The value of tracheostomy of critically ill COVID-19 patients - A multicentral study.

Autor: Rozenblat T; Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: talda1@clalit.org.il., Reifen E; Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel. Electronic address: ellar@clalit.org.il., Benov A; Israel Defense Forces, Medical Corps, Tel Hasomer, Ramat Gan, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel. Electronic address: avi.benov@gmail.com., Shaul C; Department of Otolaryngology-Head and Neck Surgery, Shaare Zedek Medical Center Affiliated with the Hebrew University Medical School, Jerusalem, Israel. Electronic address: hananshaul@gmail.com., Neuman U; Department of Otolaryngology, Meir Medical Center, Kfar Saba, Israel. Electronic address: Uri.neuman@gmail.com., Karol D; Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: danaka8@gmail.com., Schvartz R; Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: reutschvartz@gmail.com., Bachar G; Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: GideonB@clalit.org.il.
Jazyk: angličtina
Zdroj: American journal of otolaryngology [Am J Otolaryngol] 2022 Jan-Feb; Vol. 43 (1), pp. 103230. Date of Electronic Publication: 2021 Sep 15.
DOI: 10.1016/j.amjoto.2021.103230
Abstrakt: Purpose: Tracheostomy is an aerosol-generating procedure, thus performing it during the COVID-19 pandemic arises considerations such as the most appropriate timing and the patients to whom it is suitable. Medical teams lack sufficient data to assist determining whether or not to conduct tracheostomy, its short- and long-term implications are not fully understood. This study aims to shed light on the critically ill COVID-19 patients that require tracheostomy, and to investigate its value.
Methods: A retrospective multicentral case-control study of 157 hospitalized critically ill COVID-19 patients, among whom 30 patients went through tracheostomy and consisted of our study group.
Results: The mean age was similar between study and control groups (68.9 ± 12.7 years vs 70.5 ± 15.8 years, p = 0.57), as well as comorbidity prevalence (56.7% vs 67.7%, p = 0.25). Patients in the study group were hospitalized for longer duration until defined critically ill (5 ± 4.3 vs 3 ± 3.9 days; p = 0.01), until admitted to the intensive care unit (6 ± 6.6 vs 2.5 ± 3.7 days respectively; p = 0.005), and until discharged (24 ± 9.7 vs 10.7 ± 9.1 days, p < 0.001). Mortality rate was lower in the study group (30% vs 59.8%, p = 0.003). Kaplan Meier survival analysis revealed a statistically significant difference in survival time between groups (Log rank chi-sq = 20.91, p < 0.001) with mean survival time of 41 ± 3.1 days vs 21 ± 2.2 days. Survival was significantly longer in the study group (OR = 0.37, p = 0.004).
Conclusion: Tracheostomy allows for more prolonged survival for gradually deteriorating critically ill COVID-19 patients. This should be integrated into the medical teams' considerations when debating whether or not to conduct tracheostomy.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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