Tracheostomy in COVID-19 acute respiratory distress syndrome patients and follow-up: A parisian bicentric retrospective cohort.

Autor: Evrard D; Department of Otorhinolaryngology, Bichat Hospital, Paris, France., Jurcisin I; Department of Anesthesiology and Critical Care, Beaujon hospital, DMU Parabol, AP-HP.Nord, Paris, France., Assadi M; Department of Anesthesia and Surgical Intensive Care Unit, Bichat Hospital, Université de Paris, UFR Denis Diderot, INSERM UMR 1152, ANR10-LABX-17, Paris, France., Patrier J; Medical Intensive Care Unit, Bichat Hospital, Paris, France., Tafani V; Department of Otorhinolaryngology, Bichat Hospital, Paris, France., Ullmann N; Department of Oral and Maxillofacial surgery, Beaujon Hospital, Paris, France., Timsit JF; Medical Intensive Care Unit, Bichat Hospital, Paris, France., Montravers P; Department of Anesthesia and Surgical Intensive Care Unit, Bichat Hospital, Université de Paris, UFR Denis Diderot, INSERM UMR 1152, ANR10-LABX-17, Paris, France., Barry B; Department of Otorhinolaryngology, Bichat Hospital, Paris, France., Weiss E; Department of Anesthesiology and Critical Care, Beaujon hospital, DMU Parabol, AP-HP.Nord, Paris, France.; Inserm UMR-S1149, Inserm et Université de Paris, Paris, France., Rozencwajg S; Department of Anesthesia and Surgical Intensive Care Unit, Bichat Hospital, Université de Paris, UFR Denis Diderot, INSERM UMR 1152, ANR10-LABX-17, Paris, France.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2021 Dec 22; Vol. 16 (12), pp. e0261024. Date of Electronic Publication: 2021 Dec 22 (Print Publication: 2021).
DOI: 10.1371/journal.pone.0261024
Abstrakt: Background: Tracheostomy has been proposed as an option to help organize the healthcare system to face the unprecedented number of patients hospitalized for a COVID-19-related acute respiratory distress syndrome (ARDS) in intensive care units (ICU). It is, however, considered a particularly high-risk procedure for contamination. This paper aims to provide our experience in performing tracheostomies on COVID-19 critically ill patients during the pandemic and its long-term local complications.
Methods: We performed a retrospective analysis of prospectively collected data of patients tracheostomized for a COVID-19-related ARDS in two university hospitals in the Paris region between January 27th (date of first COVID-19 admission) and May 18th, 2020 (date of last tracheostomy performed). We focused on tracheostomy technique (percutaneous versus surgical), timing (early versus late) and late complications.
Results: Forty-eight tracheostomies were performed with an equal division between surgical and percutaneous techniques. There was no difference in patients' characteristics between surgical and percutaneous groups. Tracheostomy was performed after a median of 17 [12-22] days of mechanical ventilation (MV), with 10 patients in the "early" group (≤ day 10) and 38 patients in the "late" group (> day 10). Survivors required MV for a median of 32 [22-41] days and were ultimately decannulated with a median of 21 [15-34] days spent on cannula. Patients in the early group had shorter ICU and hospital stays (respectively 15 [12-19] versus 35 [25-47] days; p = 0.002, and 21 [16-28] versus 54 [35-72] days; p = 0.002) and spent less time on MV (respectively 17 [14-20] and 35 [27-43] days; p<0.001). Interestingly, patients in the percutaneous group had shorter hospital and rehabilitation center stays (respectively 44 [34-81] versus 92 [61-118] days; p = 0.012, and 24 [11-38] versus 45 [22-71] days; p = 0.045). Of the 30 (67%) patients examined by a head and neck surgeon, 17 (57%) had complications with unilateral laryngeal palsy (n = 5) being the most prevalent.
Conclusions: Tracheostomy seems to be a safe procedure that could help ICU organization by delegating work to a separate team and favoring patient turnover by allowing faster transfer to step-down units. Following guidelines alone was found sufficient to prevent the risk of aerosolization and contamination of healthcare professionals.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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