RESUMEN
BACKGROUND: During the first wave of the COVID-19 pandemic, shortages of ventilators and ICU beds overwhelmed health care systems. Whether early tracheostomy reduces the duration of mechanical ventilation and ICU stay is controversial. RESEARCH QUESTION: Can failure-free day outcomes focused on ICU resources help to decide the optimal timing of tracheostomy in overburdened health care systems during viral epidemics? STUDY DESIGN AND METHODS: This retrospective cohort study included consecutive patients with COVID-19 pneumonia who had undergone tracheostomy in 15 Spanish ICUs during the surge, when ICU occupancy modified clinician criteria to perform tracheostomy in Patients with COVID-19. We compared ventilator-free days at 28 and 60 days and ICU- and hospital bed-free days at 28 and 60 days in propensity score-matched cohorts who underwent tracheostomy at different timings (≤ 7 days, 8-10 days, and 11-14 days after intubation). RESULTS: Of 1,939 patients admitted with COVID-19 pneumonia, 682 (35.2%) underwent tracheostomy, 382 (56%) within 14 days. Earlier tracheostomy was associated with more ventilator-free days at 28 days (≤ 7 days vs > 7 days [116 patients included in the analysis]: median, 9 days [interquartile range (IQR), 0-15 days] vs 3 days [IQR, 0-7 days]; difference between groups, 4.5 days; 95% CI, 2.3-6.7 days; 8-10 days vs > 10 days [222 patients analyzed]: 6 days [IQR, 0-10 days] vs 0 days [IQR, 0-6 days]; difference, 3.1 days; 95% CI, 1.7-4.5 days; 11-14 days vs > 14 days [318 patients analyzed]: 4 days [IQR, 0-9 days] vs 0 days [IQR, 0-2 days]; difference, 3 days; 95% CI, 2.1-3.9 days). Except hospital bed-free days at 28 days, all other end points were better with early tracheostomy. INTERPRETATION: Optimal timing of tracheostomy may improve patient outcomes and may alleviate ICU capacity strain during the COVID-19 pandemic without increasing mortality. Tracheostomy within the first work on a ventilator in particular may improve ICU availability.
Asunto(s)
COVID-19/terapia , Unidades de Cuidados Intensivos , Neumonía Viral/terapia , Respiración Artificial , Traqueostomía , Anciano , Ocupación de Camas/estadística & datos numéricos , COVID-19/epidemiología , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/virología , Puntaje de Propensión , Estudios Retrospectivos , España/epidemiologíaRESUMEN
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Asunto(s)
Adulto , Femenino , Humanos , Pérdida Auditiva/diagnóstico , Otosclerosis/diagnóstico , Otosclerosis/cirugía , Estapedio/cirugía , Cirugía del Estribo , Malformaciones Vasculares , Oído Medio/cirugía , Oído Medio/anatomía & histología , Osículos del Oído/patología , Estribo/anatomía & histologíaAsunto(s)
Cálculos/diagnóstico , Reacción a Cuerpo Extraño/complicaciones , Cavidad Nasal , Enfermedades Nasales/diagnóstico , Cálculos/diagnóstico por imagen , Cálculos/etiología , Humanos , Persona de Mediana Edad , Enfermedades Nasales/diagnóstico por imagen , Enfermedades Nasales/etiología , Rinitis/etiología , Tomografía Computarizada por Rayos XRESUMEN
No disponible