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European Journal of Trauma and Emergency Surgery

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13-02-2024 | Tracheostomy | Original Article

Lessons for the next pandemic: analysis of the timing and outcomes including post-discharge decannulation rates for tracheostomy in severe COVID-19 respiratory failure

Authors: Joseph J. Lee, Alexandra S. Rooney, Andrea Krzyzaniak, Jayraan Badiee, Kristine T. Parra, Richard Y. Calvo, Julian Lichter, C. Beth Sise, Michael J. Sise, Vishal Bansal, Matthew J. Martin

Published in: European Journal of Trauma and Emergency Surgery | Issue 2/2024

Abstract

Purpose

COVID-19 patients with respiratory failure frequently require prolonged ventilatory support that would typically warrant early tracheostomy. There has been significant debate on timing, outcomes, and safety of these procedures. The purpose of this study was to determine the epidemiological, hospital, and post-discharge outcomes of this cohort, based on early (ET) versus late (LT) tracheostomy.

Methods

Retrospective review (March 2020–January 2021) in a 5-hospital system of ventilated patients who underwent tracheostomy. Demographics, hospital/ICU length of stay (LOS), procedural characteristics, APACHE II scores at ICU admission, stabilization markers, and discharge outcomes were analyzed. Long-term decannulation rates were obtained from long-term acute care facility (LTAC) data.

Results

A total of 97 patients underwent tracheostomy (mean 61 years, 62% male, 64% Hispanic). Despite ET being frequently performed during active COVID infection (85% vs. 64%), there were no differences in complication types or rates versus LT. APACHE II scores at ICU admission were comparable for both groups; however, > 50% of LT patients met PEEP stability at tracheostomy. ET was associated with significantly shorter ICU and hospital LOS, ventilator days, and higher decannulation rates. Of the cohort discharged to an LTAC, 59% were ultimately decannulated, 36% were discharged home, and 41% were discharged to a skilled nursing facility.

Conclusions

We report the first comprehensive analysis of ET and LT that includes LTAC outcomes and stabilization markers in relation to the tracheostomy. ET was associated with improved clinical outcomes and a short LOS, specifically on days of pre-tracheostomy ventilation and in-hospital decannulation rates.

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Title: Lessons for the next pandemic: analysis of the timing and outcomes including post-discharge decannulation rates for tracheostomy in severe COVID-19 respiratory failure
Authors: Joseph J. Lee
Alexandra S. Rooney
Andrea Krzyzaniak
Jayraan Badiee
Kristine T. Parra
Richard Y. Calvo
Julian Lichter
C. Beth Sise
Michael J. Sise
Vishal Bansal
Matthew J. Martin
Publication date: 13-02-2024
Publisher: Springer Berlin Heidelberg
Keywords: Tracheostomy
COVID-19
Published in: European Journal of Trauma and Emergency Surgery / Issue 2/2024
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-024-02444-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Lessons for the next pandemic: analysis of the timing and outcomes including post-discharge decannulation rates for tracheostomy in severe COVID-19 respiratory failure

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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