Early Tracheostomy for Managing ICU Capacity During the COVID-19 Outbreak : A Propensity-Matched Cohort Study

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...

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Autores: Hernandez, Gonzalo, Ramos, Francisco Javier, Añon, José Manuel, Ortiz, Ramón, Colinas, Laura, Masclans, Joan Ramón, De Haro, Candelaria, Ortega, Alfonso, Peñuelas, Oscar, Martín-Delgado, María Cruz, Cruz-Delgado, María del Mar, Canabal, Alfonso, Canabal Berlanga, Alfonso, Plans, Oriol, Vaquero, Concepción, Rialp, Gemma, Gordo, Federico, Lesmes, Amanda, Martinez, María, Figueira, Juan Carlos, Gomez-Carranza, Alejandro, Corrales, Rocio, Castellvi, Andrea, Castiñeiras, Beatriz, Frutos-Vivar, Fernando, Prada, Jorge, De Pablo, Raul, Gordo-Vidal, Federico, Naharro, Antonio, Montejo, Juan Carlos, Diaz, Claudia, Santos-Peral, Alfonso, Padilla, Rebeca, Marin-Corral, Judith, Rodriguez-Solis, Carmen, Sanchez-Giralt, Juan Antonio, Jimenez, Jorge, Cuena, Rafael, Perez-Hoyos, Santiago, Roca, Oriol
Tipo de recurso: artículo
Fecha de publicación:2022
País:España
Institución:Universidad Villanueva (UV)
Repositorio:DDFV. Repositorio Institucional de la Universidad Francisco de Vitoria
Idioma:inglés
OAI Identifier:oai:dnet:ddfv________::8c972495c004e9491ceb8a1b6a9f8512
Acceso en línea:https://hdl.handle.net/10641/7902
Access Level:acceso abierto
Palabra clave:capacity
failure-free
resource
timing
tracheostomy
Pulmonary and Respiratory Medicine
Critical Care and Intensive Care Medicine
Cardiology and Cardiovascular Medicine
Journal Article
Yes
yes
Descripción
Sumario: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.

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