Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study

Constance S. Harrell Shreckengost; Jorge Esteban Foianini; Karen Milenka Moron Encinas; Hugo Tola Guarachi; Katrina Abril; Dina Amin; David Berkowitz; Christine Aisha Castater; J. Miller Douglas; April A. Grant; Onkar Vohra Khullar; Andrea Nichole Lane; Alice Lin; Abesh Niroula; Azhar Nizam; Ammar Rashied; Alexandra W. Reitz; Steven M. Roser; Julia Spychalski; Sérgio Samir Arap; Ricardo Ferreira Bento; Pedro Prosperi Desenzi Ciaralo; Rui Imamura; Luiz Paulo Kowalski; Ali Mahmoud; Alessandro Wasum Mariani; Carlos Augusto Metidieri Menegozzo; Hélio Minamoto; Fábio Luiz M. Montenegro; Paulo Manoel Pêgo-Fernandes; Jones Santos; Edivaldo Massozo Utiyama; Jithin K. Sreedharan; Or Kalchiem-Dekel; Jonathan Nguyen; Rohan K. Dhamsania; Kerianne Allen; Adrian Modzik; Vikas Pathak; Cheryl White; Juan Blas; Issa Talal El-Abur; Gabriel Tirado; Carlos Yánez Benítez; Thomas G. Weiser; Mark Barry; Marissa Boeck; Michael Farrell; Anya Greenberg; Phoebe Miller; Paul Park; Maraya Camazine; Deidre Dillon; Randi N. Smith

doi:10.1097/CCE.0000000000000796

Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study

Constance S. Harrell Shreckengost, Jorge Esteban Foianini, Karen Milenka Moron Encinas, Hugo Tola Guarachi, Katrina Abril, Dina Amin, David Berkowitz, Christine Aisha Castater, J. Miller Douglas, April A. Grant, Onkar Vohra Khullar, Andrea Nichole Lane, Alice Lin, Abesh Niroula, Azhar Nizam, Ammar Rashied, Alexandra W. Reitz, Steven M. Roser, Julia Spychalski, Sérgio Samir ArapRicardo Ferreira Bento, Pedro Prosperi Desenzi Ciaralo, Rui Imamura, Luiz Paulo Kowalski, Ali Mahmoud, Alessandro Wasum Mariani, Carlos Augusto Metidieri Menegozzo, Hélio Minamoto, Fábio Luiz M. Montenegro, Paulo Manoel Pêgo-Fernandes, Jones Santos, Edivaldo Massozo Utiyama, Jithin K. Sreedharan, Or Kalchiem-Dekel, Jonathan Nguyen, Rohan K. Dhamsania, Kerianne Allen, Adrian Modzik, Vikas Pathak, Cheryl White, Juan Blas, Issa Talal El-Abur, Gabriel Tirado, Carlos Yánez Benítez, Thomas G. Weiser, Mark Barry, Marissa Boeck, Michael Farrell, Anya Greenberg, Phoebe Miller, Paul Park, Maraya Camazine, Deidre Dillon, Randi N. Smith

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

OBJECTIVES: Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient outcomes and alleviate resource shortages. This study compares outcomes in a diverse population of hospitalized COVID-19 patients who underwent tracheostomy either "early"(within 14 d of intubation) or "late"(more than 14 d after intubation). DESIGN: International multi-institute retrospective cohort study. SETTING: Thirteen hospitals in Bolivia, Brazil, Spain, and the United States. PATIENTS: Hospitalized patients with COVID-19 undergoing early or late tracheostomy between March 1, 2020, and March 31, 2021. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: A total of 549 patients from 13 hospitals in four countries were included in the final analysis. Multivariable regression analysis showed that early tracheostomy was associated with a 12-day decrease in time on mechanical ventilation (95% CI, -16 to -8; p < 0.001). Further, ICU and hospital lengths of stay in patients undergoing early tracheostomy were 15 days (95% CI, -23 to -9 d; p < 0.001) and 22 days (95% CI, -31 to -12 d) shorter, respectively. In contrast, early tracheostomy patients experienced lower risk-adjusted survival at 30-day post-admission (hazard ratio, 3.0; 95% CI, 1.8-5.2). Differences in 90-day post-admission survival were not identified. CONCLUSIONS: COVID-19 patients undergoing tracheostomy within 14 days of intubation have reduced ventilator dependence as well as reduced lengths of stay. However, early tracheostomy patients experienced lower 30-day survival. Future efforts should identify patients most likely to benefit from early tracheostomy while accounting for location-specific capacity.

Original language	English
Pages (from-to)	E0796
Journal	Critical Care Explorations
Volume	4
Issue number	11
DOIs	https://doi.org/10.1097/CCE.0000000000000796
State	Published - 21 Nov 2022
Externally published	Yes

Keywords

airway management
length of stay
mechanical ventilators
pandemics
survival

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1097/CCE.0000000000000796

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Harrell Shreckengost, C. S., Foianini, J. E., Moron Encinas, K. M., Tola Guarachi, H., Abril, K., Amin, D., Berkowitz, D., Castater, C. A., Douglas, J. M., Grant, A. A., Khullar, O. V., Lane, A. N., Lin, A., Niroula, A., Nizam, A., Rashied, A., Reitz, A. W., Roser, S. M., Spychalski, J., ... Smith, R. N. (2022). Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study. Critical Care Explorations, 4(11), E0796. https://doi.org/10.1097/CCE.0000000000000796

@article{733a2a0f61f5480db993302824a1c2ad,

title = "Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study",

abstract = "OBJECTIVES: Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient outcomes and alleviate resource shortages. This study compares outcomes in a diverse population of hospitalized COVID-19 patients who underwent tracheostomy either {"}early{"}(within 14 d of intubation) or {"}late{"}(more than 14 d after intubation). DESIGN: International multi-institute retrospective cohort study. SETTING: Thirteen hospitals in Bolivia, Brazil, Spain, and the United States. PATIENTS: Hospitalized patients with COVID-19 undergoing early or late tracheostomy between March 1, 2020, and March 31, 2021. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: A total of 549 patients from 13 hospitals in four countries were included in the final analysis. Multivariable regression analysis showed that early tracheostomy was associated with a 12-day decrease in time on mechanical ventilation (95\% CI, -16 to -8; p < 0.001). Further, ICU and hospital lengths of stay in patients undergoing early tracheostomy were 15 days (95\% CI, -23 to -9 d; p < 0.001) and 22 days (95\% CI, -31 to -12 d) shorter, respectively. In contrast, early tracheostomy patients experienced lower risk-adjusted survival at 30-day post-admission (hazard ratio, 3.0; 95\% CI, 1.8-5.2). Differences in 90-day post-admission survival were not identified. CONCLUSIONS: COVID-19 patients undergoing tracheostomy within 14 days of intubation have reduced ventilator dependence as well as reduced lengths of stay. However, early tracheostomy patients experienced lower 30-day survival. Future efforts should identify patients most likely to benefit from early tracheostomy while accounting for location-specific capacity.",

keywords = "airway management, length of stay, mechanical ventilators, pandemics, survival",

author = "\{Harrell Shreckengost\}, \{Constance S.\} and Foianini, \{Jorge Esteban\} and \{Moron Encinas\}, \{Karen Milenka\} and \{Tola Guarachi\}, Hugo and Katrina Abril and Dina Amin and David Berkowitz and Castater, \{Christine Aisha\} and Douglas, \{J. Miller\} and Grant, \{April A.\} and Khullar, \{Onkar Vohra\} and Lane, \{Andrea Nichole\} and Alice Lin and Abesh Niroula and Azhar Nizam and Ammar Rashied and Reitz, \{Alexandra W.\} and Roser, \{Steven M.\} and Julia Spychalski and Arap, \{S{\'e}rgio Samir\} and Bento, \{Ricardo Ferreira\} and Ciaralo, \{Pedro Prosperi Desenzi\} and Rui Imamura and Kowalski, \{Luiz Paulo\} and Ali Mahmoud and Mariani, \{Alessandro Wasum\} and Menegozzo, \{Carlos Augusto Metidieri\} and H{\'e}lio Minamoto and Montenegro, \{F{\'a}bio Luiz M.\} and P{\^e}go-Fernandes, \{Paulo Manoel\} and Jones Santos and Utiyama, \{Edivaldo Massozo\} and Sreedharan, \{Jithin K.\} and Or Kalchiem-Dekel and Jonathan Nguyen and Dhamsania, \{Rohan K.\} and Kerianne Allen and Adrian Modzik and Vikas Pathak and Cheryl White and Juan Blas and \{Talal El-Abur\}, Issa and Gabriel Tirado and \{Y{\'a}nez Ben{\'i}tez\}, Carlos and Weiser, \{Thomas G.\} and Mark Barry and Marissa Boeck and Michael Farrell and Anya Greenberg and Phoebe Miller and Paul Park and Maraya Camazine and Deidre Dillon and Smith, \{Randi N.\}",

note = "Publisher Copyright: Copyright {\textcopyright} 2022 The Authors. Published by Wolters Kluwer Health, Inc.",

year = "2022",

month = nov,

day = "21",

doi = "10.1097/CCE.0000000000000796",

language = "English",

volume = "4",

pages = "E0796",

journal = "Critical Care Explorations",

issn = "2639-8028",

publisher = "Lippincott Williams and Wilkins",

number = "11",

}

Harrell Shreckengost, CS, Foianini, JE, Moron Encinas, KM, Tola Guarachi, H, Abril, K, Amin, D, Berkowitz, D, Castater, CA, Douglas, JM, Grant, AA, Khullar, OV, Lane, AN, Lin, A, Niroula, A, Nizam, A, Rashied, A, Reitz, AW, Roser, SM, Spychalski, J, Arap, SS, Bento, RF, Ciaralo, PPD, Imamura, R, Kowalski, LP, Mahmoud, A, Mariani, AW, Menegozzo, CAM, Minamoto, H, Montenegro, FLM, Pêgo-Fernandes, PM, Santos, J, Utiyama, EM, Sreedharan, JK, Kalchiem-Dekel, O, Nguyen, J, Dhamsania, RK, Allen, K, Modzik, A, Pathak, V, White, C, Blas, J, Talal El-Abur, I, Tirado, G, Yánez Benítez, C, Weiser, TG, Barry, M, Boeck, M, Farrell, M, Greenberg, A, Miller, P, Park, P, Camazine, M, Dillon, D & Smith, RN 2022, 'Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study', Critical Care Explorations, vol. 4, no. 11, pp. E0796. https://doi.org/10.1097/CCE.0000000000000796

TY - JOUR

T1 - Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19

T2 - A Multinational Cohort Study

AU - Harrell Shreckengost, Constance S.

AU - Foianini, Jorge Esteban

AU - Moron Encinas, Karen Milenka

AU - Tola Guarachi, Hugo

AU - Abril, Katrina

AU - Amin, Dina

AU - Berkowitz, David

AU - Castater, Christine Aisha

AU - Douglas, J. Miller

AU - Grant, April A.

AU - Khullar, Onkar Vohra

AU - Lane, Andrea Nichole

AU - Lin, Alice

AU - Niroula, Abesh

AU - Nizam, Azhar

AU - Rashied, Ammar

AU - Reitz, Alexandra W.

AU - Roser, Steven M.

AU - Spychalski, Julia

AU - Arap, Sérgio Samir

AU - Bento, Ricardo Ferreira

AU - Ciaralo, Pedro Prosperi Desenzi

AU - Imamura, Rui

AU - Kowalski, Luiz Paulo

AU - Mahmoud, Ali

AU - Mariani, Alessandro Wasum

AU - Menegozzo, Carlos Augusto Metidieri

AU - Minamoto, Hélio

AU - Montenegro, Fábio Luiz M.

AU - Pêgo-Fernandes, Paulo Manoel

AU - Santos, Jones

AU - Utiyama, Edivaldo Massozo

AU - Sreedharan, Jithin K.

AU - Kalchiem-Dekel, Or

AU - Nguyen, Jonathan

AU - Dhamsania, Rohan K.

AU - Allen, Kerianne

AU - Modzik, Adrian

AU - Pathak, Vikas

AU - White, Cheryl

AU - Blas, Juan

AU - Talal El-Abur, Issa

AU - Tirado, Gabriel

AU - Yánez Benítez, Carlos

AU - Weiser, Thomas G.

AU - Barry, Mark

AU - Boeck, Marissa

AU - Farrell, Michael

AU - Greenberg, Anya

AU - Miller, Phoebe

AU - Park, Paul

AU - Camazine, Maraya

AU - Dillon, Deidre

AU - Smith, Randi N.

PY - 2022/11/21

Y1 - 2022/11/21

N2 - OBJECTIVES: Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient outcomes and alleviate resource shortages. This study compares outcomes in a diverse population of hospitalized COVID-19 patients who underwent tracheostomy either "early"(within 14 d of intubation) or "late"(more than 14 d after intubation). DESIGN: International multi-institute retrospective cohort study. SETTING: Thirteen hospitals in Bolivia, Brazil, Spain, and the United States. PATIENTS: Hospitalized patients with COVID-19 undergoing early or late tracheostomy between March 1, 2020, and March 31, 2021. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: A total of 549 patients from 13 hospitals in four countries were included in the final analysis. Multivariable regression analysis showed that early tracheostomy was associated with a 12-day decrease in time on mechanical ventilation (95% CI, -16 to -8; p < 0.001). Further, ICU and hospital lengths of stay in patients undergoing early tracheostomy were 15 days (95% CI, -23 to -9 d; p < 0.001) and 22 days (95% CI, -31 to -12 d) shorter, respectively. In contrast, early tracheostomy patients experienced lower risk-adjusted survival at 30-day post-admission (hazard ratio, 3.0; 95% CI, 1.8-5.2). Differences in 90-day post-admission survival were not identified. CONCLUSIONS: COVID-19 patients undergoing tracheostomy within 14 days of intubation have reduced ventilator dependence as well as reduced lengths of stay. However, early tracheostomy patients experienced lower 30-day survival. Future efforts should identify patients most likely to benefit from early tracheostomy while accounting for location-specific capacity.

AB - OBJECTIVES: Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient outcomes and alleviate resource shortages. This study compares outcomes in a diverse population of hospitalized COVID-19 patients who underwent tracheostomy either "early"(within 14 d of intubation) or "late"(more than 14 d after intubation). DESIGN: International multi-institute retrospective cohort study. SETTING: Thirteen hospitals in Bolivia, Brazil, Spain, and the United States. PATIENTS: Hospitalized patients with COVID-19 undergoing early or late tracheostomy between March 1, 2020, and March 31, 2021. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: A total of 549 patients from 13 hospitals in four countries were included in the final analysis. Multivariable regression analysis showed that early tracheostomy was associated with a 12-day decrease in time on mechanical ventilation (95% CI, -16 to -8; p < 0.001). Further, ICU and hospital lengths of stay in patients undergoing early tracheostomy were 15 days (95% CI, -23 to -9 d; p < 0.001) and 22 days (95% CI, -31 to -12 d) shorter, respectively. In contrast, early tracheostomy patients experienced lower risk-adjusted survival at 30-day post-admission (hazard ratio, 3.0; 95% CI, 1.8-5.2). Differences in 90-day post-admission survival were not identified. CONCLUSIONS: COVID-19 patients undergoing tracheostomy within 14 days of intubation have reduced ventilator dependence as well as reduced lengths of stay. However, early tracheostomy patients experienced lower 30-day survival. Future efforts should identify patients most likely to benefit from early tracheostomy while accounting for location-specific capacity.

KW - airway management

KW - length of stay

KW - mechanical ventilators

KW - pandemics

KW - survival

UR - https://www.scopus.com/pages/publications/85143086352

U2 - 10.1097/CCE.0000000000000796

DO - 10.1097/CCE.0000000000000796

M3 - Article

AN - SCOPUS:85143086352

SN - 2639-8028

VL - 4

SP - E0796

JO - Critical Care Explorations

JF - Critical Care Explorations

IS - 11

ER -

Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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