Haywood Matthew, Ambler Gareth, Walker Ciara, Arora Asit, Jacob Tony, Schilder Anne G M, Hamilton Nick
Royal National Ear Nose and Throat and Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, UK.
Department of Statistical Science, University College London, London, UK.
Sci Rep. 2025 Jul 2;15(1):23013. doi: 10.1038/s41598-025-93391-w.
COVIDTrach is a UK-wide, prospective cohort study evaluating tracheostomised COVID-19 patient outcomes and operator disease transmission. Early in the pandemic controversy surrounded optimal timing of tracheostomy insertion, however meta-analyses have since addressed this uncertainty. We report on our cohort's data and outcomes to help inform the management of this disease and compare our findings to the literature. Our inclusion criteria were COVID-19 patients aged ≥ 18 undergoing tracheostomy following invasive ventilation. We recorded relevant characteristics, clinical parameters, intra-operative details and outcome data. Predictors for mortality and time to ventilatory wean were determined. Among 1982 patients, there was a 21% post-tracheostomy mortality and median intubation to tracheostomy time of 15 days (IQR 11-21). The median time to successful ventilatory wean post-tracheostomy was 12 days (IQR 7-20). Advancing age, greater FiO2 and PEEP requirements and inotrope or anticoagulant use were associated with increased mortality (p < 0.05) and time to wean success (p < 0.01). Higher CRP predicted increased mortality (p < 0.05), while NIV use and extended pre-tracheostomy ventilation predicted prolonged wean time (p < 0.01). The death risk for tracheostomy performed ≤ 7 or ≥ 14 days of ventilation was equivocal (OR 1.01, 95% CI [0.37-2.72]) but lower between 8 and 14 days (OR = 0.64, 95% CI [0.47-0.86]) (p = 0.01). Eight operators tested positive within two weeks of performing a tracheostomy. Our mortality rates were similar to cohort studies but lower than early versus late tracheostomy designs. In contrast to the literature, we found reduced mortality when tracheostomy was performed 8-14 days post-intubation, with more favourable wean time and wean and decannulation rates.
“COVIDTrach”是一项全英国范围的前瞻性队列研究，旨在评估接受气管切开术的新冠肺炎患者的预后以及手术操作者的疾病传播情况。在疫情早期，关于气管切开术的最佳时机存在争议，不过此后的荟萃分析解决了这一不确定性。我们报告我们队列的数据和结果，以帮助为这种疾病的管理提供信息，并将我们的发现与文献进行比较。我们的纳入标准是年龄≥18岁、在有创通气后接受气管切开术的新冠肺炎患者。我们记录了相关特征、临床参数、术中细节和结果数据。确定了死亡率和脱机时间的预测因素。在1982例患者中，气管切开术后死亡率为21%，气管插管至气管切开术的中位时间为15天（四分位间距11 - 21天）。气管切开术后成功脱机的中位时间为12天（四分位间距7 - 20天）。年龄增长、更高的吸氧浓度和呼气末正压需求以及使用血管活性药物或抗凝剂与死亡率增加（p < 0.05）和脱机成功时间增加（p < 0.01）相关。更高的C反应蛋白水平预测死亡率增加（p < 0.05），而无创通气的使用和气管切开术前延长的通气时间预测脱机时间延长（p < 0.01）。在通气≤7天或≥14天进行气管切开术的死亡风险不明确（比值比1.01，95%置信区间[0.37 - 2.72]），但在8至14天之间较低（比值比 = 0.64，95%置信区间[0.47 - 0.86]）（p = 0.01）。8名手术操作者在进行气管切开术后两周内检测呈阳性。我们的死亡率与队列研究相似，但低于早期与晚期气管切开术设计的研究。与文献相反，我们发现插管后8 - 14天进行气管切开术时死亡率降低，脱机时间、脱机和拔管率更有利。
