Alnemri Ahab, Ricciardelli Kaley, Wang Stephanie, Baumgartner Michael, Chao Tiffany N
Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA.
Department of Otorhinolaryngology-Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA.
World J Otorhinolaryngol Head Neck Surg. 2023 Aug 21;10(4):253-260. doi: 10.1002/wjo2.129. eCollection 2024 Dec.
Tracheostomy is often performed in patients with a prolonged course of endotracheal intubation. This study sought to examine the clinical utility of tracheostomy during severe Coronavirus disease 2019 (COVID-19) infection.
A retrospective single-system, multicenter observational cohort study was performed on patients intubated for COVID-19 infection. Patients who received intubation alone were compared with patients who received intubation and subsequent tracheostomy. Patient demographics, comorbidities, and hospital courses were analyzed.
The University of Pennsylvania Health System from 2020 to 2021.
Logistic regression analysis was performed on patient demographics and comorbidities. Kaplan-Meier survival curves were generated depending on whether patients received a tracheostomy.
Of 777 intubated patients, 452 were male (58.2%) and 325 were female (41.8%) with a median age of 63 (interquartile range [IQR]: 54-73) years. One-hundred and eighty-five (23.8%) patients underwent tracheostomy. The mean time from intubation to tracheostomy was (17.3 ± 9.7) days. Patients who underwent tracheostomy were less likely to expire during their hospitalization than those who did not undergo tracheostomy (odds ratio [OR] = 0.31, < 0.001), and patient age was positively associated with mortality (OR = 1.04 per year, < 0.001). Likelihood of receiving tracheostomy was positively associated with being on extra-corporeal membranous oxygenation (ECMO) (OR = 101.10, < 0.001), immunocompromised status (OR = 3.61, = 0.002), and current tobacco smoking (OR = 4.81, = 0.041). Tracheostomy was also associated with a significantly longer hospital length of stay ([57.5 ± 32.2] days vs. [19.9 ± 18.1] days, < 0.001).
Tracheostomy was associated with reduced in-hospital mortality, despite also being associated with increased comorbidities. Tracheostomy should not be held back from patients with comorbidities for this reason alone and may even improve survival in high-risk patients.
气管切开术常用于气管插管疗程延长的患者。本研究旨在探讨2019冠状病毒病（COVID-19）重症感染期间气管切开术的临床应用价值。
对因COVID-19感染而插管的患者进行了一项回顾性单系统多中心观察性队列研究。将仅接受插管的患者与接受插管并随后进行气管切开术的患者进行比较。分析了患者的人口统计学特征、合并症和住院病程。
2020年至2021年的宾夕法尼亚大学医疗系统。
对患者的人口统计学特征和合并症进行逻辑回归分析。根据患者是否接受气管切开术绘制Kaplan-Meier生存曲线。
在777例插管患者中，男性452例（58.2%），女性325例（41.8%），中位年龄为63岁（四分位间距[IQR]：54 - 73岁）。185例（23.8%）患者接受了气管切开术。从插管到气管切开术的平均时间为（17.3±9.7）天。接受气管切开术的患者在住院期间死亡的可能性低于未接受气管切开术的患者（优势比[OR]=0.31，<0.001），且患者年龄与死亡率呈正相关（OR=每年1.04，<0.001）。接受气管切开术的可能性与接受体外膜肺氧合（ECMO）（OR=101.10，<0.001）、免疫功能低下状态（OR=3.61，=0.002）和当前吸烟（OR=4.81，=0.041）呈正相关。气管切开术还与显著更长的住院时间相关（[57.5±32.2]天对[19.9±18.1]天，<0.001）。
气管切开术与降低住院死亡率相关，尽管也与合并症增加有关。不应仅因此而不让合并症患者接受气管切开术，甚至它可能会提高高危患者的生存率。
