Otorhinolaryngology Department, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, s/n, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
Departament de Ciències Clíniques, Universitat de Barcelona, Carrer de Casanova 143, 08036, Barcelona, Spain.
Eur Arch Otorhinolaryngol. 2022 Jun;279(6):3095-3103. doi: 10.1007/s00405-021-07120-w. Epub 2021 Oct 12.
Analyse the evolution and outcomes of COVID-19 tracheostomised patients. Clarify if this cohort presents an increased risk of haemorrhagic complications and verify the correlation between some risk factors with increased mortality.
A retrospective single-centre observational study of a prospective cohort of all COVID-19 patients admitted to our centre between March and April 2020. A control group was obtained from a historical cohort of patients who required tracheostomy due to prolonged invasive mechanical ventilation (IMV) before 2020.
A total of 1768 patients were included: 67 tracheostomised non-COVID-19 patients (historic cohort), 1371 COVID-19 patients that did not require ICU admission, 266 non-tracheostomised COVID-19 patients and 64 tracheostomised COVID-19 patients. Comparing the obesity prevalence, 54.69% of the tracheostomised COVID-19 patients were obese and 10.53% of the non-tracheostomised COVID-19 patients (p < 0.001). The median of ICU admission days was lower (p < 0.001) in the non-tracheostomised cohort (12.5 days) compared with the COVID-19 tracheostomised cohort (34 days). The incidence of haemorrhagic complications was significantly higher in tracheostomised COVID-19 patients (20.31%) compared with tracheostomised non-COVID-19 patients (5.97%) and presented a higher percentage of obesity, hypertension, diabetes and smoking, significantly different from the historic cohort (p < 0.001). A Cox model showed that tracheostomy had no statistically significant effect on mortality in COVID-19 patients.
Obesity and smoking may be risk factors for tracheostomy in COVID-19 patients, tracheostomised COVID-19 patients present a higher risk of bleeding complications than those admitted for other reasons and an elevated LDH and INR on ICU admission may be associated with increased mortality.
分析 COVID-19 行气管切开术患者的演变和结局。阐明该患者群体是否存在出血并发症风险增加的情况，并验证一些风险因素与死亡率增加之间的相关性。
这是一项回顾性单中心观察性研究，纳入了 2020 年 3 月至 4 月间我院收治的所有 COVID-19 患者的前瞻性队列。通过获取我院在 2020 年前因长时间接受有创机械通气（IMV）而需行气管切开术的患者的历史队列，建立对照组。
共纳入 1768 例患者：67 例行气管切开术的非 COVID-19 患者（历史队列），1371 例无需入住 ICU 的 COVID-19 患者，266 例非气管切开术 COVID-19 患者和 64 例行气管切开术 COVID-19 患者。与非 COVID-19 患者相比，COVID-19 行气管切开术患者中肥胖的比例更高（54.69%），而非气管切开术 COVID-19 患者中肥胖的比例为 10.53%（p＜0.001）。非气管切开术 COVID-19 患者的 ICU 住院天数中位数较低（p＜0.001）（12.5 天），而 COVID-19 气管切开术患者的 ICU 住院天数中位数较高（34 天）。与非 COVID-19 患者相比（20.31%），COVID-19 行气管切开术患者的出血并发症发生率更高（5.97%），并且肥胖、高血压、糖尿病和吸烟的比例更高，与历史队列有显著差异（p＜0.001）。Cox 模型显示，气管切开术对 COVID-19 患者的死亡率无统计学显著影响。
肥胖和吸烟可能是 COVID-19 患者行气管切开术的危险因素，与因其他原因入住 ICU 的患者相比，COVID-19 行气管切开术患者发生出血并发症的风险更高，而 ICU 入院时的 LDH 和 INR 升高可能与死亡率增加有关。
