Viana Sofia Wagemaker, Feres Brenda, Roberto Gabriel, Sardenberg Rodrigo
Physician. Kursk State Medical University (KSMU), Kursk, Russia.
Physician. Center for Advanced Research at Union of Great Lakes University, São Paulo (SP), Brazil.
Sao Paulo Med J. 2025 Aug 29;143(4):e2024036. doi: 10.1590/1516-3180.2024.0036.R2.07032025. eCollection 2025.
The coronavirus disease 2019 (COVID-19) pandemic has placed unprecedented strain on healthcare systems, particularly on critically ill patients requiring prolonged mechanical ventilation (MV). Percutaneous tracheostomy (PT) has emerged as a potential strategy to facilitate weaning, reduce intensive care unit (ICU) stay, and optimize resource use. However, the timing, safety, and outcomes of PT in COVID-19 patients remain debatable.
This study aimed to describe the technical aspects of the procedure and evaluate the early safety of our technique to healthcare professionals, as well as the short-term factors affecting survival in 103 consecutive patients after tracheostomy.
We retrospectively analyzed patients with COVID-19 who underwent PT between March 2020 and June 2020 at Hospital Alemão Oswaldo Cruz, São Paulo. The factors considered for analysis included age, sex, timing of tracheostomy, proportion of affected lungs, comorbidities, fraction of inspired oxygen on MV, and availability of professional private equipment. Univariate analysis was performed for screening, and variables with P < 0.20 were included in the multivariate Cox proportional hazards regression model.
Most patients were male, with a median age of 68 years. The most common comorbidities were hypertension (n = 55/52%), diabetes (n = 37/36%), and heart disease (n = 24/21%). Patients over 60 years old had reduced survival (hazard ratio [HR] = 3.35; P = 0.003), and those who underwent high nasal flow catheter (HR = 0.49; P = 0.02) and PT earlier (< 10 days) had better survival (HR = 0.37; P = 0.04).
Early PT in selected patients may reduce the duration of MV and lead to shorter ICU stays. The health system is overloaded by the scarcity of ventilators and beds for critically ill patients.
2019年冠状病毒病（COVID-19）大流行给医疗系统带来了前所未有的压力，尤其是对需要长时间机械通气（MV）的重症患者。经皮气管切开术（PT）已成为促进撤机、缩短重症监护病房（ICU）住院时间和优化资源利用的一种潜在策略。然而，COVID-19患者PT的时机、安全性和结果仍存在争议。
本研究旨在描述该手术的技术方面，并评估我们的技术对医护人员的早期安全性，以及气管切开术后103例连续患者生存的短期影响因素。
我们回顾性分析了2020年3月至2020年6月在圣保罗奥斯瓦尔多·克鲁兹阿莱芒医院接受PT的COVID-19患者。分析考虑的因素包括年龄、性别、气管切开术时机、患侧肺比例、合并症、MV时的吸入氧分数以及专业私人设备的可用性。进行单因素分析进行筛选，P<0.20的变量纳入多因素Cox比例风险回归模型。
大多数患者为男性，中位年龄68岁。最常见的合并症为高血压（n=55/52%）、糖尿病（n=37/36%）和心脏病（n=24/21%）。60岁以上患者生存率降低（风险比[HR]=3.35；P=0.003），接受高流量鼻导管治疗（HR=0.49；P=0.02）和更早（<10天）进行PT的患者生存率更高（HR=0.37；P=0.04）。
对选定患者尽早进行PT可能会缩短MV持续时间并缩短ICU住院时间。呼吸机和重症患者床位的短缺使卫生系统不堪重负。
