Battaglini Denise, Missale Francesco, Schiavetti Irene, Filauro Marta, Iannuzzi Francesca, Ascoli Alessandro, Bertazzoli Alberto, Pascucci Federico, Grasso Salvatore, Murgolo Francesco, Binda Simone, Maraggia Davide, Montrucchio Giorgia, Sales Gabriele, Pascarella Giuseppe, Agrò Felice Eugenio, Faccio Gaia, Ferraris Sandra, Spadaro Savino, Falò Giulia, Mereto Nadia, Uva Alessandro, Maugeri Jessica Giuseppina, Agrippino Bellissima, Vargas Maria, Servillo Giuseppe, Robba Chiara, Ball Lorenzo, Mora Francesco, Signori Alessio, Torres Antoni, Giacobbe Daniele Roberto, Vena Antonio, Bassetti Matteo, Peretti Giorgio, Rocco Patricia R M, Pelosi Paolo
Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy.
Department of Medicine, University of Barcelona, 08007 Barcelona, Spain.
J Clin Med. 2021 Jun 16;10(12):2651. doi: 10.3390/jcm10122651.
Tracheostomy can be performed safely in patients with coronavirus disease 2019 (COVID-19). However, little is known about the optimal timing, effects on outcome, and complications.
A multicenter, retrospective, observational study. This study included 153 tracheostomized COVID-19 patients from 11 intensive care units (ICUs). The primary endpoint was the median time to tracheostomy in critically ill COVID-19 patients. Secondary endpoints were survival rate, length of ICU stay, and post-tracheostomy complications, stratified by tracheostomy timing (early versus late) and technique (surgical versus percutaneous).
The median time to tracheostomy was 15 (1-64) days. There was no significant difference in survival between critically ill COVID-19 patients who received tracheostomy before versus after day 15, nor between surgical and percutaneous techniques. ICU length of stay was shorter with early compared to late tracheostomy ( < 0.001) and percutaneous compared to surgical tracheostomy ( = 0.050). The rate of lower respiratory tract infections was higher with surgical versus percutaneous technique ( = 0.007).
Among critically ill patients with COVID-19, neither early nor percutaneous tracheostomy improved outcomes, but did shorten ICU stay. Infectious complications were less frequent with percutaneous than surgical tracheostomy.
2019冠状病毒病（COVID-19）患者可安全地进行气管切开术。然而，关于最佳时机、对预后的影响及并发症知之甚少。
一项多中心、回顾性观察研究。本研究纳入了来自11个重症监护病房（ICU）的153例接受气管切开术的COVID-19患者。主要终点是危重症COVID-19患者气管切开术的中位时间。次要终点是生存率、ICU住院时间及气管切开术后并发症，按气管切开术时机（早期与晚期）和技术（手术与经皮）分层。
气管切开术的中位时间为15（1 - 64）天。在第15天之前或之后接受气管切开术的危重症COVID-19患者之间，以及手术和经皮技术之间，生存率无显著差异。与晚期气管切开术相比，早期气管切开术的ICU住院时间更短（<0.001），与手术气管切开术相比，经皮气管切开术的ICU住院时间更短（=0.050）。与经皮技术相比，手术技术导致的下呼吸道感染发生率更高（=0.007）。
在危重症COVID-19患者中，早期或经皮气管切开术均未改善预后，但确实缩短了ICU住院时间。与手术气管切开术相比，经皮气管切开术的感染并发症更少。
