Early Tracheostomy for Managing ICU Capacity During the COVID-19 Outbreak: A Propensity-Matched Cohort Study.

Autor:	Hernandez G; Intensive Care Unit, University Hospital Virgen de la Salud, Toledo, Spain. Electronic address: ghernandezm@telefonica.net., Ramos FJ; Intensive Care Unit, Vall d'Hebron University Hospital, Barcelona, Spain., Añon JM; Intensive Care Unit, La Paz University Hospital, Madrid, Spain; Ciber Enfermedades Respiratorias (CIBERES), Health Institute Carlos III, Madrid, Spain., Ortiz R; Intensive Care Unit, Ciudad Real University Hospital, Ciudad Real, Sabadell, Spain., Colinas L; Intensive Care Unit, University Hospital Virgen de la Salud, Toledo, Spain., Masclans JR; Intensive Care Unit, Del Mar University Hospital, Barcelona, Spain; Mar Medical Research Institute, UPF, Departament de Ciències Experimentals i de la Salut-DCEXS, Barcelona, Spain., De Haro C; Intensive Care Unit, Parc Tauli University Hospital, Sabadell, Spain., Ortega A; Intensive Care Unit, Puerta de Hierro University Hospital, Madrid, Spain., Peñuelas O; Intensive Care Unit, Getafe University Hospital, Madrid, Spain., Cruz-Delgado MDM; Intensive Care Unit, Torrejón University Hospital, Madrid, Spain., Canabal A; Intensive Care Unit, La Princesa University Hospital, Madrid, Spain., Plans O; Intensive Care Unit, Joan XXIII University Hospital, Tarragona, Spain., Vaquero C; Intensive Care Unit, Ramón y Cajal University Hospital, Madrid, Spain., Rialp G; Intensive Care Unit, Son Llatzer University Hospital, Mallorca, Spain., Gordo F; Intensive Care Unit, Henares University Hospital, Madrid, Spain; Universidad Francisco de Vitoria, Madrid, Spain., Lesmes A; Intensive Care Unit, 12 de Octubre University Hospital, Madrid, Spain., Martinez M; Intensive Care Unit, Vall d'Hebron University Hospital, Barcelona, Spain., Figueira JC; Intensive Care Unit, La Paz University Hospital, Madrid, Spain., Gomez-Carranza A; Intensive Care Unit, Ciudad Real University Hospital, Ciudad Real, Sabadell, Spain., Corrales R; Department of Otolaryngology-Head and Neck Surgery, University Hospital Virgen de la Salud, Toledo, Spain., Castellvi A; Intensive Care Unit, Del Mar University Hospital, Barcelona, Spain., Castiñeiras B; Intensive Care Unit, Puerta de Hierro University Hospital, Madrid, Spain., Frutos-Vivar F; Intensive Care Unit, Getafe University Hospital, Madrid, Spain., Prada J; Department of Otolaryngology-Head and Neck Surgery, La Princesa University Hospital, Madrid, Spain., De Pablo R; Intensive Care Unit, Ramón y Cajal University Hospital, Madrid, Spain; Critical Care Department, Alcala de Henares University, Alcala de Henares, Spain., Naharro A; Intensive Care Unit, Henares University Hospital, Madrid, Spain., Montejo JC; Intensive Care Unit, 12 de Octubre University Hospital, Madrid, Spain., Diaz C; Intensive Care Unit, La Paz University Hospital, Madrid, Spain., Santos-Peral A; Intensive Care Unit, Ciudad Real University Hospital, Ciudad Real, Sabadell, Spain., Padilla R; Intensive Care Unit, University Hospital Virgen de la Salud, Toledo, Spain., Marin-Corral J; Intensive Care Unit, Del Mar University Hospital, Barcelona, Spain., Rodriguez-Solis C; Intensive Care Unit, Getafe University Hospital, Madrid, Spain., Sanchez-Giralt JA; Intensive Care Unit, La Princesa University Hospital, Madrid, Spain., Jimenez J; Intensive Care Unit, Getafe University Hospital, Madrid, Spain., Cuena R; Research Unit, Medical Council, Toledo, Spain., Perez-Hoyos S; Statistics and Bioinformatics Unit, Vall d'Hebron Research Institute, Barcelona, Spain; IDIBAPS, the Genetics, Microbiology and Statistics Department, University of Barcelona, Barcelona, Spain., Roca O; Intensive Care Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Ciber Enfermedades Respiratorias (CIBERES), Health Institute Carlos III, Madrid, Spain.
Jazyk:	angličtina
Zdroj:	Chest [Chest] 2022 Jan; Vol. 161 (1), pp. 121-129. Date of Electronic Publication: 2021 Jun 17.
DOI:	10.1016/j.chest.2021.06.015
Abstrakt:	Background: During the first wave of the COVID-19 pandemic, shortages of ventilators and ICU beds overwhelmed health care systems. Whether early tracheostomy reduces the duration of mechanical ventilation and ICU stay is controversial. Research Question: Can failure-free day outcomes focused on ICU resources help to decide the optimal timing of tracheostomy in overburdened health care systems during viral epidemics? Study Design and Methods: This retrospective cohort study included consecutive patients with COVID-19 pneumonia who had undergone tracheostomy in 15 Spanish ICUs during the surge, when ICU occupancy modified clinician criteria to perform tracheostomy in Patients with COVID-19. We compared ventilator-free days at 28 and 60 days and ICU- and hospital bed-free days at 28 and 60 days in propensity score-matched cohorts who underwent tracheostomy at different timings (≤ 7 days, 8-10 days, and 11-14 days after intubation). Results: Of 1,939 patients admitted with COVID-19 pneumonia, 682 (35.2%) underwent tracheostomy, 382 (56%) within 14 days. Earlier tracheostomy was associated with more ventilator-free days at 28 days (≤ 7 days vs > 7 days [116 patients included in the analysis]: median, 9 days [interquartile range (IQR), 0-15 days] vs 3 days [IQR, 0-7 days]; difference between groups, 4.5 days; 95% CI, 2.3-6.7 days; 8-10 days vs > 10 days [222 patients analyzed]: 6 days [IQR, 0-10 days] vs 0 days [IQR, 0-6 days]; difference, 3.1 days; 95% CI, 1.7-4.5 days; 11-14 days vs > 14 days [318 patients analyzed]: 4 days [IQR, 0-9 days] vs 0 days [IQR, 0-2 days]; difference, 3 days; 95% CI, 2.1-3.9 days). Except hospital bed-free days at 28 days, all other end points were better with early tracheostomy. Interpretation: Optimal timing of tracheostomy may improve patient outcomes and may alleviate ICU capacity strain during the COVID-19 pandemic without increasing mortality. Tracheostomy within the first work on a ventilator in particular may improve ICU availability. (Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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