos Yánez Benítez, MD, MSc Thomas G. Weiser, MD, MPH Mark Barry, MD Marissa Boeck, MD, MPH Michael Farrell, MD, MS Anya Greenberg, MBA Phoebe Miller, MS Paul Park, MS Maraya Camazine, MS Deidre Dillon, BS Randi N. Smith, MD, MPH |
| author_sort | Constance S. Harrell Shreckengost, MD, PhD |
| collection | DOAJ |
| description | Objectives:. Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient outcomes and alleviate resource shortages. This study compares outcomes in a diverse population of hospitalized COVID-19 patients who underwent tracheostomy either “early” (within 14 d of intubation) or “late” (more than 14 d after intubation).
Design:. International multi-institute retrospective cohort study.
Setting:. Thirteen hospitals in Bolivia, Brazil, Spain, and the United States.
Patients:. Hospitalized patients with COVID-19 undergoing early or late tracheostomy between March 1, 2020, and March 31, 2021.
Interventions:. Not applicable.
Measurements and Main Results:. A total of 549 patients from 13 hospitals in four countries were included in the final analysis. Multivariable regression analysis showed that early tracheostomy was associated with a 12-day decrease in time on mechanical ventilation (95% CI, −16 to −8; p < 0.001). Further, ICU and hospital lengths of stay in patients undergoing early tracheostomy were 15 days (95% CI, −23 to −9 d; p < 0.001) and 22 days (95% CI, −31 to −12 d) shorter, respectively. In contrast, early tracheostomy patients experienced lower risk-adjusted survival at 30-day post-admission (hazard ratio, 3.0; 95% CI, 1.8−5.2). Differences in 90-day post-admission survival were not identified.
Conclusions:. COVID-19 patients undergoing tracheostomy within 14 days of intubation have reduced ventilator dependence as well as reduced lengths of stay. However, early tracheostomy patients experienced lower 30-day survival. Future efforts should identify patients most likely to benefit from early tracheostomy while accounting for location-specific capacity. |
| first_indexed | 2024-04-11T04:58:29Z |
| format | Article |
| id | doaj.art-2a366ae756bf4ca0a933b2c67c42ec21 |
| institution | Directory Open Access Journal |
| issn | 2639-8028 |
| language | English |
| last_indexed | 2024-04-11T04:58:29Z |
| publishDate | 2022-12-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj.art-2a366ae756bf4ca0a933b2c67c42ec212022-12-26T06:01:07ZengWolters KluwerCritical Care Explorations2639-80282022-12-01412e079610.1097/CCE.0000000000000796202212000-00013Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort StudyConstance S. Harrell Shreckengost, MD, PhD0Jorge Esteban Foianini, MD1Karen Milenka Moron Encinas, MD2Hugo Tola Guarachi, MD3Katrina Abril, MD, MSc4Dina Amin, DDS5David Berkowitz, MD6Christine Aisha Castater, MD7J. Miller Douglas, BS8April A. Grant, MD9Onkar Vohra Khullar, MD10Andrea Nichole Lane, PhD11Alice Lin, MPH12Abesh Niroula, MD13Azhar Nizam, MS14Ammar Rashied, MS15Alexandra W. Reitz, MD, MPH16Steven M. Roser, DMD, MD17Julia Spychalski, BS18Sérgio Samir Arap, MD, PhD19Ricardo Ferreira Bento, MD, PhD20Pedro Prosperi Desenzi Ciaralo, MD21Rui Imamura, MD, PhD22Luiz Paulo Kowalski, MD, PhD23Ali Mahmoud, MD24Alessandro Wasum Mariani, MD, PhD25Carlos Augusto Metidieri Menegozzo, MD26Hélio Minamoto, MD, PhD27Fábio Luiz M. Montenegro, MD, PhD28Paulo Manoel Pêgo-Fernandes, MD, PhD29Jones Santos, Jr, MD30Edivaldo Massozo Utiyama, MD31Jithin K. Sreedharan, BScRT, MScRT32Or Kalchiem-Dekel, MD33Jonathan Nguyen, DO34Rohan K. Dhamsania, MS35Kerianne Allen, BA36Adrian Modzik, BS37Vikas Pathak, MD38Cheryl White, RN, BSN39Juan Blas, MD, MBBS-MBChB40Issa Talal El-Abur, PhD, MSc, MD, MBBS-MBChB41Gabriel Tirado, MD, MBBS-MBChB42Carlos Yánez Benítez, MD, MSc43Thomas G. Weiser, MD, MPH44Mark Barry, MD45Marissa Boeck, MD, MPH46Michael Farrell, MD, MS47Anya Greenberg, MBA48Phoebe Miller, MS49Paul Park, MS50Maraya Camazine, MS51Deidre Dillon, BS52Randi N. Smith, MD, MPH531 Department of Surgery, Emory University School of Medicine, Atlanta, GA.2 Clínica Foianini, Santa Cruz de la Sierra, Bolivia.2 Clínica Foianini, Santa Cruz de la Sierra, Bolivia.2 Clínica Foianini, Santa Cruz de la Sierra, Bolivia.3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA.4 Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA.1 Department of Surgery, Emory University School of Medicine, Atlanta, GA.1 Department of Surgery, Emory University School of Medicine, Atlanta, GA.1 Department of Surgery, Emory University School of Medicine, Atlanta, GA.5 Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.6 Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA.6 Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA.3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA.6 Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA.6 Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA.7 Emory University School of Medicine, Atlanta, GA.4 Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.6 Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA.8 Division of Head and Neck Surgery, University of São Paulo, São Paulo, Brazil.9 Division of Otolaringology, University of São Paulo, São Paulo, Brazil.10 Division of Thoracic Surgery, University of São Paulo, São Paulo, Brazil.9 Division of Otolaringology, University of São Paulo, São Paulo, Brazil.8 Division of Head and Neck Surgery, University of São Paulo, São Paulo, Brazil.8 Division of Head and Neck Surgery, University of São Paulo, São Paulo, Brazil.11 University of São Paulo, São Paulo, Brazil.12 Division of General Surgery and Trauma, University of São Paulo, São Paulo, Brazil.10 Division of Thoracic Surgery, University of São Paulo, São Paulo, Brazil.8 Division of Head and Neck Surgery, University of São Paulo, São Paulo, Brazil.10 Division of Thoracic Surgery, University of São Paulo, São Paulo, Brazil.12 Division of General Surgery and Trauma, University of São Paulo, São Paulo, Brazil.12 Division of General Surgery and Trauma, University of São Paulo, São Paulo, Brazil.13 Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia.14 Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY.15 Department of Surgery, Morehouse School of Medicine, Atlanta, GA.16 Philadelphia College of Osteopathic Medicine Georgia Campus, Suwanee, GA.17 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Riverside Health System, Newport News, VA.17 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Riverside Health System, Newport News, VA.17 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Riverside Health System, Newport News, VA.17 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Riverside Health System, Newport News, VA.18 Department of Surgery, Royo Villanova Hospital, Zaragoza, Spain.18 Department of Surgery, Royo Villanova Hospital, Zaragoza, Spain.19 Department of Critical Care Medicine, Royo Villanova Hospital, Zaragoza, Spain.18 Department of Surgery, Royo Villanova Hospital, Zaragoza, Spain.20 Department of Surgery, Stanford University, Stanford, CA.21 Department of Surgery, University of California San Francisco, San Francisco, CA.21 Department of Surgery, University of California San Francisco, San Francisco, CA.21 Department of Surgery, University of California San Francisco, San Francisco, CA.22 School of Medicine, University of California San Francisco, San Francisco, CA.21 Department of Surgery, University of California San Francisco, San Francisco, CA.22 School of Medicine, University of California San Francisco, San Francisco, CA.23 Division of Acute Care Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, MO.23 Division of Acute Care Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, MO.1 Department of Surgery, Emory University School of Medicine, Atlanta, GA.Objectives:. Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient outcomes and alleviate resource shortages. This study compares outcomes in a diverse population of hospitalized COVID-19 patients who underwent tracheostomy either “early” (within 14 d of intubation) or “late” (more than 14 d after intubation). Design:. International multi-institute retrospective cohort study. Setting:. Thirteen hospitals in Bolivia, Brazil, Spain, and the United States. Patients:. Hospitalized patients with COVID-19 undergoing early or late tracheostomy between March 1, 2020, and March 31, 2021. Interventions:. Not applicable. Measurements and Main Results:. A total of 549 patients from 13 hospitals in four countries were included in the final analysis. Multivariable regression analysis showed that early tracheostomy was associated with a 12-day decrease in time on mechanical ventilation (95% CI, −16 to −8; p < 0.001). Further, ICU and hospital lengths of stay in patients undergoing early tracheostomy were 15 days (95% CI, −23 to −9 d; p < 0.001) and 22 days (95% CI, −31 to −12 d) shorter, respectively. In contrast, early tracheostomy patients experienced lower risk-adjusted survival at 30-day post-admission (hazard ratio, 3.0; 95% CI, 1.8−5.2). Differences in 90-day post-admission survival were not identified. Conclusions:. COVID-19 patients undergoing tracheostomy within 14 days of intubation have reduced ventilator dependence as well as reduced lengths of stay. However, early tracheostomy patients experienced lower 30-day survival. Future efforts should identify patients most likely to benefit from early tracheostomy while accounting for location-specific capacity.http://journals.lww.com/10.1097/CCE.0000000000000796 |
| spellingShingle | Constance S. Harrell Shreckengost, MD, PhD Jorge Esteban Foianini, MD Karen Milenka Moron Encinas, MD Hugo Tola Guarachi, MD Katrina Abril, MD, MSc Dina Amin, DDS David Berkowitz, MD Christine Aisha Castater, MD J. Miller Douglas, BS April A. Grant, MD Onkar Vohra Khullar, MD Andrea Nichole Lane, PhD Alice Lin, MPH Abesh Niroula, MD Azhar Nizam, MS Ammar Rashied, MS Alexandra W. Reitz, MD, MPH Steven M. Roser, DMD, MD Julia Spychalski, BS Sérgio Samir Arap, MD, PhD Ricardo Ferreira Bento, MD, PhD Pedro Prosperi Desenzi Ciaralo, MD Rui Imamura, MD, PhD Luiz Paulo Kowalski, MD, PhD Ali Mahmoud, MD Alessandro Wasum Mariani, MD, PhD Carlos Augusto Metidieri Menegozzo, MD Hélio Minamoto, MD, PhD Fábio Luiz M. Montenegro, MD, PhD Paulo Manoel Pêgo-Fernandes, MD, PhD Jones Santos, Jr, MD Edivaldo Massozo Utiyama, MD Jithin K. Sreedharan, BScRT, MScRT Or Kalchiem-Dekel, MD Jonathan Nguyen, DO Rohan K. Dhamsania, MS Kerianne Allen, BA Adrian Modzik, BS Vikas Pathak, MD Cheryl White, RN, BSN Juan Blas, MD, MBBS-MBChB Issa Talal El-Abur, PhD, MSc, MD, MBBS-MBChB Gabriel Tirado, MD, MBBS-MBChB Carlos Yánez Benítez, MD, MSc Thomas G. Weiser, MD, MPH Mark Barry, MD Marissa Boeck, MD, MPH Michael Farrell, MD, MS Anya Greenberg, MBA Phoebe Miller, MS Paul Park, MS Maraya Camazine, MS Deidre Dillon, BS Randi N. Smith, MD, MPH Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study Critical Care Explorations |
| title | Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study |
| title_full | Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study |
| title_fullStr | Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study |
| title_full_unstemmed | Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study |
| title_short | Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study |
| title_sort | outcomes of early versus late tracheostomy in patients with covid 19 a multinational cohort study |
| url | http://journals.lww.com/10.1097/CCE.0000000000000796 |
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