Early ventilator liberation and decreased sedation needs after tracheostomy in patients with COVID-19 infection
Autor: | Juan Pablo Idrovo, Catherine G. Velopulos, Shane Urban, Heather Carmichael, Ellen L. Burnham, Robert C. McIntyre, Franklin L. Wright, Thomas O. Vogler, Whitney Firth, Sarah E. Jolley |
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Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
medicine.medical_specialty
RD1-811 Sedation medicine.medical_treatment Population tracheostomy Critical Care and Intensive Care Medicine law.invention 03 medical and health sciences 0302 clinical medicine law medicine Intubation pneumonia 030212 general & internal medicine 030223 otorhinolaryngology education Original Research Mechanical ventilation education.field_of_study RC86-88.9 business.industry adult Medical emergencies. Critical care. Intensive care. First aid Retrospective cohort study Intensive care unit respiratory distress syndrome critical care Respiratory failure Cohort Emergency medicine Surgery medicine.symptom business |
Zdroj: | Trauma Surgery & Acute Care Open Trauma Surgery & Acute Care Open, Vol 6, Iss 1 (2021) |
ISSN: | 2397-5776 |
Popis: | BackgroundSince the outset of the coronavirus disease 2019 (COVID-19) pandemic, published tracheostomy guidelines have generally recommended deferral of the procedure beyond the initial weeks of intubation given high mortality as well as concerns about transmission of the infection to providers. It is unclear whether tracheostomy in patients with COVID-19 infection facilitates ventilator weaning, and long-term outcomes are not yet reported in the literature.MethodsThis is a retrospective study of tracheostomy outcomes in patients with COVID-19 infection at a single-center academic tertiary referral intensive care unit. Patients underwent percutaneous tracheostomy at the bedside; the procedure was performed with limited staffing to reduce risk of disease transmission.ResultsBetween March 1 and June 30, 2020, a total of 206 patients with COVID-19 infection required mechanical ventilation and 26 underwent tracheostomy at a mean of 25±5 days after initial intubation. Overall, 81% of tracheostomy patients were liberated from the ventilator at a mean of 9±6 days postprocedure, and 54% were decannulated prior to hospital discharge at a mean of 21±10 days postprocedure. Sedation and pain medication requirements decreased significantly in the week after the procedure. In-hospital mortality was 15%. Among tracheostomy survivors, 68% were discharged to a facility.DiscussionThe management of patients with COVID-19 related respiratory failure can be challenging due to prolonged ventilator dependency. In our initial experience, outcomes post-tracheostomy in this population are encouraging, with short time to liberation from the ventilator, a high rate of decannulation prior to hospital discharge, and similar mortality to tracheostomy performed for other indications. Barriers to weaning ventilation in this cohort may be high sedation needs and ventilator dyssynchrony.Level of evidenceLevel V—Therapeutic/care management. |
Databáze: | OpenAIRE |
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