Tracheotomy in COVID-19 patients: Optimizing patient selection and identifying prognostic indicators.

Autor: Stubington TJ; Department of Otorhinolaryngology-Head and Neck Surgery, Royal Derby Hospital, Derby, UK., Mallick AS; Department of Otorhinolaryngology-Head and Neck Surgery, Royal Derby Hospital, Derby, UK., Garas G; Department of Otorhinolaryngology-Head and Neck Surgery, Nottingham University Hospitals NHS Trust, Queens Medical Center Campus, Nottingham, UK., Stubington E; Centre for Doctoral Training, Lancaster University, Lancaster, UK., Reddy C; Department of Anaesthesia, Royal Derby Hospital, Derby, UK., Mansuri MS; Department of Otorhinolaryngology-Head and Neck Surgery, Royal Derby Hospital, Derby, UK.
Jazyk: angličtina
Zdroj: Head & neck [Head Neck] 2020 Jul; Vol. 42 (7), pp. 1386-1391. Date of Electronic Publication: 2020 May 22.
DOI: 10.1002/hed.26280
Abstrakt: Background: Tracheotomy, through its ability to wean patients off ventilation, can shorten ICU length of stay and in doing so increase ICU bed capacity, crucial for saving lives during the COVID-19 pandemic. To date, there is a paucity of patient selection criteria and prognosticators to facilitate decision making and enhance precious ICU capacity.
Methods: Prospective study of COVID-19 patients undergoing tracheotomy (n = 12) over a 4-week period (March-April 2020). Association between preoperative and postoperative ventilation requirements and outcomes (ICU stay, time to decannulation, and death) were examined.
Results: Patients who sustained FiO 2  ≤ 50% and PEEP ≤ 8 cm H 2 O in the 24 hours pretracheotomy exhibited a favorable outcome. Those whose requirements remained below these thresholds post-tracheotomy could be safely stepped down after 48 hours.
Conclusion: Sustained FiO 2  ≤ 50% and PEEP ≤ 8 cm H 2 O in the 48 hours post-tracheotomy are strong predictive factors for a good outcome, raising the potential for these patients to be stepped down early, thus increasing ICU capacity.
(© 2020 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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