TY - JOUR
T1 - Association between tracheostomy timing and outcomes for older critically ill COVID-19 patients
T2 - prospective observational study in European intensive care units
AU - Polok, Kamil
AU - Fronczek, Jakub
AU - van Heerden, Peter Vernon
AU - Flaatten, Hans
AU - Guidet, Bertrand
AU - De Lange, Dylan W.
AU - Fjølner, Jesper
AU - Leaver, Susannah
AU - Beil, Michael
AU - Sviri, Sigal
AU - Bruno, Raphael Romano
AU - Wernly, Bernhard
AU - Artigas, Antonio
AU - Pinto, Bernardo Bollen
AU - Schefold, Joerg C.
AU - Studzińska, Dorota
AU - Joannidis, Michael
AU - Oeyen, Sandra
AU - Marsh, Brian
AU - Andersen, Finn H.
AU - Moreno, Rui
AU - Cecconi, Maurizio
AU - Jung, Christian
AU - Szczeklik, Wojciech
N1 - Funding Information:
JF was supported by research grants from the Polish National Agency for Academic Exchange (Iwanowska Programme Scholarship) and Polpharma Scientific Foundation (Doctoral Scholarship) .
Publisher Copyright:
© 2021 British Journal of Anaesthesia
PY - 2022/3
Y1 - 2022/3
N2 - Background: Tracheostomy is performed in patients expected to require prolonged mechanical ventilation, but to date optimal timing of tracheostomy has not been established. The evidence concerning tracheostomy in COVID-19 patients is particularly scarce. We aimed to describe the relationship between early tracheostomy (≤10 days since intubation) and outcomes for patients with COVID-19. Methods: This was a prospective cohort study performed in 152 centres across 16 European countries from February to December 2020. We included patients aged ≥70 yr with confirmed COVID-19 infection admitted to an intensive care unit, requiring invasive mechanical ventilation. Multivariable analyses were performed to evaluate the association between early tracheostomy and clinical outcomes including 3-month mortality, intensive care length of stay, and duration of mechanical ventilation. Results: The final analysis included 1740 patients with a mean age of 74 yr. Tracheostomy was performed in 461 (26.5%) patients. The tracheostomy rate varied across countries, from 8.3% to 52.9%. Early tracheostomy was performed in 135 (29.3%) patients. There was no difference in 3-month mortality between early and late tracheostomy in either our primary analysis (hazard ratio [HR]=0.96; 95% confidence interval [CI], 0.70–1.33) or a secondary landmark analysis (HR=0.78; 95% CI, 0.57–1.06). Conclusions: There is a wide variation across Europe in the timing of tracheostomy for critically ill patients with COVID-19. However, we found no evidence that early tracheostomy is associated with any effect on survival amongst older critically ill patients with COVID-19. Clinical Trial registration: ClinicalTrials.gov NCT 04321265.
AB - Background: Tracheostomy is performed in patients expected to require prolonged mechanical ventilation, but to date optimal timing of tracheostomy has not been established. The evidence concerning tracheostomy in COVID-19 patients is particularly scarce. We aimed to describe the relationship between early tracheostomy (≤10 days since intubation) and outcomes for patients with COVID-19. Methods: This was a prospective cohort study performed in 152 centres across 16 European countries from February to December 2020. We included patients aged ≥70 yr with confirmed COVID-19 infection admitted to an intensive care unit, requiring invasive mechanical ventilation. Multivariable analyses were performed to evaluate the association between early tracheostomy and clinical outcomes including 3-month mortality, intensive care length of stay, and duration of mechanical ventilation. Results: The final analysis included 1740 patients with a mean age of 74 yr. Tracheostomy was performed in 461 (26.5%) patients. The tracheostomy rate varied across countries, from 8.3% to 52.9%. Early tracheostomy was performed in 135 (29.3%) patients. There was no difference in 3-month mortality between early and late tracheostomy in either our primary analysis (hazard ratio [HR]=0.96; 95% confidence interval [CI], 0.70–1.33) or a secondary landmark analysis (HR=0.78; 95% CI, 0.57–1.06). Conclusions: There is a wide variation across Europe in the timing of tracheostomy for critically ill patients with COVID-19. However, we found no evidence that early tracheostomy is associated with any effect on survival amongst older critically ill patients with COVID-19. Clinical Trial registration: ClinicalTrials.gov NCT 04321265.
KW - COVID-19
KW - healthcare
KW - intensive care units
KW - mechanical ventilation
KW - outcome assessment
KW - tracheostomy
UR - http://www.scopus.com/inward/record.url?scp=85121715939&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2021.11.027
DO - 10.1016/j.bja.2021.11.027
M3 - Article
C2 - 34955167
AN - SCOPUS:85121715939
SN - 0007-0912
VL - 128
SP - 482
EP - 490
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 3
ER -