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Association between tracheostomy timing and outcomes for older critically ill COVID-19 patients: prospective observational study in European intensive care units.
Polok, Kamil; Fronczek, Jakub; van Heerden, Peter Vernon; Flaatten, Hans; Guidet, Bertrand; De Lange, Dylan W; Fjølner, Jesper; Leaver, Susannah; Beil, Michael; Sviri, Sigal; Bruno, Raphael Romano; Wernly, Bernhard; Artigas, Antonio; Pinto, Bernardo Bollen; Schefold, Joerg C; Studzinska, Dorota; Joannidis, Michael; Oeyen, Sandra; Marsh, Brian; Andersen, Finn H; Moreno, Rui; Cecconi, Maurizio; Jung, Christian; Szczeklik, Wojciech.
Afiliación
  • Polok K; Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
  • Fronczek J; Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
  • van Heerden PV; Department of Anesthesia, Intensive Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
  • Flaatten H; Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
  • Guidet B; 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.
  • De Lange DW; Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, the Netherlands.
  • Fjølner J; Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
  • Leaver S; Research Lead Critical Care Directorate St George's Hospital, London, UK.
  • Beil M; Medical Intensive Care Unit, Hadassah Medical Center, Jerusalem, Israel.
  • Sviri S; Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
  • Bruno RR; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Dusseldorf, Germany.
  • Wernly B; 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.
  • Artigas A; Critical Care Department, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain.
  • Pinto BB; Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland.
  • Schefold JC; Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
  • Studzinska D; Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
  • Joannidis M; Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria.
  • Oeyen S; Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium.
  • Marsh B; Mater Misericordiae University Hospital, Dublin, Ireland.
  • Andersen FH; Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
  • Moreno R; 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.
  • Cecconi M; 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.
  • Jung C; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine-University Duesseldorf, Dusseldorf, Germany.
  • Szczeklik W; Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland. Electronic address: wojciech.szczeklik@uj.edu.pl.
Br J Anaesth ; 128(3): 482-490, 2022 03.
Article en En | MEDLINE | ID: mdl-34955167
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Traqueostomía / Enfermedad Crítica / Cuidados Críticos / COVID-19 Tipo de estudio: Clinical_trials / Observational_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: Br J Anaesth Año: 2022 Tipo del documento: Article País de afiliación: Polonia Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Traqueostomía / Enfermedad Crítica / Cuidados Críticos / COVID-19 Tipo de estudio: Clinical_trials / Observational_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: Br J Anaesth Año: 2022 Tipo del documento: Article País de afiliación: Polonia Pais de publicación: Reino Unido