TY - JOUR
T1 - Safety and 30-day outcomes of tracheostomy for COVID-19
T2 - a prospective observational cohort study
AU - Queen Elizabeth Hospital Birmingham COVID-19 airway team
AU - Breik, Omar
AU - Nankivell, Paul
AU - Sharma, Neil
AU - Bangash, Mansoor
AU - Dawson, Camilla
AU - Idle, Matthew
AU - Isherwood, Peter
AU - Jennings, Christopher
AU - Keene, Damian
AU - Manji, Mav
AU - Martin, Tim
AU - Moss, Rob
AU - Murphy, Nick
AU - Parekh, Dhruv
AU - Parmar, Sat
AU - Patel, Jaimin
AU - Pracy, Paul
AU - Praveen, Prav
AU - Richardson, Carla
AU - Richter, Alex
AU - Sachdeva, Rajneesh
AU - Shields, Adrian
AU - Siddiq, Somiah
AU - Smart, Simon
AU - Tasker, Laura
N1 - Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
PY - 2020/12
Y1 - 2020/12
N2 - Background: The role of tracheostomy in coronavirus disease 2019 (COVID-19) is unclear, with several consensus guidelines advising against this practice. We developed both a dedicated airway team and coordinated education programme to facilitate ward management of tracheostomised COVID-19 patients. Here, we report outcomes in the first 100 COVID-19 patients who underwent tracheostomy at our institution. Methods: This was a prospective observational cohort study of patients confirmed to have COVID-19 who required mechanical ventilation at Queen Elizabeth Hospital, Birmingham, UK. The primary outcome measure was 30-day survival, accounting for severe organ dysfunction (Acute Physiology and Chronic Health [APACHE]-II score>17). Secondary outcomes included duration of ventilation, ICU stay, and healthcare workers directly involved in tracheostomy care acquiring COVID-19. Results: A total of 164 patients with COVID-19 were admitted to the ICU between March 9, 2020 and April 21, 2020. A total of 100 patients (mean [standard deviation] age: 55 [12] yr; 29% female) underwent tracheostomy; 64 (age: 57 [14] yr; 25% female) did not undergo tracheostomy. Despite similar APACHE-II scores, 30-day survival was higher in 85/100 (85%) patients after tracheostomy, compared with 27/64 (42%) non-tracheostomised patients {relative risk: 3.9 (95% confidence intervals [CI]: 2.3–6.4); P<0.0001}. In patients with APACHE-II scores ≥17, 68/100 (68%) tracheotomised patients survived, compared with 12/64 (19%) non-tracheotomised patients (P<0.001). Tracheostomy within 14 days of intubation was associated with shorter duration of ventilation (mean difference: 6.0 days [95% CI: 3.1–9.0]; P<0.0001) and ICU stay (mean difference: 6.7 days [95% CI: 3.7–9.6]; P<0.0001). No healthcare workers developed COVID-19. Conclusion: Independent of the severity of critical illness from COVID-19, 30-day survival was higher and ICU stay shorter in patients receiving tracheostomy. Early tracheostomy appears to be safe in COVID-19.
AB - Background: The role of tracheostomy in coronavirus disease 2019 (COVID-19) is unclear, with several consensus guidelines advising against this practice. We developed both a dedicated airway team and coordinated education programme to facilitate ward management of tracheostomised COVID-19 patients. Here, we report outcomes in the first 100 COVID-19 patients who underwent tracheostomy at our institution. Methods: This was a prospective observational cohort study of patients confirmed to have COVID-19 who required mechanical ventilation at Queen Elizabeth Hospital, Birmingham, UK. The primary outcome measure was 30-day survival, accounting for severe organ dysfunction (Acute Physiology and Chronic Health [APACHE]-II score>17). Secondary outcomes included duration of ventilation, ICU stay, and healthcare workers directly involved in tracheostomy care acquiring COVID-19. Results: A total of 164 patients with COVID-19 were admitted to the ICU between March 9, 2020 and April 21, 2020. A total of 100 patients (mean [standard deviation] age: 55 [12] yr; 29% female) underwent tracheostomy; 64 (age: 57 [14] yr; 25% female) did not undergo tracheostomy. Despite similar APACHE-II scores, 30-day survival was higher in 85/100 (85%) patients after tracheostomy, compared with 27/64 (42%) non-tracheostomised patients {relative risk: 3.9 (95% confidence intervals [CI]: 2.3–6.4); P<0.0001}. In patients with APACHE-II scores ≥17, 68/100 (68%) tracheotomised patients survived, compared with 12/64 (19%) non-tracheotomised patients (P<0.001). Tracheostomy within 14 days of intubation was associated with shorter duration of ventilation (mean difference: 6.0 days [95% CI: 3.1–9.0]; P<0.0001) and ICU stay (mean difference: 6.7 days [95% CI: 3.7–9.6]; P<0.0001). No healthcare workers developed COVID-19. Conclusion: Independent of the severity of critical illness from COVID-19, 30-day survival was higher and ICU stay shorter in patients receiving tracheostomy. Early tracheostomy appears to be safe in COVID-19.
KW - COVID-19
KW - ICU
KW - SARS-CoV-2
KW - safety
KW - tracheostomy
UR - http://www.scopus.com/inward/record.url?scp=85091844940&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2020.08.023
DO - 10.1016/j.bja.2020.08.023
M3 - Article
C2 - 32988602
SN - 0007-0912
VL - 125
SP - 872
EP - 879
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 6
ER -