BMJ Surg Interv Health Technol. 2021 Jul;3(1):e000077. doi: 10.1136/bmjsit-2020-000077. Epub 2021 Jul 8.
COVIDTrach is a UK multicentre prospective cohort study project that aims to evaluate the outcomes of tracheostomy in patients with COVID-19 receiving mechanical ventilation and record the incidence of SARS-CoV-2 infection among healthcare workers involved in the procedure.
Data on patient demographic, clinical history and outcomes were entered prospectively and updated over time via an online database (REDCap). Clinical variables were compared with outcomes, with logistic regression used to develop a model for mortality. Participants recorded whether any operators tested positive for SARS-CoV-2 within 2 weeks of the procedure.
UK National Health Service departments involved in treating patients with COVID-19 receiving mechanical ventilation.
The cohort comprised 1605 tracheostomy cases from 126 UK hospitals collected between 6 April and 26 August 2020.
Mortality following tracheostomy, successful wean from mechanical ventilation and length of time from tracheostomy to wean, discharge from hospital, complications from tracheostomy, reported SARS-CoV-2 infection among operators.
The median time from intubation to tracheostomy was 15 days (IQR 11, 21). 285 (18%) patients died following the procedure. 1229 (93%) of the survivors had been successfully weaned from mechanical ventilation at censoring and 1049 (81%) had been discharged from hospital. Age, inspired oxygen concentration, positive end-expiratory pressure setting, fever, number of days of ventilation before tracheostomy, C reactive protein and the use of anticoagulation and inotropic support independently predicted mortality. Six reports were received of operators testing positive for SARS-CoV-2 within 2 weeks of the procedure.
Tracheostomy appears to be safe in mechanically ventilated patients with COVID-19 and to operators performing the procedure and we identified clinical parameters that are predictive of mortality.
The study is registered with ClinicalTrials.Gov (NCT04572438).
COVIDTrach是一项英国多中心前瞻性队列研究项目，旨在评估接受机械通气的新冠肺炎患者气管切开术的结果，并记录参与该手术的医护人员中感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的发生率。
前瞻性录入患者人口统计学、临床病史和结果数据，并通过在线数据库（REDCap）随时间更新。将临床变量与结果进行比较，使用逻辑回归建立死亡率模型。参与者记录手术2周内是否有任何手术人员的SARS-CoV-2检测呈阳性。
参与治疗接受机械通气的新冠肺炎患者的英国国民医疗服务体系部门。
该队列包括2020年4月6日至8月26日期间从英国126家医院收集的1605例气管切开术病例。
气管切开术后的死亡率、成功脱机、从气管切开术到脱机的时间、出院、气管切开术并发症、报告的手术人员SARS-CoV-2感染情况。
从插管到气管切开术的中位时间为15天（四分位间距11，21）。285例（18%）患者术后死亡。1229例（93%）幸存者在审查时已成功脱机，1049例（81%）已出院。年龄、吸入氧浓度、呼气末正压设置、发热、气管切开术前通气天数、C反应蛋白以及抗凝和血管活性药物支持的使用独立预测死亡率。收到6份报告，称手术人员在手术2周内SARS-CoV-2检测呈阳性。
气管切开术对于接受机械通气的新冠肺炎患者以及实施该手术的人员似乎是安全的，并且我们确定了可预测死亡率的临床参数。
该研究已在ClinicalTrials.Gov注册（NCT04572438）。
