Abunasser Jafar J, Perez Oscar, Wang Xiaofeng, Wang Yifan, Khouli Hassan, Duggal Abhijit
Respiratory Institute, Department of Critical Care, Cleveland Clinic, Cleveland, OH.
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
Crit Care Explor. 2023 Aug 2;5(8):e0951. doi: 10.1097/CCE.0000000000000951. eCollection 2023 Aug.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease it causes (COVID-19) have resulted in an increase in critical illness and in the prevalence of acute respiratory failure with the need for tracheostomy. The characteristics and long-term outcomes of this patient cohort are not well identified.
What are the characteristics of patients who develop the need for tracheostomy due to SARS-CoV-2 with acute respiratory distress syndrome (ARDS)? What is their 90-day and 1-year survival and are there any identifiable risk factors for mortality and ventilator dependency?
Retrospective, follow-up cohort study of adult patients with COVID-19 infection and ARDS who required tracheostomy placement in a large healthcare system.
One hundred sixty-four consecutive patients with SARS-CoV-2 admitted to ICUs for ARDS who required tracheostomy placement between March 2020 and March 2021 were identified. One hundred nine (66.5%) were male. Average age was 63.5 years. The most common comorbidities were obesity, hypertension, diabetes mellitus, congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease (COPD), atrial fibrillation, and asthma. The most common complications during hospitalization were delirium, secondary infections, acute kidney injury, pneumothorax, and venous thromboembolism. Ninety-day and 1-year mortality were 29.9% and 44.5%, respectively. Ninety-six patients (58.5%) were liberated from the ventilator, and 84 (51.2%) had the tracheostomy tube decannulated. Asthma, COPD, atrial fibrillation, and renal replacement therapy requirement in the ICU correlated with increased risk of ventilator dependency. Among survivors at 1 year, 71 patients (43.3%) were residing at home and 20 patients (12.2%) remained in a skilled nursing facility.
COVID-19 has resulted in a significant burden of acute critical illness and acute respiratory failure with the need for tracheostomy. A significant percentage of patients with SARS-CoV-2 requiring tracheostomy were alive and at home 1 year after tracheostomy placement. Long-term care support, including tracheostomy, beyond 90 days appears to be beneficial in this patient population and warrants further investigation.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）及其引发的疾病（COVID-19）导致危重病增加以及急性呼吸衰竭患病率上升，从而需要进行气管切开术。这一患者群体的特征和长期预后尚未得到充分明确。
因SARS-CoV-2导致急性呼吸窘迫综合征（ARDS）而需要气管切开术的患者有哪些特征？他们90天和1年的生存率如何，是否存在可识别的死亡和呼吸机依赖风险因素？
对在一个大型医疗系统中因COVID-19感染和ARDS而需要进行气管切开术的成年患者进行回顾性随访队列研究。
确定了2020年3月至2021年3月期间连续164例因ARDS入住重症监护病房（ICU）且需要进行气管切开术的SARS-CoV-2患者。其中109例（66.5%）为男性。平均年龄为63.5岁。最常见的合并症为肥胖、高血压、糖尿病、充血性心力衰竭、慢性肾脏病、慢性阻塞性肺疾病（COPD）、心房颤动和哮喘。住院期间最常见的并发症为谵妄、继发感染、急性肾损伤、气胸和静脉血栓栓塞。90天和1年死亡率分别为29.9%和44.5%。96例患者（58.5%）脱机，84例患者（51.2%）气管切开管拔管。哮喘、COPD、心房颤动以及ICU中需要肾脏替代治疗与呼吸机依赖风险增加相关。在1年幸存者中，71例患者（43.3%）居家，20例患者（12.2%）仍住在专业护理机构。
COVID-19导致了急性危重病和急性呼吸衰竭的重大负担，从而需要进行气管切开术。相当比例的需要气管切开术的SARS-CoV-2患者在气管切开术后1年仍存活且居家。超过90天的长期护理支持，包括气管切开术，似乎对该患者群体有益，值得进一步研究。
