nach oben

European Archives of Oto-Rhino-Laryngology

Erschienen in:

01.08.2020 | COVID-19 | Head and Neck Zur Zeit gratis

Tracheostomy, ventilatory wean, and decannulation in COVID-19 patients

verfasst von: Chrysostomos Tornari, Pavol Surda, Arunjit Takhar, Nikul Amin, Alison Dinham, Rachel Harding, David A. Ranford, Sally K. Archer, Duncan Wyncoll, Stephen Tricklebank, Imran Ahmad, Ricard Simo, Asit Arora

Erschienen in: European Archives of Oto-Rhino-Laryngology | Ausgabe 5/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

COVID-19 patients requiring mechanical ventilation can overwhelm existing bed capacity. We aimed to better understand the factors that influence the trajectory of tracheostomy care in this population to facilitate capacity planning and improve outcomes.

Methods

We conducted an observational cohort study of patients in a high-volume centre in the worst-affected region of the UK including all patients that underwent tracheostomy for COVID-19 pneumonitis ventilatory wean from 1st March 2020 to 10th May 2020. The primary outcome was time from insertion to decannulation. The analysis utilised Cox regression to account for patients that are still progressing through their tracheostomy pathway.

Results

At the point of analysis, a median 21 days (IQR 15–28) post-tracheostomy and 39 days (IQR 32–45) post-intubation, 35/69 (57.4%) patients had been decannulated a median of 17 days (IQR 12-20.5) post-insertion. The overall median age was 55 (IQR 48–61) with a male-to-female ratio of 2:1. In Cox regression analysis, FiO₂ at tracheostomy ≥ 0.4 (HR 1.80; 95% CI 0.89–3.60; p = 0.048) and last pre-tracheostomy peak cough flow (HR 2.27; 95% CI 1.78–4.45; p = 0.001) were independent variables associated with prolonged time to decannulation.

Conclusion

Higher FiO₂ at tracheostomy and higher pre-tracheostomy peak cough flow are associated with increased delay in COVID-19 tracheostomy patient decannulation. These finding comprise the most comprehensive report of COVID-19 tracheostomy decannulation to date and will assist service planning for future peaks of this pandemic.

Wu Z, McGoogan JM (2020) Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in china: summary of a report of 72314 cases from the chinese center for disease control and prevention. JAMA—J Am Med Assoc 323:1239–1242. https://doi.org/10.1001/jama.2020.2648CrossRef

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395:497–506. https://doi.org/10.1016/S0140-6736(20)30183-5CrossRefPubMedPubMedCentral

Gold JAW, Wong KK, Szablewski CM, Patel PR, Rossow J, Silva J et al (2020) Characteristics and clinical outcomes of adult patients hospitalized with COVID-19—Georgia, March 2020. Morb Mortal Wkly Rep 69:1–6CrossRef

Carenzo L, Costantini E, Greco M, Barra FL, Rendiniello V, Mainetti M et al (2020) Hospital surge capacity in a tertiary emergency referral centre during the COVID-19 outbreak in Italy. Anaesthesia 1174:1–7. https://doi.org/10.1111/anae.15072CrossRef

Litton E, Bucci T, Chavan S, Ho YY, Holley A, Howard G et al (2020) Surge capacity of intensive care units in case of acute increase in demand caused by COVID-19 in Australia. Med J Aust. https://doi.org/10.5694/mja2.50596CrossRefPubMedPubMedCentral

Shoukat A, Wells CR, Langley JM, Singer BH, Galvani AP (2020) Projecting demand for critical care beds during COVID-19 outbreaks in Canada. CMAJ. https://doi.org/10.1503/cmaj.200457CrossRefPubMedPubMedCentral

Anandaciva S (2020) Critical care services in the English NHS. In: King’s Fund. Critical care services in the English NHS. Accessed 9 May 2020

Adly A, Youssef TA, El-Begermy MM, Younis HM (2018) Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review. Eur Arch Oto-Rhino-Laryngol 275:679–690. https://doi.org/10.1007/s00405-017-4838-7CrossRef

Curry SD, Rowan PJ (2020) Laryngotracheal stenosis in early vs late tracheostomy: a systematic review. Otolaryngol—Head Neck Surg (US) 162:160–167. https://doi.org/10.1177/0194599819889690CrossRef

10.

Wang R, Pan C, Wang X, Xu F, Jiang S, Li M (2019) The impact of tracheotomy timing in critically ill patients undergoing mechanical ventilation: a meta-analysis of randomized controlled clinical trials with trial sequential analysis. Hear Lung 48:46–54. https://doi.org/10.1016/j.hrtlng.2018.09.005CrossRef

11.

Sommer DD, Engels PT, Usaf C, Khalili S, Corsten M, Tewfik MA et al (2020) Recommendations from the CSO-HNS taskforce on performance of tracheotomy during the COVID-19 pandemic. J Otolaryngol Head Neck Surg 49:23. https://doi.org/10.1186/s40463-020-00414-9CrossRefPubMedPubMedCentral

12.

Mcgrath BA, Brenner MJ, Warrillow SJ, Pandian V, Arora A, Cameron TS et al (2020) Health-care development tracheostomy in the COVID-19 era: global and multidisciplinary guidance. Anaesthesia 2600:1–8. https://doi.org/10.1016/S2213-2600(20)30230-7CrossRef

13.

Lin WC, Chen CW, Der Wang J, Tsai LM (2015) Is tracheostomy a better choice than translaryngeal intubation for critically ill patients requiring mechanical ventilation for more than 14 days? A comparison of short-term outcomes. BMC Anesthesiol 15:1–8. https://doi.org/10.1186/s12871-015-0159-9CrossRef

14.

Parker NP, Schiff BA, Fritz MA, Rapoport SK, Schild S, Altman KW et al (2020) Tracheotomy recommendations during the COVID-19 pandemic. Am Acad Otolaryngol—Head Neck Surg. https://www.entnet.org/content/tracheotomy-recommendations-during-covid-19-pandemic. Accessed 11 May 2020

15.

Schultz P, Morvan J-B, Fakhry N, Morinière S, Vergez S, Lacroix C et al (2020) French consensus regarding precautions during tracheostomy and post-tracheostomy care in the context of COVID-19 pandemic. Eur Ann Otorhinolaryngol Head Neck Dis. https://doi.org/10.1016/j.anorl.2020.04.006CrossRefPubMedPubMedCentral

16.

Takhar A, Walker A, Tricklebank S, Wyncoll D, Hart N, Jacob T et al (2020) Recommendation of a practical guideline for safe tracheostomy during the COVID-19 pandemic. Eur Arch Otorhinolaryngol. https://doi.org/10.1007/s00405-020-05993-xCrossRefPubMedPubMedCentral

17.

NCEPOD (2014) On the right trach? J Anaesth Pract 24:158–159. https://www.ncepod.org.uk/2014report1/downloads/OnTheRightTrach_FullReport.pdf. Accessed 4 May 2020

18.

BLA (2020) Tracheostomy guideline Covid-19 tracheostomy guideline. ENT UK, pp 1–6. https://www.britishlaryngological.org/sites/default/files/BLA%20Tracheostomy%20guideline%20-BLA%20April%202020%20FINAL.pdf. Accessed 14 May 2020

19.

RCSLT (2020) RCSLT GUIDANCE speech and language therapist-led endoscopic procedures in the COVID-19 pandemic. https://www.rcslt.org/-/media/docs/Covid/RCSLT-COVID-19-SLT-led-endoscopic-procedure-guidance_FINAL-(2).PDF?la=en&hash=8101575091FE8F1ABA41B4B472387DAFB023A39D. Accessed 9 May 2020

20.

Kutsukutsa J, Kuupiel D, Monori-Kiss A, Del Rey-Puech P, Mashamba-Thompson TP (2019) Tracheostomy decannulation methods and procedures for assessing readiness for decannulation in adults: a systematic scoping review. Int J Evid Based Healthc 17:74–91. https://doi.org/10.1097/XEB.0000000000000166CrossRefPubMed

21.

Singh RK, Saran S, Baronia AK (2017) The practice of tracheostomy decannulation-a systematic review. J Intensive Care. https://doi.org/10.1186/s40560-017-0234-zCrossRefPubMedPubMedCentral

22.

Santus P, Gramegna A, Radovanovic D, Raccanelli R, Valenti V, Rabbiosi D et al (2014) A systematic review on tracheostomy decannulation: a proposal of a quantitative semiquantitative clinical score. BMC Pulm Med 14:1–8. https://doi.org/10.1186/1471-2466-14-201CrossRef

23.

Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E et al (2020) Surviving Sepsis Campaign: guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19). Springer, Berlin

24.

Ye Q, Wang B, Mao J (2020) The pathogenesis and treatment of the ‘Cytokine Storm’’ in COVID-19′. J Infect. https://doi.org/10.1016/j.jinf.2020.03.037CrossRefPubMedPubMedCentral

25.

Russell CD, Millar JE, Baillie JK (2020) Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet 395:473–475. https://doi.org/10.1016/S0140-6736(20)30317-2CrossRefPubMedPubMedCentral

26.

Stubington TJ, Hospital RD, Mansuri MS (2020) Tracheotomy in COVID-19 patients: optimizing patient selection and identifying prognostic indicators. Authorea. https://doi.org/10.22541/au.158888293.33092171(pre-print)CrossRef

27.

Turri-Zanoni M, Battaglia P, Czaczkes C, Pelosi P, Castelnuovo P, Cabrini L (2020) Elective tracheostomy during mechanical ventilation in patients affected by COVID-19: preliminary case series from Lombardy, Italy. Otolaryngol Head Neck Surg. https://doi.org/10.1177/0194599820928963CrossRefPubMed

28.

Takhar A, Tornari C, Amin N, Wyncoll D, Arora A, Ahmad I et al (2020) Percutaneous tracheostomy in COVID-19 pneumonitis patients requiring prolonged mechanical ventilation : Initial experience in 51 patients and preliminary outcomes. Authorea. https://doi.org/10.22541/au.158801954.47538762/v2(pre-print)CrossRef

29.

Angel L, Kon ZN, Chang SH, Rafeq S, Shekar SP, Mitzman B et al (2020) Novel percutaneous tracheostomy for critically ill patients with COVID-19. Ann Thorac Surg. https://doi.org/10.1016/j.athoracsur.2020.04.010CrossRefPubMedPubMedCentral

30.

Broderick D, Kyzas P, Baldwin AJ, Graham RM, Duncan T, Chaintoutis C et al (2020) Surgical tracheostomies in COVID-19 patients: a multidisciplinary approach and lessons learned. Oral Oncol. https://doi.org/10.1016/j.oraloncology.2020.104767CrossRefPubMedPubMedCentral

31.

ICNARC (2020) Report on COVID-19 in critical care. Intensive Care Natl Audit Res Cent, 1–24. https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports

32.

Rovira A, Dawson D, Walker A, Tornari C, Dinham A, Foden N et al (2020) Tracheostomy care and decannulation during the COVID-19 pandemic. Eur Arch Oto-Rhino-Laryngol, A multidisciplinary clinical practice guideline. https://doi.org/10.1007/s00405-020-06126-0CrossRef

33.

Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ (2020) COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 395(10229):1033–1034. https://doi.org/10.1016/S0140-6736(20)30629-0CrossRefPubMedPubMedCentral

34.

Mokhlesi B, Tulaimat A, Gluckman TJ, Wang Y, Evans AT, Corbridge TC (2007) Predicting extubation failure after successful completion of a spontaneous breathing trial. Respir Care 52:1710–1717PubMed

35.

Cardoso FEF, De Abreu LC, Raimundo RD, Faustino NANM, Araújo SF, Valenti VE et al (2012) Evaluation of peak cough flow in Brazilian healthy adults. Int Arch Med 5:2–5. https://doi.org/10.1186/1755-7682-5-25CrossRef

36.

Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH et al (2012) Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J 40:1324–1343. https://doi.org/10.1183/09031936.00080312CrossRefPubMedPubMedCentral

37.

Shahane N, Edward K, Hospital M, Jiandani MP, Edward K, Hospital M (2018) Correlation of peak cough flow rate with peak expiratory flow rate in patients with chronic respiratory diseases correlation of peak cough flow rate with peak expiratory flow rate in patients with chronic respiratory diseases. NJIRM 9:21–25

38.

Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW et al (2020) Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 10022:1–8. https://doi.org/10.1001/jama.2020.6775CrossRef

39.

UK Government: Regional Ethnic Diversity. https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/national-and-regional-populations/regional-ethnic-diversity/latest#data-sources. Accessed 11 May 2020

40.

Platt L, Warwick R (2020) Are some ethnic groups more vulnerable to COVID-19 than others? Inst Fisc Stud. https://www.ifs.org.uk/inequality/chapter/are-some-ethnic-groups-more-vulnerable-to-covid-19-than-others/. Accessed 11 May 2020

41.

Winck JC, LeBlanc C, Soto JL, Plano F (2015) The value of cough peak flow measurements in the assessment of extubation or decannulation readiness. Rev Port Pneumol 21:94–98. https://doi.org/10.1016/j.rppnen.2014.12.002CrossRefPubMed

42.

McGrath BA, Wallace S, Goswamy J (2020) Laryngeal oedema associated with COVID -19 complicating airway management. Anaesthesia. https://doi.org/10.1111/anae.15092CrossRefPubMedPubMedCentral

43.

de Oliveira ACM, de Friche AA, Salomão MS, Bougo GC, Vicente LLC (2018) Predictive factors for oropharyngeal dysphagia after prolonged orotracheal intubation. Braz J Otorhinolaryngol 84:722–728. https://doi.org/10.1016/j.bjorl.2017.08.010CrossRefPubMed

44.

Young D, Harrison DA, Cuthbertson BH, Rowan K (2013) Effect of early vs late tracheostomy. JAMA 309:2121–2129. https://doi.org/10.1001/jama.2013.5154CrossRefPubMed

Titel: Tracheostomy, ventilatory wean, and decannulation in COVID-19 patients
verfasst von: Chrysostomos Tornari
Pavol Surda
Arunjit Takhar
Nikul Amin
Alison Dinham
Rachel Harding
David A. Ranford
Sally K. Archer
Duncan Wyncoll
Stephen Tricklebank
Imran Ahmad
Ricard Simo
Asit Arora
Publikationsdatum: 01.08.2020
Verlag: Springer Berlin Heidelberg
Schlagwort: COVID-19
Erschienen in: European Archives of Oto-Rhino-Laryngology / Ausgabe 5/2021
Print ISSN: 0937-4477
Elektronische ISSN: 1434-4726
DOI: https://doi.org/10.1007/s00405-020-06187-1

Update HNO

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Springer Medizin

Tracheostomy, ventilatory wean, and decannulation in COVID-19 patients