Al Balushi Yasir, Burad Jyoti
Anesthesia and Intensive Care, Sultan Qaboos University Hospital, Muscat, OMN.
Cureus. 2024 Jul 13;16(7):e64481. doi: 10.7759/cureus.64481. eCollection 2024 Jul.
Background Tracheostomy is a common intervention for intensive care unit (ICU) patients for various reasons. The superiority of early versus late tracheostomy is still unfounded for non-COVID-19 cases. The COVID-19 pandemic complicated the matter, as little literature was available on the ideal timing of tracheostomy for patients with COVID-19. Research question This study aimed to establish the superiority of early or late tracheostomy for COVID-19 and non-COVID-19 cases by comparing outcomes, including ICU mortality, ventilation days after tracheostomy, and ICU length of stay (LOS). Study design and methods A single-center retrospective cohort study was conducted on ventilated ICU patients both with and without COVID-19 at a university hospital between January 2020 and December 2021. During the study period, 1,393 ventilated patients were scanned, and 156 were found to be tracheostomized. Tracheostomy was considered to be early when performed within 10 days of intubation, after which it was considered to be late. Results Tracheostomy was performed early for 84/156 (53.8%) of tracheostomized patients and late for 72/156 (46.2%) of patients. The overall mortality was 42.9% (36/84) versus 69.4% (50/72) (P=0.001, OR=3.03, 95% CI=1.563-5.874), 31.4% versus 65.5% in the non-COVID-19 group and 60.6% versus 72.1% (P=0.005, OR=2.640, 95% CI=1.345-5.181) in the COVID-19 group for the early and late tracheostomy groups, respectively. Ventilation days were higher for the late tracheostomy group than for the early tracheostomy group in the non-COVID-19 group (17.10 versus 9.18 days, P<0.001). However, it was almost the same for the early and late tracheostomy groups in the COVID-19 group (14.15 versus 13.86 days, P=0.821). The ICU LOS was greater for the late tracheostomy group for both the COVID-19 and non-COVID-19 groups. Multivariate analysis revealed that ICU mortality is significantly associated with age, ventilation days, and ICU LOS. Interpretation The results of this study indicate that early tracheostomy was associated with lower mortality, fewer ventilation days, and shorter LOS in both the COVID-19 and non-COVID-19 groups.
由于各种原因，气管切开术是重症监护病房（ICU）患者常见的干预措施。对于非新冠病毒疾病（COVID-19）病例，早期气管切开术与晚期气管切开术相比的优势尚无定论。COVID-19大流行使情况变得复杂，因为关于COVID-19患者气管切开术的理想时机的文献很少。研究问题：本研究旨在通过比较包括ICU死亡率、气管切开术后通气天数和ICU住院时间（LOS）等结果，确定早期或晚期气管切开术对COVID-19和非COVID-19病例的优势。研究设计和方法：2020年1月至2021年12月期间，在一家大学医院对有和没有COVID-19的通气ICU患者进行了单中心回顾性队列研究。在研究期间，扫描了1393例通气患者，发现156例进行了气管切开术。气管切开术在插管后10天内进行被视为早期，之后进行则被视为晚期。结果：156例气管切开患者中，84例（53.8%）为早期气管切开，72例（46.2%）为晚期气管切开。总体死亡率分别为42.9%（36/84）和69.4%（50/72）（P = 0.001，OR = 3.03，95% CI = 1.563 - 5.874），非COVID-19组早期和晚期气管切开组分别为31.4%和65.5%，COVID-19组分别为60.6%和72.1%（P = 0.005，OR = 2.640，95% CI = 1.345 - 5.181）。在非COVID-19组中，晚期气管切开组的通气天数高于早期气管切开组（17.10天对9.18天，P < 0.001）。然而，在COVID-19组中，早期和晚期气管切开组几乎相同（14.15天对13.86天，P = 0.821）。COVID-19组和非COVID-19组晚期气管切开组的ICU住院时间都更长。多变量分析显示，ICU死亡率与年龄、通气天数和ICU住院时间显著相关。解读：本研究结果表明，在COVID-19组和非COVID-19组中，早期气管切开术与较低的死亡率、较少的通气天数和较短的住院时间相关。
