TY - JOUR
T1 - Early Tracheostomy for Managing ICU Capacity During the COVID-19 Outbreak
T2 - A Propensity-Matched Cohort Study
AU - Hernandez, Gonzalo
AU - Ramos, Francisco Javier
AU - Añon, José Manuel
AU - Ortiz, Ramón
AU - Colinas, Laura
AU - Masclans, Joan Ramón
AU - De Haro, Candelaria
AU - Ortega, Alfonso
AU - Peñuelas, Oscar
AU - Cruz-Delgado, María del Mar
AU - Canabal, Alfonso
AU - Plans, Oriol
AU - Vaquero, Concepción
AU - Rialp, Gemma
AU - Gordo, Federico
AU - Lesmes, Amanda
AU - Martinez, María
AU - Figueira, Juan Carlos
AU - Gomez-Carranza, Alejandro
AU - Corrales, Rocio
AU - Castellvi, Andrea
AU - Castiñeiras, Beatriz
AU - Frutos-Vivar, Fernando
AU - Prada, Jorge
AU - De Pablo, Raul
AU - Naharro, Antonio
AU - Montejo, Juan Carlos
AU - Diaz, Claudia
AU - Santos-Peral, Alfonso
AU - Padilla, Rebeca
AU - Marin-Corral, Judith
AU - Rodriguez-Solis, Carmen
AU - Sanchez-Giralt, Juan Antonio
AU - Jimenez, Jorge
AU - Cuena, Rafael
AU - Perez-Hoyos, Santiago
AU - Roca, Oriol
N1 - Publisher Copyright:
© 2021 American College of Chest Physicians
PY - 2022/1
Y1 - 2022/1
N2 - 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.
AB - 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.
KW - capacity
KW - failure-free
KW - resource
KW - timing
KW - tracheostomy
UR - https://www.scopus.com/pages/publications/85116555886
U2 - 10.1016/j.chest.2021.06.015
DO - 10.1016/j.chest.2021.06.015
M3 - Article
C2 - 34147502
AN - SCOPUS:85116555886
SN - 0012-3692
VL - 161
SP - 121
EP - 129
JO - Chest
JF - Chest
IS - 1
ER -
