Dataset Information

Timing of elective tracheotomy and duration of mechanical ventilation among patients admitted to intensive care with severe COVID-19: A multicenter prospective cohort study.

ABSTRACT:

Background

Optimal timing for tracheotomy for critically ill COVID-19 patients requiring invasive mechanical ventilation (IMV) is not established.

Methods

Multicenter prospective cohort including all COVID-19 patients admitted to intensive care units (ICUs) in 36 hospitals who required tracheotomy during first pandemic wave. With a target emulation trial framework, we studied the causal effects of early (7-10 days) versus late (>10 days) tracheotomy (LT) on time from tracheotomy to weaning, postoperative mortality, and tracheotomy complications.

Results

Of 696 patients, 20.4% received early tracheotomy (ET). ET was associated with faster weaning (hazard ratio [HR] [95% confidence interval, CI]: 1.25 [1.00-1.56]) without differences in mortality (HR [95% CI]: 0.85 [0.60-1.21]) or complications (adjusted rate ratio [95% CI]: 0.56 [0.23-1.33]).

Conclusions

ET had a similar or lower post-tracheotomy weaning time than LT, potentially shortening IMV and ICU stays, without changing complication or mortality rates in COVID-19 patients.

SUBMITTER: Prats-Uribe A

PROVIDER: S-EPMC8652734 | biostudies-literature | 2021 Dec

REPOSITORIES: biostudies-literature

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Publications

Timing of elective tracheotomy and duration of mechanical ventilation among patients admitted to intensive care with severe COVID-19: A multicenter prospective cohort study.

Prats-Uribe Albert A Tobed Marc M Villacampa José Miguel JM Agüero Adriana A García-Bastida Clara C Tato José Ignacio JI Rodrigáñez Laura L Holguera Victoria Duque VD Hernández-García Estefanía E Poletti Daniel D Simonetti Gabriela G Villarraga Vanessa V Meler-Claramonte Carla C Sánchez Barrueco Álvaro Á Chiesa-Estomba Carlos C Casasayas Maria M Parente-Arias Pablo P Mata-Castro Nieves N Rello Jordi J Castro Pedro P Prieto-Alhambra Daniel D Vilaseca Isabel I Avilés-Jurado Francesc Xavier FX

Head & neck 20210915 12

<h4>Background</h4>Optimal timing for tracheotomy for critically ill COVID-19 patients requiring invasive mechanical ventilation (IMV) is not established.<h4>Methods</h4>Multicenter prospective cohort including all COVID-19 patients admitted to intensive care units (ICUs) in 36 hospitals who required tracheotomy during first pandemic wave. With a target emulation trial framework, we studied the causal effects of early (7-10 days) versus late (>10 days) tracheotomy (LT) on time from tracheotomy t ...[more]

PMID: 34524714

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Project description:ObjectiveTo compare patient outcomes across body mass index (BMI) subgroups in the setting of recent tracheotomy.MethodsThis retrospective chart review included patients over 18 years old who underwent tracheotomy placement between February 2017 and March 2020. Patients were divided into five groups based on BMI: underweight, normal weight, overweight, obese, and morbidly obese. Data were collected from the electronic medical record (EMR). Statistical analyses were completed via Kruskal-Wallis, Chi-square, log-rank tests, and Cox proportional hazards regression. If significant differences were found between groups, then subsequent pairwise comparisons of BMI were completed.ResultsThere were 391 patients included in the study. There were significant differences in length of stay (p = .015) and duration of mechanical ventilation (p < .001) among the groups. This was mainly driven by comparisons between the normal weight and obese groups, with patients of normal weight having shorter hospital stays and shorter ventilation durations. With each increasing BMI category from normal weight, a greater proportion of patients were ventilator-dependent at the time of discharge (p < .001). Interestingly, after adjustment for comorbidities, the rate of tracheotomy change was 0.86 times lower for every increase in BMI category (95% CI 0.77-0.96). There was a significant difference among the BMI groups with respect to time to tracheotomy collar placement according to both the log-rank test (p < .001) and the Cox model with adjustment for the presence of heart failure (p = .011).ConclusionsAmong patients undergoing tracheotomy, obese and morbidly obese patients have increased lengths of hospital stays. Additionally, they are dependent on ventilators for longer and are more likely to be ventilator-dependent at the time of discharge. It is important to understand how BMI impacts the hospital course for patients undergoing tracheotomy so that patients and their families can be better informed.Level of evidenceLevel 3.

Project description:IntroductionDue to hospital crowding, mechanically ventilated patients are increasingly spending hours boarding in emergency departments (ED) before intensive care unit (ICU) admission. This study aims to evaluate the association between time ventilated in the ED and in-hospital mortality, duration of mechanical ventilation, ICU and hospital length of stay (LOS).MethodsThis was a multi-center, prospective, observational study of patients ventilated in the ED, conducted at three academic Level I Trauma Centers from July 2011 to March 2013. All consecutive adult patients on invasive mechanical ventilation were eligible for enrollment. We performed a Cox regression to assess for a mortality effect for mechanically ventilated patients with each hour of increasing LOS in the ED and multivariable regression analyses to assess for independently significant contributors to in-hospital mortality. Our primary outcome was in-hospital mortality, with secondary outcomes of ventilator days, ICU LOS and hospital LOS. We further commented on use of lung protective ventilation and frequency of ventilator changes made in this cohort.ResultsWe enrolled 535 patients, of whom 525 met all inclusion criteria. Altered mental status without respiratory pathology was the most common reason for intubation, followed by trauma and respiratory failure. Using iterated Cox regression, a mortality effect occurred at ED time of mechanical ventilation > 7 hours, and the longer ED stay was also associated with a longer total duration of intubation. However, adjusted multivariable regression analysis demonstrated only older age and admission to the neurosciences ICU as independently associated with increased mortality. Of interest, only 23.8% of patients ventilated in the ED for over seven hours had changes made to their ventilator.ConclusionIn a prospective observational study of patients mechanically ventilated in the ED, there was a significant mortality benefit to expedited transfer of patients into an appropriate ICU setting.

Dataset Information

Timing of elective tracheotomy and duration of mechanical ventilation among patients admitted to intensive care with severe COVID-19: A multicenter prospective cohort study.

Background

Methods

Results

Conclusions

Publications

Timing of elective tracheotomy and duration of mechanical ventilation among patients admitted to intensive care with severe COVID-19: A multicenter prospective cohort study.

Similar Datasets

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