Early Tracheostomy for Managing ICU Capacity During the COVID-19 Outbreak : A Propensity-Matched Cohort Study

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URI: https://hdl.handle.net/10641/7902
ISSN: 0012-3692
DOI: 10.1016/j.chest.2021.06.015

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2022-01

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Background: During the first wave of the COVID-19 pandemic, shortages of ventilators and ICU beds overwhelmed health care systems. Whether early tracheostomy reduces the duration of mechanical ventilation and ICU stay is controversial. Research Question: Can failure-free day outcomes focused on ICU resources help to decide the optimal timing of tracheostomy in overburdened health care systems during viral epidemics? Study Design and Methods: This retrospective cohort study included consecutive patients with COVID-19 pneumonia who had undergone tracheostomy in 15 Spanish ICUs during the surge, when ICU occupancy modified clinician criteria to perform tracheostomy in Patients with COVID-19. We compared ventilator-free days at 28 and 60 days and ICU- and hospital bed-free days at 28 and 60 days in propensity score-matched cohorts who underwent tracheostomy at different timings (≤ 7 days, 8-10 days, and 11-14 days after intubation). Results: Of 1,939 patients admitted with COVID-19 pneumonia, 682 (35.2%) underwent tracheostomy, 382 (56%) within 14 days. Earlier tracheostomy was associated with more ventilator-free days at 28 days (≤ 7 days vs > 7 days [116 patients included in the analysis]: median, 9 days [interquartile range (IQR), 0-15 days] vs 3 days [IQR, 0-7 days]; difference between groups, 4.5 days; 95% CI, 2.3-6.7 days; 8-10 days vs > 10 days [222 patients analyzed]: 6 days [IQR, 0-10 days] vs 0 days [IQR, 0-6 days]; difference, 3.1 days; 95% CI, 1.7-4.5 days; 11-14 days vs > 14 days [318 patients analyzed]: 4 days [IQR, 0-9 days] vs 0 days [IQR, 0-2 days]; difference, 3 days; 95% CI, 2.1-3.9 days). Except hospital bed-free days at 28 days, all other end points were better with early tracheostomy. Interpretation: Optimal timing of tracheostomy may improve patient outcomes and may alleviate ICU capacity strain during the COVID-19 pandemic without increasing mortality. Tracheostomy within the first work on a ventilator in particular may improve ICU availability.

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Publisher Copyright: © 2021 American College of Chest Physicians

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capacity, failure-free, resource, timing, tracheostomy, Pulmonary and Respiratory Medicine, Critical Care and Intensive Care Medicine, Cardiology and Cardiovascular Medicine, Journal Article, Yes, yes

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Hernandez, G, Ramos, F J, Añon, J M, Ortiz, R, Colinas, L, Masclans, J R, De Haro, C, Ortega, A, Peñuelas, O, Cruz-Delgado, M D M, Canabal, A, Plans, O, Vaquero, C, Rialp, G, Gordo, F, Lesmes, A, Martinez, M, Figueira, J C, Gomez-Carranza, A, Corrales, R, Castellvi, A, Castiñeiras, B, Frutos-Vivar, F, Prada, J, De Pablo, R, Naharro, A, Montejo, J C, Diaz, C, Santos-Peral, A, Padilla, R, Marin-Corral, J, Rodriguez-Solis, C, Sanchez-Giralt, J A, Jimenez, J, Cuena, R, Perez-Hoyos, S & Roca, O 2022, 'Early Tracheostomy for Managing ICU Capacity During the COVID-19 Outbreak : A Propensity-Matched Cohort Study', Chest, vol. 161, no. 1, pp. 121-129. https://doi.org/10.1016/j.chest.2021.06.015

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FACULTAD DE MEDICINA