Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Nov 25, 2022; 11(6): 477-484
Published online Nov 25, 2022. doi: 10.5501/wjv.v11.i6.477
Clinical characteristics of COVID-19 patients who underwent tracheostomy and its effect on outcome: A retrospective observational study
Yudhyavir Singh, Kapil Dev Soni, Abhishek Singh, Nikita Choudhary, Fahina Perveen, Richa Aggarwal, Nishant Patel, Shailendra Kumar, Anjan Trikha
Yudhyavir Singh, Abhishek Singh, Nikita Choudhary, Fahina Perveen, Nishant Patel, Shailendra Kumar, Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India
Kapil Dev Soni, Richa Aggarwal, Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi 110029, India
Anjan Trikha, Department of Anesthesia, All India Institute of Medical Sciences, New Delhi 110029, India
Author contributions: Singh A, Soni KD, Aggarwal R, Singh Y, Patel N, Kumar K, Chaudhary N, Perveen F, and Trikha A contributed to conception, study design, as well as data collection and evaluation; Singh A and Soni KD contributed to statistical analysis, and interpretation of data; Singh A, Singh Y, and Trikha A drafted the manuscript, which was revised by Soni KD; all authors have read and approved the final manuscript.
Institutional review board statement: The retrospective data presented in this study is the part of the project titled–Post discharge outcomes of COVID-19 patients following admission to the intensive care unit, which was approved by the institute ethics committee (Reference No. IEC-291/17.04.2020).
Informed consent statement: As the study was retrospective in nature, informed written consent from individual patients was waived.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: Data can be made available at proper request by writing to the authors at bikunrs77@gmail.com.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Abhishek Singh, MD, Assistant Professor, Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, 5th floor, Teaching block All India Institute of Medical Sciences, New Delhi 110029, India. bikunrs77@gmail.com
Received: April 20, 2022
Peer-review started: April 20, 2022
First decision: May 31, 2022
Revised: June 12, 2022
Accepted: September 21, 2022
Article in press: September 21, 2022
Published online: November 25, 2022
Processing time: 216 Days and 21.1 Hours
Abstract
BACKGROUND

The exponential rise in Coronavirus disease 2019 (COVID-19) cases has resulted in an increased number of patients requiring prolonged ventilatory support and subsequent tracheostomy. With the limited availability of literature regarding the outcomes of COVID-19 patients with tracheostomy, we attempted to study the clinical characteristics and multiple parameters affecting the outcomes in these patients.

AIM

To determine all-cause mortality following tracheostomy and its association with various risk factors in COVID-19 patients.

METHODS

This retrospective study included 73 adult COVID-19 patients admitted to the ICU between 1 April, 2020 and 30 September, 2021 who underwent tracheostomy as a result of acute respiratory failure due to COVID-19. The data collected included demographics (age, sex), comorbidities, type of oxygen support at admission, severity of COVID-19, complications, and other parameters such as admission to tracheostomy, intubation to tracheostomy, ICU stay, hospital stay, and outcome.

RESULTS

This study included 73 adult patients with an average age of 52 ± 16.67 years, of which 52% were men. The average time for admission to tracheostomy was 18.12 ± 12.98 days while intubation to tracheostomy was 11.97 ± 9 days. The mortality rate was 71.2% and 28.8% of patients were discharged alive. The mean duration of ICU and hospital stay was 25 ± 11 days and 28.21 ± 11.60 days, respectively. Greater age, severe COVID-19, mechanical ventilation, shock and acute kidney injury were associated with poor prognosis; however, early tracheostomy in intubated patients resulted in better outcomes.

CONCLUSION

Patients with severe COVID-19 requiring mechanical ventilation have a poor prognosis but patients with early tracheostomy may benefit with no added risk. We recommend that the timing of tracheostomy be decided on a case-by-case basis and a well-designed randomised controlled trial should be performed to elucidate the potential benefit of early tracheostomy in such patients.

Keywords: COVID-19, Intubation, Mechanical ventilation, ICU, Tracheostomy, Oxygen therapy

Core Tip: Tracheostomies are commonly performed in critically ill patients who require mechanical ventilation for a prolonged duration. Various recommendations and guidelines have been published regarding the safety of tracheostomy in Coronavirus disease 2019 (COVID-19) patients but literature with respect to indication, timing and outcome of tracheostomy in COVID-19 patients is still lacking. Therefore, in this study we aimed to describe the clinical characteristics of patients who underwent elective tracheostomies and multiple parameters affecting the outcomes in these patients. We found that patients with severe COVID-19 requiring mechanical ventilation had a poor prognosis but patients with early tracheostomy may benefit from this procedure.