Tracheostomy in 80 COVID-19 Patients: A Multicenter, Retrospective, Observational Study

Frontiers in Medicine

article

Yun Tang¹  Aiguo Cheng²  Zhengqin Xu³  Boyi Liu⁴  Song Hu⁵  Guochao Zhu⁶  Xuepeng Fan⁷  Xijing Zhang⁸  Yadong Yang⁹  Huibin Feng^1,10  Lixia Yu^1,11  Yongran Wu¹  Bing Wang^1,12  Zhiqiang Li^1,13  Yong Peng^1,14  Zubo Shen^1,15  Shouzhi Fu^1,16  Yaqi Ouyang¹  Jiqian Xu¹  Xiaojing Zou¹  Minghao Fang^1,17  Zhui Yu^1,18  Fangfang Zhu^1,19  Bo Hu^1,19  You Shang¹  Xiaobo Yang¹  Chaolin Huang^1,18  Guo Hou^2,20  Wenhao Xu^2,21  Ming Hu^2,22  Lu Zhang^2,23 

[1] Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology;Department of Critical Care, The Third People's Hospital of Yichang;Department of Critical Care Medicine, Xiangyang No.1 People's Hospital, Affiliated Hospital of Hubei University of Medicine;Department of Critical Care Medicine, Taihe Hospital Affiliated to Hubei University Medicine;Department of Critical Care Medicine, Fifth Hospital of Wuhan;Department of Critical Care Medicine, The Affiliated Hospital of Jianghan University;Department of Critical Care, Wuhan No.1 Hospital;Intensive Care Unit (ICU) Center of Xijing Hospital, Airforce Medical University;Department of Critical Care Medicine, Huanggang Central Hospital;Department of Intensive Care Unit (ICU), Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Edong Healthcare Group;Department of Critical Care Medicine, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University;Department of Critical Care Medicine, No.2 Hospital of Huangshi;Department of Critical Care Medicine, The First People's Hospital of Jingmen;Intensive Care Unit, Xiehe Wuhan Red Cross Hospital;Department of Critical Care Medicine, Ezhou Central Hospital;Department of Intensive Care Unit (ICU)/Emergency, Wuhan Third Hospital;Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology;Research Center for Translational Medicine, Wuhan Jinyin-Tan Hospital;Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University;Department of Critical Care Medicine, Renmin Hospital, Wuhan University;Department of Critical Care Medicine, Xiaogan Central Hospital;Department of Critical Care Medicine, Wuhan Pulmonary Hospital;Department of Critical Care Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science

关键词: COVID-19;    tracheostomy;    mechanical ventilation;    intensive care unit;    critically ill patients;   

DOI  :  10.3389/fmed.2020.615845

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: The outbreak of coronavirus disease 2019 (COVID-19) has led to a large and increasing number of patients requiring prolonged mechanical ventilation and tracheostomy. The indication and optimal timing of tracheostomy in COVID-19 patients are still unclear, and the outcomes about tracheostomy have not been extensively reported. We aimed to describe the clinical characteristics and outcomes of patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia who underwent elective tracheostomies. Methods: The multi-center, retrospective, observational study investigated all the COVID-19 patients who underwent elective tracheostomies in intensive care units (ICUs) of 23 hospitals in Hubei province, China, from January 8, 2020 to March 25, 2020. Demographic information, clinical characteristics, treatment, details of the tracheostomy procedure, successful weaning after tracheostomy, and living status were collected and analyzed. Data were compared between early tracheostomy patients (tracheostomy performed within 14 days of intubation) and late tracheostomy patients (tracheostomy performed after 14 days). Results: A total of 80 patients were included. The median duration from endotracheal intubation to tracheostomy was 17.5 [IQR 11.3–27.0] days. Most tracheotomies were performed by ICU physician [62 (77.5%)], and using percutaneous techniques [63 (78.8%)] at the ICU bedside [76 (95.0%)]. The most common complication was tracheostoma bleeding [14 (17.5%)], and major bleeding occurred in 4 (5.0%) patients. At 60 days after intubation, 31 (38.8%) patients experienced successful weaning from ventilator, 17 (21.2%) patients discharged from ICU, and 43 (53.8%) patients had died. Higher 60 day mortality [22 (73.3%) vs. 21 (42.0%)] were identified in patients who underwent early tracheostomy. Conclusions: In patients with SARS-CoV-2 pneumonia, tracheostomies were feasible to conduct by ICU physician at bedside with few major complications. Compared with tracheostomies conducted after 14 days of intubation, tracheostomies within 14 days were associated with an increased mortality rate.

【 授权许可】

CC BY