Tracheotomy Outcomes in 71 COVID-19 Patients: A Multi-Centric Study in Saudi Arabia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Setting and Participants
2.2. Data Collection
2.3. Statistics and Data Analysis
2.4. Ethics
3. Results
3.1. Demographic Characteristics and Comorbidities of the Study Participants
3.2. Timing of Tracheostomy Events
3.3. Prognostic Risk Factors and Mortality after Tracheostomy
3.4. Tracheotomy Complications and Outcomes
3.5. Tracheostomy-Related Events between Survivors and Non-Survivors
4. Discussion
5. Conclusions
6. Limitations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- World Health Organization. WHO Coronavirus (COVID-19) Dashboard. Available online: https://covid19.who.int (accessed on 28 April 2021).
- Lim, C.-K.; Ruan, S.-Y.; Lin, F.-C.; Wu, C.L.; Chang, H.T.; Jerng, J.S.; Wu, H.D.; Yu, C.J. Effect of tracheostomy on weaning parameters in difficult-to-wean mechanically ventilated patients: A prospective observational study. PLoS ONE 2015, 10, e0138294. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Huang, C.; Wang, Y.; Li, X.; Ren, L.; Zhao, J.; Hu, Y.; Zhang, L.; Fan, G.; Xu, J.; Gu, X.; et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020, 395, 497–506. [Google Scholar] [CrossRef] [Green Version]
- Ahmed, Y.; Cao, A.; Thal, A.; Shah, S.; Kinkhabwala, C.; Liao, D.; Li, D.; Parides, M.; Mehta, V.; Ow, T.; et al. Tracheotomy Outcomes in 64 Ventilated COVID-19 Patients at a High-Volume Center in Bronx, NY. Laryngoscope 2021, 131, E1797–E1804. [Google Scholar] [CrossRef]
- Johnson-Obaseki, S.; Veljkovic, A.; Javidnia, H. Complication rates of open surgical versus percutaneous tracheostomy in critically ill patients. Laryngoscope 2016, 126, 2459–2467. [Google Scholar] [CrossRef] [PubMed]
- Mecham, J.C.; Thomas, O.J.; Pirgousis, P.; Janus, J.R. Utility of Tracheostomy in Patients With COVID-19 and Other Special Considerations. Laryngoscope 2020, 130, 2546–2549. [Google Scholar] [CrossRef] [PubMed]
- Chiesa-Estomba, C.M.; Lechien, J.R.; Calvo-Henríquez, C.; Fakhry, N.; Karkos, P.D.; Peer, S.; Sistiaga-Suarez, J.A.; Gónzalez-García, J.A.; Cammaroto, G.; Mayo-Yánez, M.; et al. Systematic review of international guidelines for tracheostomy in COVID-19 patients. Oral Oncol. 2020, 108, 104844. [Google Scholar] [CrossRef]
- Courtney, A.; Lignos, L.; Ward, P.A.; Vizcaychipi, M.P. Surgical Tracheostomy Outcomes in COVID-19-Positive Patients. OTO Open 2021, 5, 2473974X20984998. [Google Scholar] [CrossRef]
- Chao, T.N.; Harbison, S.P.; Braslow, B.M.; Hutchinson, C.T.; Rajasekaran, K.; Go, B.C.; Paul, E.A.; Lambe, L.D.; Kearney, J.J.; Chalian, A.A.; et al. Outcomes After Tracheostomy in COVID-19 Patients. Ann. Surg. 2020, 272, e181–e186. [Google Scholar] [CrossRef]
- Li, X.; Xu, S.; Yu, M.; Wang, K.; Tao, Y.; Zhou, Y.; Shi, J.; Zhou, M.; Wu, B.; Yang, Z.; et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin. Immunol. 2020, 146, 110–118. [Google Scholar] [CrossRef] [PubMed]
- Givi, B.; Schiff, B.A.; Chinn, S.B.; Clayburgh, D.; Iyer, N.G.; Jalisi, S.; Moore, M.G.; Nathan, C.A.; Orloff, L.A.; O’Neill, J.P.; et al. Safety recommendations for evaluation and surgery of the head and neck during the COVID-19 pandemic. JAMA Otolaryngol.–Head Neck Surg. 2020, 146, 579–584. [Google Scholar] [CrossRef] [Green Version]
- Takhar, A.; Walker, A.; Tricklebank, S.; Wyncoll, D.; Hart, N.; Jacob, T.; Arora, A.; Skilbeck, C.; Simo, R.; Surda, P. Recommenda- tion of a practical guideline for safe tracheostomy during the COVID-19 pandemic. Eur. Arch. Otorhinolaryngol. 2020, 277, 2173–2184. [Google Scholar] [CrossRef] [PubMed]
- David, A.P.; Russell, M.D.; El-Sayed, I.H.; Russell, M.S. Tracheostomy guidelines developed at a large academic medical center during the COVID-19 pandemic. Head Neck 2020, 42, 1291–1296. [Google Scholar] [CrossRef]
- Mcgrath, B.A.; Brenner, M.J.; Warrillow, S.J.; Pandian, V.; Arora, A.; Cameron, T.S.; Añon, J.M.; Martínez, G.H.; Truog, R.D.; Block, S.D.; et al. Tracheost- omy in the COVID-19 era: Global and multidisciplinary guidance. Lancet Respir. Med. 2020, 8, 717–725. [Google Scholar] [CrossRef]
- Volo, T.; Stritoni, P.; Battel, I.; Zennaro, B.; Lazzari, F.; Bellin, M.; Michieletto, L.; Spinato, G.; Busatto, C.; Politi, D.; et al. Elective tracheostomy during COVID-19 outbreak: To whom, when, how? Early experience from Venice, Italy. Eur. Arch. Oto-Rhino-Laryngol. 2021, 278, 781–789. [Google Scholar] [CrossRef] [PubMed]
- Tang, Y.; Wu, Y.; Zhu, F.; Yang, X.; Huang, C.; Hou, G.; Xu, W.; Hu, M.; Zhang, L.; Cheng, A.; et al. Tracheostomy in 80 COVID-19 Patients: A multicenter, retrospective, observational study. Front. Med. 2020, 7, 615845. [Google Scholar] [CrossRef] [PubMed]
- Avilés-Jurado, F.X.; Prieto-Alhambra, D.; González-Sánchez, N.; De Ossó, J.; Arancibia, C.; Rojas-Lechuga, M.J.; Ruiz-Sevilla, L.; Remacha, J.; Sánchez, I.; Lehrer-Coriat, E.; et al. Timing, complications, and safety of tracheotomy in critically Ill patients with COVID-19. JAMA Otolaryngol.–Head Neck Surg. 2020, 147, 1–8. [Google Scholar] [CrossRef]
- Adly, A.; Youssef, T.A.; El-Begermy, M.M.; Younis, H.M. Timing of tracheostomy in patients with prolonged endotracheal intubation: A systematic review. Eur. Arch. Otorhinolaryngol. 2018, 275, 679–690. [Google Scholar] [CrossRef]
- Wang, R.; Pan, C.; Wang, X.; Xu, F.; Jiang, S.; Li, M. The impact of tracheotomy timing in critically ill patients undergoing mechanical ventilation: A meta-analysis of randomized controlled clinical trials with trial sequential analysis. Heart Lung 2019, 48, 46–54. [Google Scholar] [CrossRef] [Green Version]
- Chandran, A.; Kumar, R.; Kanodia, A.; Shaphaba, K.; Sagar, P.; Thakar, A. Outcomes of Ttracheostomy in COVID-19 Patients: A Single Centre Experience. Indian J. Otolaryngol. Head Neck Surg. 2021, 1–7. [Google Scholar] [CrossRef]
- Thal, A.G.; Schiff, B.A.; Ahmed, Y.; Cao, A.; Mo, A.; Mehta, V.; Smith, R.V.; Cohen, H.W.; Ow, T.J. Tracheotomy in a high-volume center during the COVID-19 pandemic: Evaluating the surgeon’s risk. Otolaryngol. Head Neck Surg. 2021, 164, 522–527. [Google Scholar] [CrossRef]
- Zhou, F.; Yu, T.; Du RFan, G.; Liu, Y.; Liu, Z.; Xiang, J.; Wang, Y.; Song, B.; Gu, X. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020, 395, 1054–1062. [Google Scholar] [CrossRef]
Patient Number (n = 71) | |
---|---|
Age (median (IQR); range) | 60 (15); 21–84 |
Male sex, No. (%) | 47 (66.2) |
Coexisting Conditions | No. (%) |
Hypertension | 32 (45.1) |
Hyperlipidemia | 25 (35.2) |
Diabetes | 38 (53.5) |
Lung Disease | 22 (31) |
Heart disease | 18 (25.4) |
Obesity (BMI ≥ 30 kgm−2) | 26 (36.6) |
Tracheostomy Technique | No. (%) |
Percutaneous | 56 (78.9) |
Open | 15 (21.1) |
Tracheostomy Events (days) | Mean ± SD |
---|---|
Hospital admission to tracheostomy | 13.32 ± 2.63 |
Intubation to tracheostomy | 9.97 ± 2.72 |
ICU admission to tracheostomy | 10.90 ± 2.4 |
Tracheostomy to weaning from the ventilator | 6.39 ± 1.53 |
Tracheostomy to ICU discharge | 13.68 ± 2.91 |
Prognostic Variable | Category | Number of Patients | p | OR * | 95% CI ** | |
---|---|---|---|---|---|---|
Non-Survivors Survivors | ||||||
Age | More than 40 years | 2 | 5 | 0.536 | 0.58 | 0.10–3.24 |
More than 40 years | 26 | 38 | ||||
Gender | Male | 2 | 25 | 0.075 | 2.64 | 0.89–7.83 |
Female | 6 | 18 | ||||
Hypertension | Yes | 17 | 15 | 0.033 | 0.34 | 0.13–0.92 |
NO | 11 | 28 | ||||
Hyperlipidemia | Yes | 12 | 13 | 0.276 | 0.72 | 0.21–1.55 |
NO | 16 | 30 | ||||
Diabetes | Yes | 20 | 18 | 0.015 | 0.28 | 0.10–0.79 |
NO | 8 | 25 | ||||
Lung Disease | Yes | 13 | 9 | 0.023 | 0.30 | 0.10–0.86 |
NO | 15 | 34 | ||||
Heart Disease | Yes | 10 | 8 | 0.105 | 0.41 | 0.13–1.22 |
NO | 18 | 35 | ||||
BMI, subgroups | <30 | 13 | 32 | 0.017 | 0.29 | 0.10–2.73 |
>30 | 15 | 11 |
Complications | Number (%) |
---|---|
Oozing from Tracheostomy site | 11 (15.5) |
Mucous plug | 5 (7) |
Positional cuff leak | 3 (4.2) |
Pneumomediastinum | 2 (2.8) |
Tracheal infection | 3 (4.2) |
Outcomes | - |
Deceased | 28 (38.4) |
Survived and discharged | 43 (60.6) |
Tracheostomy Events | Mean ± SD Duration in Non-Survivors | Mean ± SD Duration in Survivors | p |
---|---|---|---|
Hospital admission to tracheostomy | 12.75 ± 2.41 | 13.70 ± 2.28 | 0.533 |
Intubation to tracheostomy | 10.18 ± 2.40 | 10.63 ± 2.7 | 0.176 |
ICU admission to tracheostomy | 10.68 ± 2.07 | 11.05 ± 2.30 | 0.458 |
Tracheostomy to weaning from the ventilator | 6.71 ± 1.68 | 6.19 ± 1.70 | 0.867 |
Tracheostomy to ICU discharge | 12.32 ± 2.35 | 14.56 ± 3.69 | 0.044 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Almutairi, D.; Alqahtani, R.; Alghamdi, A.; Binammar, D.; Alzaidi, S.; Ghafori, A.; Alsharif, H. Tracheotomy Outcomes in 71 COVID-19 Patients: A Multi-Centric Study in Saudi Arabia. Clin. Pract. 2021, 11, 947-953. https://doi.org/10.3390/clinpract11040109
Almutairi D, Alqahtani R, Alghamdi A, Binammar D, Alzaidi S, Ghafori A, Alsharif H. Tracheotomy Outcomes in 71 COVID-19 Patients: A Multi-Centric Study in Saudi Arabia. Clinics and Practice. 2021; 11(4):947-953. https://doi.org/10.3390/clinpract11040109
Chicago/Turabian StyleAlmutairi, Dakheelallah, Raneem Alqahtani, Arwa Alghamdi, Dina Binammar, Suzan Alzaidi, Abdullah Ghafori, and Hassan Alsharif. 2021. "Tracheotomy Outcomes in 71 COVID-19 Patients: A Multi-Centric Study in Saudi Arabia" Clinics and Practice 11, no. 4: 947-953. https://doi.org/10.3390/clinpract11040109
APA StyleAlmutairi, D., Alqahtani, R., Alghamdi, A., Binammar, D., Alzaidi, S., Ghafori, A., & Alsharif, H. (2021). Tracheotomy Outcomes in 71 COVID-19 Patients: A Multi-Centric Study in Saudi Arabia. Clinics and Practice, 11(4), 947-953. https://doi.org/10.3390/clinpract11040109