Characteristics and Outcomes of Tracheostomized Patients With and Without COVID-19

Jeeyune Bahk; Bridget Dolan; Venus Sharma; Mantej Sehmbhi; Jennifer Y Fung; Young Im Lee

doi:10.1097/CCE.0000000000000950

Characteristics and Outcomes of Tracheostomized Patients With and Without COVID-19

Crit Care Explor. 2023 Aug 3;5(8):e0950. doi: 10.1097/CCE.0000000000000950. eCollection 2023 Aug.

Authors

Jeeyune Bahk¹, Bridget Dolan², Venus Sharma¹, Mantej Sehmbhi¹, Jennifer Y Fung³, Young Im Lee⁴

Affiliations

¹ Department of Medicine, Mount Sinai Morningside and Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY.
² Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY.
³ Division of Pulmonary and Critical Care, Department of Medicine, Mount Sinai Morningside, Icahn School of Medicine at Mount Sinai, New York, NY.
⁴ Division of Pulmonary and Critical Care, Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, NY.

Abstract

Outcomes of tracheostomized patients with COVID-19 are seldomly investigated with conflicting evidence from the existing literature.

Objectives: To create a study evaluating the impact of COVID-19 on tracheostomized patients by comparing clinical outcomes and weaning parameters in COVID-19 positive and negative cohorts.

Design setting and participants: A retrospective observational cohort study of 604 tracheostomized patients hospitalized in 16 ICUs in New York City between March 9, 2020, and September 8, 2021.

Main outcomes and measures: Patients were stratified into two cohorts: 398 COVID-19 negative (COVID-ve) and 206 COVID-19 positive (COVID+ve) patients. Clinical characteristics, outcomes, and weaning parameters (first pressure support [PS], tracheostomy collar [TC], speech valve placement, and decannulation) were analyzed.

Results: COVID+ve had fewer comorbidities including coronary artery disease, congestive heart failure, malignancy, chronic kidney disease, liver disease, and HIV (p < 0.05). Higher Fio₂ (53% vs 44%), positive end-expiratory pressure (PEEP) (7.15 vs 5.69), Pco₂ (45.8 vs 38.2), and lower pH (7.41 vs 7.43) were observed at the time of tracheostomy in COVID+ve (p < 0.005). There was no statistical difference in post-tracheostomy complication rates. Longer time from intubation to tracheostomy (15.90 vs 13.60 d; p = 0.002), tracheostomy to first PS (2.87 vs 1.80 d; p = 0.005), and TC placement (11.07 vs 4.46 d; p < 0.001) were seen in COVID+ve. However, similar time to speech valve placement, decannulation, and significantly lower 1-year mortality (23.3% vs 36.7%; p = 0.001) with higher number of discharges to long-term acute care hospital (LTACH) (23.8% vs 13.6%; p = 0.015) were seen in COVID+ve.

Conclusions and relevance: Patients with COVID-19 required higher Fio₂ and PEEP ventilatory support at the time of tracheostomy, with no observed change in complication rates. Despite longer initial weaning period with PS or TC, similar time to speech valve placement or decannulation with significantly lower mortality and higher LTACH discharges suggest favorable outcome in COVID-19 positive patients. Higher ventilatory support requirements and prolonged weaning should not be a deterrent to pursuing a tracheostomy.

Keywords: COVID-19; decannulation; tracheostomy; ventilator weaning; weaning parameters.