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Trach and trace: observational outcomes of patients with COVID-19 who received a tracheostomy during the first pandemic surge in North Central London

Stephanie K. Mansell, Torraine Exall, Louisa Greenham, Richard Page, Amanda Thomas

DOI: https://doi.org/10.56792/OCKQ7831

Amanda ThomasCritical Care Outreach, The Royal London Hospital, London, U.K, Amanda.Thomas21@nhs.net,

  • Abstract
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Purpose

Insertion of tracheostomy tubes to facilitate ventilator weaning was increasingly indicated during the first COVID-19 pandemic surge and was associated with various recommendations relating to tracheostomy insertion, care and management in this specific cohort. Early publications regarding COVID-19 tracheostomy outcomes were limited by incomplete follow up, small sample sizes and inconsistent variable reporting. Interventions related to weaning a patient from tracheostomy have not previously been reported. We aimed to report a broad set of outcomes in adult patients diagnosed with COVID-19 who required a tracheostomy to contribute to the standardisation of tracheostomy reporting across all populations.

Methods

A multi-centre longitudinal review was undertaken of patients with COVID-19 who required tracheostomies between 4th March and 31st July 2020. Data included; diagnosis, indication for tracheostomy, timing of tracheostomy insertion, tube insertion procedure, size of tube, tube changes, timing of weaning interventions, decannulation, and patient outcomes including length of stay metrics.

Results

Data from 124 patients were included. Weaning from mechanical ventilation was possible from a median of six days (IQR 3–13) and interventions to wean tracheostomy began on day nine (IQR 4–9). We report a median intensive care LoS of 41 days and median hospital LoS of 53 days. There was a moderate correlation between time to spontaneous breathing trial and the duration of tracheostomy (r = 0.641, p <0.0001). Strong correlations were found between tracheostomy duration and duration of ETT (r = 0.863, p <0.0001), time to first cuff deflation trial (r = 0.707, p <0.0001) and time to first one way valve (OWV) trial (r = 0.775, p <0.0001). There were strong correlations between duration of tracheostomy and both intensive care length of stay (LoS) (r = 0.717, p <0.0001) and hospital LoS (r = 0.718, p <0.0001). Moderate correlations were observed between time from intubation and tracheostomy insertion and both intensive care LoS (r = 0.519, p <0.0001) and hospital LoS (r = 0.378, p <0.0001).

Conclusion

This report followed patients with COVID-19 who required a tracheostomy during their acute hospital admission, detailing the characteristics of tracheostomy insertion, significant weaning interventions, decannulation, intensive care and hospital discharge. It is hoped that this data contributes to the standardisation of tracheostomy reporting and the ability to evaluate the impact of recommendations for practice modification in the future.



2022 Journal (Vol. 54 Issue 3)
Journal of the Association of Chartered Physiotherapists in Respiratory Care. Volume 54. Issue 3. 2022. Article on: p28-45
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