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Polok K, Fronczek J, van Heerden PV, et al. Association between tracheostomy timing and outcomes for older critically ill COVID-19 patients: prospective observational study in European intensive care units. Br J Anaesth. 2021;doi: 10.1016/j.bja.2021.11.027.
Polok, K., Fronczek, J., van Heerden, P. V., Flaatten, H., Guidet, B., De Lange, D. W., Fjølner, J., Leaver, S., Beil, M., Sviri, S., Bruno, R. R., Wernly, B., Artigas, A., Pinto, B. B., Schefold, J. C., Studzińska, D., Joannidis, M., Oeyen, S., Marsh, B., Andersen, F. H., Moreno, R., Cecconi, M., Jung, C., Szczeklik, W. (2021). Association between tracheostomy timing and outcomes for older critically ill COVID-19 patients: prospective observational study in European intensive care units. British journal of anaesthesia, . https://doi.org/10.1016/j.bja.2021.11.027
Polok, Kamil, et al. "Association between tracheostomy timing and outcomes for older critically ill COVID-19 patients: prospective observational study in European intensive care units." British journal of anaesthesia vol. (2021). doi: https://doi.org/10.1016/j.bja.2021.11.027
Polok K, Fronczek J, van Heerden PV, Flaatten H, Guidet B, De Lange DW, Fjølner J, Leaver S, Beil M, Sviri S, Bruno RR, Wernly B, Artigas A, Pinto BB, Schefold JC, Studzińska D, Joannidis M, Oeyen S, Marsh B, Andersen FH, Moreno R, Cecconi M, Jung C, Szczeklik W. Association between tracheostomy timing and outcomes for older critically ill COVID-19 patients: prospective observational study in European intensive care units. Br J Anaesth. 2021 Nov 29; doi: 10.1016/j.bja.2021.11.027. Epub 2021 Nov 29. PMID: 34955167; PMCID: PMC8627864.
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Br J Anaesth. 2021 Nov 29; doi: 10.1016/j.bja.2021.11.027. Epub 2021 Nov 29.

Association between tracheostomy timing and outcomes for older critically ill COVID-19 patients: prospective observational study in European intensive care units.

British journal of anaesthesia

Kamil Polok, Jakub Fronczek, Peter Vernon van Heerden, Hans Flaatten, Bertrand Guidet, Dylan W De Lange, Jesper Fjølner, Susannah Leaver, Michael Beil, Sigal Sviri, Raphael Romano Bruno, Bernhard Wernly, Antonio Artigas, Bernardo Bollen Pinto, Joerg C Schefold, Dorota Studzińska, Michael Joannidis, Sandra Oeyen, Brian Marsh, Finn H Andersen, Rui Moreno, Maurizio Cecconi, Christian Jung, Wojciech Szczeklik,

Affiliations

  1. Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
  2. Department of Anesthesia, Intensive Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
  3. Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
  4. Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Epidémiologie Hospitalière Qualité et Organisation des Soins, Assistance Publique-Hôpitaux de Paris, Paris, France.
  5. Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, the Netherlands.
  6. Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
  7. Research Lead Critical Care Directorate St George's Hospital, London, UK.
  8. Medical Intensive Care Unit, Hadassah Medical Center, Jerusalem, Israel.
  9. Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
  10. Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Dusseldorf, Germany.
  11. Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria; Center for Public Health and Healthcare Research, Paracelsus Medical University of Salzburg, Salzburg, Austria.
  12. Critical Care Department, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain.
  13. Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland.
  14. Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
  15. Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria.
  16. Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium.
  17. Mater Misericordiae University Hospital, Dublin, Ireland.
  18. Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
  19. Unidade de Cuidados Intensivos Neurocríticos e Trauma, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Faculdade de Ciências Médicas de Lisboa (Nova Médical School), Lisbon, Portugal.
  20. Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Rozzano, Milan, Italy.
  21. Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland. Electronic address: [email protected].

PMID: 34955167 PMCID: PMC8627864 DOI: 10.1016/j.bja.2021.11.027

Abstract

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 NCT04321265.

Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

Keywords: COVID-19; healthcare; intensive care units; mechanical ventilation; outcome assessment; tracheostomy

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