Emory University School of Medicine, Atlanta, GA, USA.
Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA.
Innovations (Phila). 2023 Sep-Oct;18(5):472-478. doi: 10.1177/15569845231200226.
Obese patients with coronavirus disease 2019 (COVID-19)-associated acute respiratory failure (ARDS) often require prolonged intubation. However, data are sparse regarding optimal tracheostomy timing in obese adults with COVID-19 requiring venovenous extracorporeal membrane oxygenation (VV-ECMO). This study retrospectively describes the course of obese patients with COVID-19 who underwent tracheostomy on VV-ECMO between March 2020 and December 2022.
There were 62 participants with a median age of 43 (interquartile range [IQR] 33 to 53) years and a median body mass index of 42 (IQR 34 to 50) kg/m who received VV-ECMO for COVID-19-associated ARDS. Of those, 42 underwent tracheostomy on VV-ECMO, and 50% ( = 21) of the 42 patients underwent early (within 14 days of initiated ventilatory support) tracheostomy.
Among patients who received tracheostomies, the combined respiratory tract and lung parenchymal bleeding rate was 29% ( = 12), but only 7% required surgical intervention for bleeding from the tracheostomy site ( = 3). The hospital length of stay (LOS) was 42 (IQR 36 to 57) days, and mortality rate was 38% ( = 16). Tracheostomy timing was not associated with differences in respiratory tract bleeding, mechanical ventilatory support duration, VV-ECMO support duration, intensive care unit LOS, hospital LOS, mortality, or survival probability.
Although an individualized and holistic approach to clinical decision making continues to be necessary, the findings of this study suggest that early tracheostomy may be performed safely in obese patients with COVID-19 on VV-ECMO.
患有 2019 年冠状病毒病（COVID-19）相关急性呼吸衰竭（ARDS）的肥胖患者通常需要长时间插管。然而，关于肥胖 COVID-19 患者在需要静脉-静脉体外膜肺氧合（VV-ECMO）的情况下进行气管切开术的最佳时机的数据很少。本研究回顾性描述了 2020 年 3 月至 2022 年 12 月期间在 VV-ECMO 上接受气管切开术的肥胖 COVID-19 患者的病程。
共有 62 名参与者，中位年龄为 43 岁（四分位距 [IQR] 33 至 53），中位体重指数为 42（IQR 34 至 50）kg/m2，因 COVID-19 相关 ARDS 接受 VV-ECMO。其中，42 名患者在 VV-ECMO 上接受了气管切开术，42 名患者中有 50%（=21）接受了早期（在开始通气支持的 14 天内）气管切开术。
在接受气管切开术的患者中，联合呼吸道和肺实质出血率为 29%（=12），但只有 7%（=3）的患者因气管切开部位出血需要手术干预。住院时间（LOS）为 42（IQR 36 至 57）天，死亡率为 38%（=16）。气管切开术时机与呼吸道出血、机械通气支持时间、VV-ECMO 支持时间、重症监护病房 LOS、住院 LOS、死亡率或生存率无差异。
尽管继续需要个体化和整体的临床决策方法，但本研究的结果表明，肥胖 COVID-19 患者在 VV-ECMO 上可以安全地进行早期气管切开术。
