Timing, Complications, and Safety of Tracheotomy in Critically Ill Patients With COVID-19
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Le résumé fourni par la source
IMPORTANCE: The current coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented needs for invasive ventilation, with 10% to 15% of intubated patients subsequently requiring tracheotomy. OBJECTIVE: To assess the complications, safety, and timing of tracheotomy performed for critically ill patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study assessed consecutive patients admitted to the intensive care unit (ICU) who had COVID-19 that required tracheotomy. Patients were recruited from March 16 to April 10, 2020, at a tertiary referral center. EXPOSURES: A surgical tracheotomy was performed for all patients following recommended criteria for use of personal protective equipment (PPE). MAIN OUTCOMES AND MEASURES: The number of subthyroid operations, the tracheal entrance protocol, and use of PPE. Infections among the surgeons were monitored weekly by reverse-transcriptase polymerase chain reaction of nasopharyngeal swab samples. Short-term complications, weaning, and the association of timing of tracheotomy (early [≤10 days] vs late [>10 days]) with total required days of invasive ventilation were assessed. RESULTS: A total of 50 patients (mean [SD] age, 63.8 [9.2] years; 33 [66%] male) participated in the study. All tracheotomies were performed at the bedside. The median time from intubation to tracheotomy was 9 days (interquartile range, 2-24 days). A subthyroid approach was completed for 46 patients (92%), and the tracheal protocol was adequately achieved for 40 patients (80%). Adequate PPE was used, with no infection among surgeons identified 4 weeks after the last tracheotomy. Postoperative complications were rare, with minor bleeding (in 6 patients [12%]) being the most common complication. The successful weaning rate was higher in the early tracheotomy group than in the late tracheotomy group (adjusted hazard ratio, 2.55; 95% CI, 0.96-6.75), but the difference was not statistically significant. There was less time of invasive mechanical ventilatory support with early tracheotomy compared with late tracheotomy (mean [SD], 18 [5.4] vs 22.3 [5.7] days). The reduction of invasive ventilatory support was achieved at the expense of the pretracheotomy period. CONCLUSIONS AND RELEVANCE: In this cohort study, with the use of a standardized protocol aimed at minimizing COVID-19 risks, bedside open tracheotomy was a safe procedure for patients and surgeons, with minimal complications. Timing of tracheotomy may be important in reducing time of invasive mechanical ventilation, with potential implications to intensive care unit availability during the COVID-19 pandemic.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Timing, Complications, and Safety of Tracheotomy in Critically Ill Patients With COVID-19
- Date Crossref
- 01/01/2021
- Éditeur
- American Medical Association (AMA)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Agència de Gestió d'Ajuts Universitaris i de Recerca pays non établi dans la noticeOrganisme public
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Hospital Clínic de Barcelona pays non établi dans la noticeÉtablissement de santé
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Consorci Institut D'Investigacions Biomediques August Pi I Sunyer pays non établi dans la noticeStructure de recherche
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Universitat de Barcelona Departament de Cirurgia i Especialitats Mèdico-Quirúrgiques pays non établi dans la noticeUniversité ou école supérieure
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Nuffield Orthopaedic Centre pays non établi dans la noticeÉtablissement de santé
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University of Oxford and Musculoskeletal Sciences pays non établi dans la noticeUniversité ou école supérieure
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Centro de Investigación Biomédica en Red de Enfermedades Respiratorias pays non établi dans la noticeStructure de recherche
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Universitat de València pays non établi dans la noticeUniversité ou école supérieure
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Head Neck Clínic pays non établi dans la noticeÉtablissement de santé
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Otorhinolaryngology Head Neck Surgery Department pays non établi dans la noticeOrganisation à but non lucratif
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Centro de Investigación Biomédica en Red sobre Enfermedades Respiratorias pays non établi dans la noticeInstitution
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Otorhinolaryngology Division pays non établi dans la noticeOrganisation à but non lucratif
Agència de Gestió d'Ajuts Universitaris i de Recerca, Hospital Clínic de Barcelona et Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.