Early tracheostomy for managing ICU capacity during the COVID-19 outbreak: A propensity-matched cohort study

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• dc.contributor.author Hernández, Gonzalo
• dc.contributor.author Masclans Enviz, Joan Ramon
• dc.contributor.author Castellvi, Andrea
• dc.contributor.author Marin Corral, Judith
• dc.contributor.author Roca, Oriol
• dc.date.accessioned 2022-01-11T06:48:40Z
• dc.date.issued 2022
• dc.description.abstract 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.
• dc.format.mimetype application/pdf
• dc.identifier.citation Hernandez G, Ramos FJ, Añon JM, Ortiz R, Colinas L, Masclans JR et al. Early tracheostomy for managing ICU capacity during the COVID-19 outbreak: A propensity-matched cohort study. Chest. 2022;161(1):121-9. DOI: 10.1016/j.chest.2021.06.015
• dc.identifier.doi http://dx.doi.org/10.1016/j.chest.2021.06.015
• dc.identifier.issn 0012-3692
• dc.identifier.uri http://hdl.handle.net/10230/52181
• dc.language.iso eng
• dc.publisher Elsevier
• dc.relation.ispartof Chest. 2022;161(1):121-9
• dc.rights © Elsevier http://dx.doi.org/10.1016/j.chest.2021.06.015
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.subject.keyword Capacity
• dc.subject.keyword Failure-free
• dc.subject.keyword Resource
• dc.subject.keyword Timing
• dc.subject.keyword Tracheostomy
• dc.title Early tracheostomy for managing ICU capacity during the COVID-19 outbreak: A propensity-matched cohort study
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/acceptedVersion