Br J Anaesth. 2020 Dec;125(6):872-879. doi: 10.1016/j.bja.2020.08.023. Epub 2020 Aug 28.
The role of tracheostomy in coronavirus disease 2019 (COVID-19) is unclear, with several consensus guidelines advising against this practice. We developed both a dedicated airway team and coordinated education programme to facilitate ward management of tracheostomised COVID-19 patients. Here, we report outcomes in the first 100 COVID-19 patients who underwent tracheostomy at our institution.
This was a prospective observational cohort study of patients confirmed to have COVID-19 who required mechanical ventilation at Queen Elizabeth Hospital, Birmingham, UK. The primary outcome measure was 30-day survival, accounting for severe organ dysfunction (Acute Physiology and Chronic Health [APACHE]-II score>17). Secondary outcomes included duration of ventilation, ICU stay, and healthcare workers directly involved in tracheostomy care acquiring COVID-19.
A total of 164 patients with COVID-19 were admitted to the ICU between March 9, 2020 and April 21, 2020. A total of 100 patients (mean [standard deviation] age: 55 [12] yr; 29% female) underwent tracheostomy; 64 (age: 57 [14] yr; 25% female) did not undergo tracheostomy. Despite similar APACHE-II scores, 30-day survival was higher in 85/100 (85%) patients after tracheostomy, compared with 27/64 (42%) non-tracheostomised patients {relative risk: 3.9 (95% confidence intervals [CI]: 2.3-6.4); P<0.0001}. In patients with APACHE-II scores ≥17, 68/100 (68%) tracheotomised patients survived, compared with 12/64 (19%) non-tracheotomised patients (P<0.001). Tracheostomy within 14 days of intubation was associated with shorter duration of ventilation (mean difference: 6.0 days [95% CI: 3.1-9.0]; P<0.0001) and ICU stay (mean difference: 6.7 days [95% CI: 3.7-9.6]; P<0.0001). No healthcare workers developed COVID-19.
Independent of the severity of critical illness from COVID-19, 30-day survival was higher and ICU stay shorter in patients receiving tracheostomy. Early tracheostomy appears to be safe in COVID-19.
在 2019 年冠状病毒病（COVID-19）中，气管切开术的作用尚不清楚，有几个共识指南建议不要进行这种手术。我们专门成立了一个气道团队并协调了教育计划，以促进对 COVID-19 气管切开患者的病房管理。在此，我们报告了在我们机构接受气管切开术的前 100 名 COVID-19 患者的结果。
这是一项对在英国伯明翰伊丽莎白女王医院接受机械通气的确诊 COVID-19 患者进行的前瞻性观察队列研究。主要观察指标是 30 天生存率，包括严重器官功能障碍（急性生理学和慢性健康[APACHE]-II 评分>17）。次要结果包括通气时间、重症监护病房（ICU）住院时间和直接参与气管切开护理的医护人员感染 COVID-19。
2020 年 3 月 9 日至 4 月 21 日期间，共有 164 名 COVID-19 患者入住 ICU。共有 100 名患者（平均[标准差]年龄：55[12]岁；29%为女性）接受了气管切开术；64 名（年龄：57[14]岁；25%为女性）未接受气管切开术。尽管 APACHE-II 评分相似，但接受气管切开术的 85/100（85%）患者在 30 天后的生存率高于未接受气管切开术的 27/64（42%）患者{相对风险：3.9（95%置信区间[CI]：2.3-6.4）；P<0.0001}。在 APACHE-II 评分≥17 的患者中，接受气管切开术的 68/100（68%）患者存活，而未接受气管切开术的 64 名患者中仅 12 名存活（P<0.001）。插管后 14 天内进行气管切开术与通气时间（平均差异：6.0 天[95%CI：3.1-9.0]；P<0.0001）和 ICU 住院时间（平均差异：6.7 天[95%CI：3.7-9.6]；P<0.0001）缩短有关。没有医护人员感染 COVID-19。
无论 COVID-19 导致的疾病严重程度如何，接受气管切开术的患者 30 天生存率更高，ICU 住院时间更短。COVID-19 患者早期进行气管切开术似乎是安全的。
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