Safety and 30-day outcomes of tracheostomy for COVID-19 : a prospective observational cohort study
Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved..
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.
| Errataetall: |
CommentIn: Br J Anaesth. 2020 Dec;125(6):867-871. - PMID 32951840 |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
|---|---|
| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:125 |
|---|---|
| Enthalten in: |
British journal of anaesthesia - 125(2020), 6 vom: 10. Dez., Seite 872-879 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Queen Elizabeth Hospital Birmingham COVID-19 airway team [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
COVID-19 |
|---|
| Anmerkungen: |
Date Completed 25.11.2020 Date Revised 10.01.2021 published: Print-Electronic CommentIn: Br J Anaesth. 2020 Dec;125(6):867-871. - PMID 32951840 Citation Status MEDLINE |
|---|
| doi: |
10.1016/j.bja.2020.08.023 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM315592869 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM315592869 | ||
| 003 | DE-627 | ||
| 005 | 20231225155239.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2020 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.bja.2020.08.023 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1051.xml |
| 035 | |a (DE-627)NLM315592869 | ||
| 035 | |a (NLM)32988602 | ||
| 035 | |a (PII)S0007-0912(20)30678-4 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 0 | |a Queen Elizabeth Hospital Birmingham COVID-19 airway team |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Safety and 30-day outcomes of tracheostomy for COVID-19 |b a prospective observational cohort study |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 25.11.2020 | ||
| 500 | |a Date Revised 10.01.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Br J Anaesth. 2020 Dec;125(6):867-871. - PMID 32951840 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a ICU | |
| 650 | 4 | |a SARS-CoV-2 | |
| 650 | 4 | |a safety | |
| 650 | 4 | |a tracheostomy | |
| 700 | 1 | |a Breik, Omar |e investigator |4 oth | |
| 700 | 1 | |a Nankivell, Paul |e investigator |4 oth | |
| 700 | 1 | |a Sharma, Neil |e investigator |4 oth | |
| 700 | 1 | |a Bangash, Mansoor N |e investigator |4 oth | |
| 700 | 1 | |a Dawson, Camilla |e investigator |4 oth | |
| 700 | 1 | |a Idle, Matthew |e investigator |4 oth | |
| 700 | 1 | |a Isherwood, Peter |e investigator |4 oth | |
| 700 | 1 | |a Jennings, Christopher |e investigator |4 oth | |
| 700 | 1 | |a Keene, Damian |e investigator |4 oth | |
| 700 | 1 | |a Manji, Mav |e investigator |4 oth | |
| 700 | 1 | |a Martin, Tim |e investigator |4 oth | |
| 700 | 1 | |a Moss, Rob |e investigator |4 oth | |
| 700 | 1 | |a Murphy, Nick |e investigator |4 oth | |
| 700 | 1 | |a Parekh, Dhruv |e investigator |4 oth | |
| 700 | 1 | |a Parmar, Sat |e investigator |4 oth | |
| 700 | 1 | |a Patel, Jaimin |e investigator |4 oth | |
| 700 | 1 | |a Pracy, Paul |e investigator |4 oth | |
| 700 | 1 | |a Praveen, Prav |e investigator |4 oth | |
| 700 | 1 | |a Richardson, Carla |e investigator |4 oth | |
| 700 | 1 | |a Richter, Alex |e investigator |4 oth | |
| 700 | 1 | |a Sachdeva, Rajneesh |e investigator |4 oth | |
| 700 | 1 | |a Shields, Adrian |e investigator |4 oth | |
| 700 | 1 | |a Siddiq, Somiah |e investigator |4 oth | |
| 700 | 1 | |a Smart, Simon |e investigator |4 oth | |
| 700 | 1 | |a Tasker, Laura |e investigator |4 oth | |
| 773 | 0 | 8 | |i Enthalten in |t British journal of anaesthesia |d 1946 |g 125(2020), 6 vom: 10. Dez., Seite 872-879 |w (DE-627)NLM000000310 |x 1471-6771 |7 nnns |
| 773 | 1 | 8 | |g volume:125 |g year:2020 |g number:6 |g day:10 |g month:12 |g pages:872-879 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.bja.2020.08.023 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 125 |j 2020 |e 6 |b 10 |c 12 |h 872-879 | ||