Canadian Journal of Respiratory Therapy (Sep 2022)

Tracheostomy in critically ill patients with SARS 2 COVID-19 infection: a prospective observational multi-center study of short- and long-term outcomes

  • Alberto Corona,
  • Vincenzo De Santis,
  • Domenico Vitale,
  • Cecilia Nencini,
  • Antonella Potalivo,
  • Anna Prete,
  • Nicoletta Barzaghi,
  • Sara Tardivo,
  • Marina Terzitta,
  • Anna Malfatto,
  • Luigi Tritapepe,
  • Alessandro Locatelli,
  • Mervyn Singer

Journal volume & issue
Vol. 58

Abstract

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Background We report the characteristics, timing, and factors related to the decision to perform a tracheostomy in patients with confirmed COVID-19 infection admitted to eight Italian intensive care units (ICUs). Materials and methods Prospective observational cohort study of patients with COVID-19 disease on mechanical ventilation. Long-term functional impairment (up to 180 days' post-hospital discharge) was assessed using the Karnofsky scale. Kaplan--Meier analysis assessed differences in survival and freedom from tracheostomy in relation to ICU stay. Cox regression model was used to assess which variables impacted on tracheostomy as a categorical outcome. Results A total of 248 patients were recruited in the eight participating ICUs. Patients undergoing tracheostomy (n = 128) had longer ICU (25 (18--36) vs. 10 (7--16), P = 0.001) and hospital (37 (26.5--50) vs. 19 (8.5--34.5) P = 0.02) stays. ICU and hospital mortality of patients tracheostomized was 34% and 37%, respectively. Cumulative survival Kaplan--Meier analysis documented improved survival rates in patients undergoing tracheostomy (Log-Rank, Mantel--Cox = 4.8, P = 0.028). Median Karnofsky scale values improved over time but were similar between survivors receiving or not receiving tracheostomy. No healthcare worker involved in the tracheostomy procedure developed COVID-19 infection during the study period. Conclusions Patients with COVID-19 infection who underwent tracheostomy had a better cumulative survival but similar long-term functional outcomes at 30, 60, and 180 days after hospital discharge.