Critical Care Explorations (Dec 2022)
Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study
- Constance S. Harrell Shreckengost, MD, PhD,
- Jorge Esteban Foianini, MD,
- Karen Milenka Moron Encinas, MD,
- Hugo Tola Guarachi, MD,
- Katrina Abril, MD, MSc,
- Dina Amin, DDS,
- David Berkowitz, MD,
- Christine Aisha Castater, MD,
- J. Miller Douglas, BS,
- April A. Grant, MD,
- Onkar Vohra Khullar, MD,
- Andrea Nichole Lane, PhD,
- Alice Lin, MPH,
- Abesh Niroula, MD,
- Azhar Nizam, MS,
- Ammar Rashied, MS,
- Alexandra W. Reitz, MD, MPH,
- Steven M. Roser, DMD, MD,
- Julia Spychalski, BS,
- Sérgio Samir Arap, MD, PhD,
- Ricardo Ferreira Bento, MD, PhD,
- Pedro Prosperi Desenzi Ciaralo, MD,
- Rui Imamura, MD, PhD,
- Luiz Paulo Kowalski, MD, PhD,
- Ali Mahmoud, MD,
- Alessandro Wasum Mariani, MD, PhD,
- Carlos Augusto Metidieri Menegozzo, MD,
- Hélio Minamoto, MD, PhD,
- Fábio Luiz M. Montenegro, MD, PhD,
- Paulo Manoel Pêgo-Fernandes, MD, PhD,
- Jones Santos, Jr, MD,
- Edivaldo Massozo Utiyama, MD,
- Jithin K. Sreedharan, BScRT, MScRT,
- Or Kalchiem-Dekel, MD,
- Jonathan Nguyen, DO,
- Rohan K. Dhamsania, MS,
- Kerianne Allen, BA,
- Adrian Modzik, BS,
- Vikas Pathak, MD,
- Cheryl White, RN, BSN,
- Juan Blas, MD, MBBS-MBChB,
- Issa Talal El-Abur, PhD, MSc, MD, MBBS-MBChB,
- Gabriel Tirado, MD, MBBS-MBChB,
- Carlos Yánez Benítez, MD, MSc,
- Thomas G. Weiser, MD, MPH,
- Mark Barry, MD,
- Marissa Boeck, MD, MPH,
- Michael Farrell, MD, MS,
- Anya Greenberg, MBA,
- Phoebe Miller, MS,
- Paul Park, MS,
- Maraya Camazine, MS,
- Deidre Dillon, BS,
- Randi N. Smith, MD, MPH
Affiliations
- Constance S. Harrell Shreckengost, MD, PhD
- 1 Department of Surgery, Emory University School of Medicine, Atlanta, GA.
- Jorge Esteban Foianini, MD
- 2 Clínica Foianini, Santa Cruz de la Sierra, Bolivia.
- Karen Milenka Moron Encinas, MD
- 2 Clínica Foianini, Santa Cruz de la Sierra, Bolivia.
- Hugo Tola Guarachi, MD
- 2 Clínica Foianini, Santa Cruz de la Sierra, Bolivia.
- Katrina Abril, MD, MSc
- 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
- Dina Amin, DDS
- 4 Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
- David Berkowitz, MD
- 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
- Christine Aisha Castater, MD
- 1 Department of Surgery, Emory University School of Medicine, Atlanta, GA.
- J. Miller Douglas, BS
- 1 Department of Surgery, Emory University School of Medicine, Atlanta, GA.
- April A. Grant, MD
- 1 Department of Surgery, Emory University School of Medicine, Atlanta, GA.
- Onkar Vohra Khullar, MD
- 5 Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
- Andrea Nichole Lane, PhD
- 6 Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA.
- Alice Lin, MPH
- 6 Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA.
- Abesh Niroula, MD
- 3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
- Azhar Nizam, MS
- 6 Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA.
- Ammar Rashied, MS
- 6 Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA.
- Alexandra W. Reitz, MD, MPH
- 7 Emory University School of Medicine, Atlanta, GA.
- Steven M. Roser, DMD, MD
- 4 Division of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
- Julia Spychalski, BS
- 6 Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA.
- Sérgio Samir Arap, MD, PhD
- 8 Division of Head and Neck Surgery, University of São Paulo, São Paulo, Brazil.
- Ricardo Ferreira Bento, MD, PhD
- 9 Division of Otolaringology, University of São Paulo, São Paulo, Brazil.
- Pedro Prosperi Desenzi Ciaralo, MD
- 10 Division of Thoracic Surgery, University of São Paulo, São Paulo, Brazil.
- Rui Imamura, MD, PhD
- 9 Division of Otolaringology, University of São Paulo, São Paulo, Brazil.
- Luiz Paulo Kowalski, MD, PhD
- 8 Division of Head and Neck Surgery, University of São Paulo, São Paulo, Brazil.
- Ali Mahmoud, MD
- 8 Division of Head and Neck Surgery, University of São Paulo, São Paulo, Brazil.
- Alessandro Wasum Mariani, MD, PhD
- 11 University of São Paulo, São Paulo, Brazil.
- Carlos Augusto Metidieri Menegozzo, MD
- 12 Division of General Surgery and Trauma, University of São Paulo, São Paulo, Brazil.
- Hélio Minamoto, MD, PhD
- 10 Division of Thoracic Surgery, University of São Paulo, São Paulo, Brazil.
- Fábio Luiz M. Montenegro, MD, PhD
- 8 Division of Head and Neck Surgery, University of São Paulo, São Paulo, Brazil.
- Paulo Manoel Pêgo-Fernandes, MD, PhD
- 10 Division of Thoracic Surgery, University of São Paulo, São Paulo, Brazil.
- Jones Santos, Jr, MD
- 12 Division of General Surgery and Trauma, University of São Paulo, São Paulo, Brazil.
- Edivaldo Massozo Utiyama, MD
- 12 Division of General Surgery and Trauma, University of São Paulo, São Paulo, Brazil.
- Jithin K. Sreedharan, BScRT, MScRT
- 13 Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia.
- Or Kalchiem-Dekel, MD
- 14 Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY.
- Jonathan Nguyen, DO
- 15 Department of Surgery, Morehouse School of Medicine, Atlanta, GA.
- Rohan K. Dhamsania, MS
- 16 Philadelphia College of Osteopathic Medicine Georgia Campus, Suwanee, GA.
- Kerianne Allen, BA
- 17 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Riverside Health System, Newport News, VA.
- Adrian Modzik, BS
- 17 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Riverside Health System, Newport News, VA.
- Vikas Pathak, MD
- 17 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Riverside Health System, Newport News, VA.
- Cheryl White, RN, BSN
- 17 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Riverside Health System, Newport News, VA.
- Juan Blas, MD, MBBS-MBChB
- 18 Department of Surgery, Royo Villanova Hospital, Zaragoza, Spain.
- Issa Talal El-Abur, PhD, MSc, MD, MBBS-MBChB
- 18 Department of Surgery, Royo Villanova Hospital, Zaragoza, Spain.
- Gabriel Tirado, MD, MBBS-MBChB
- 19 Department of Critical Care Medicine, Royo Villanova Hospital, Zaragoza, Spain.
- Carlos Yánez Benítez, MD, MSc
- 18 Department of Surgery, Royo Villanova Hospital, Zaragoza, Spain.
- Thomas G. Weiser, MD, MPH
- 20 Department of Surgery, Stanford University, Stanford, CA.
- Mark Barry, MD
- 21 Department of Surgery, University of California San Francisco, San Francisco, CA.
- Marissa Boeck, MD, MPH
- 21 Department of Surgery, University of California San Francisco, San Francisco, CA.
- Michael Farrell, MD, MS
- 21 Department of Surgery, University of California San Francisco, San Francisco, CA.
- Anya Greenberg, MBA
- 22 School of Medicine, University of California San Francisco, San Francisco, CA.
- Phoebe Miller, MS
- 21 Department of Surgery, University of California San Francisco, San Francisco, CA.
- Paul Park, MS
- 22 School of Medicine, University of California San Francisco, San Francisco, CA.
- Maraya Camazine, MS
- 23 Division of Acute Care Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, MO.
- Deidre Dillon, BS
- 23 Division of Acute Care Surgery, Department of Surgery, University of Missouri School of Medicine, Columbia, MO.
- Randi N. Smith, MD, MPH
- 1 Department of Surgery, Emory University School of Medicine, Atlanta, GA.
- DOI
- https://doi.org/10.1097/CCE.0000000000000796
- Journal volume & issue
-
Vol. 4,
no. 12
p. e0796
Abstract
Objectives:. Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient outcomes and alleviate resource shortages. This study compares outcomes in a diverse population of hospitalized COVID-19 patients who underwent tracheostomy either “early” (within 14 d of intubation) or “late” (more than 14 d after intubation). Design:. International multi-institute retrospective cohort study. Setting:. Thirteen hospitals in Bolivia, Brazil, Spain, and the United States. Patients:. Hospitalized patients with COVID-19 undergoing early or late tracheostomy between March 1, 2020, and March 31, 2021. Interventions:. Not applicable. Measurements and Main Results:. A total of 549 patients from 13 hospitals in four countries were included in the final analysis. Multivariable regression analysis showed that early tracheostomy was associated with a 12-day decrease in time on mechanical ventilation (95% CI, −16 to −8; p < 0.001). Further, ICU and hospital lengths of stay in patients undergoing early tracheostomy were 15 days (95% CI, −23 to −9 d; p < 0.001) and 22 days (95% CI, −31 to −12 d) shorter, respectively. In contrast, early tracheostomy patients experienced lower risk-adjusted survival at 30-day post-admission (hazard ratio, 3.0; 95% CI, 1.8−5.2). Differences in 90-day post-admission survival were not identified. Conclusions:. COVID-19 patients undergoing tracheostomy within 14 days of intubation have reduced ventilator dependence as well as reduced lengths of stay. However, early tracheostomy patients experienced lower 30-day survival. Future efforts should identify patients most likely to benefit from early tracheostomy while accounting for location-specific capacity.
