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Marc MS, Rosca D, Bratosin F, Fira-Mladinescu O, Oancea C, Pescaru CC, Velescu D, Wellmann N, Motofelea AC, Ciuca IM, Saracin K, Manolescu D. The Effect of Comorbidities and Complications on COVID-19 Mortality: A Detailed Retrospective Study in Western Romania. J Pers Med 2023; 13:1552. [PMID: 38003867 PMCID: PMC10672588 DOI: 10.3390/jpm13111552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
COVID-19 continues to impact global health systems even after being declared over, with some patients exhibiting severe complications linked to pre-existing conditions. This study aimed to investigate the association between comorbidities, complications, and survival outcomes among COVID-19 survivors in Western Romania. Our hypothesis posited that comorbidities and complications significantly influence survival rates. We conducted a retrospective analysis of 1948 COVID-19 survivors admitted from January to December 2021, with 192 selected for detailed analysis based on inclusion and exclusion criteria. The severity of COVID-19 was classified according to WHO guidelines, and conditions like hypertension and obesity were defined using criteria from the European Society of Hypertension (ESH), the European Society of Cardiology (ESC), and WHO, respectively. Among the 192 patients, 33 had mild, 62 had moderate, and 97 had severe COVID-19. The median age across the severity groups was 63.2 years. Patients undergoing tracheostomy had a mortality rate of 83.3% versus 22.2% for non-tracheostomy patients (p < 0.001) and presented with significantly higher lung injury, hospitalization duration, and complications. Remarkably, tracheostomized patients were 17.50 times more likely to succumb to the disease (95% CI 4.39-116.91, p < 0.001). Furthermore, pneumothorax increased the mortality risk significantly (OR 22.11, 95% CI 5.72-146.03, p < 0.001). Intriguingly, certain conditions like grade I hypertension and grade II obesity showed a protective effect against mortality, whereas type 2 diabetes mellitus increased mortality risk (univariate OR 2.89, p = 0.001). The presence of certain comorbidities and complications significantly impacts the survival rates of COVID-19 patients in Western Romania. Notably, tracheostomy, pneumothorax, and T2DM were associated with increased mortality. This study underscores the importance of personalized patient care and provides insights for healthcare policymakers in Western Romania to improve clinical management strategies.
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Affiliation(s)
- Monica Steluta Marc
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.S.M.); (O.F.-M.); (C.O.); (C.C.P.); (D.V.); (D.M.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Daniela Rosca
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (N.W.)
| | - Felix Bratosin
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (N.W.)
- Discipline of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ovidiu Fira-Mladinescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.S.M.); (O.F.-M.); (C.O.); (C.C.P.); (D.V.); (D.M.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.S.M.); (O.F.-M.); (C.O.); (C.C.P.); (D.V.); (D.M.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Camelia Corina Pescaru
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.S.M.); (O.F.-M.); (C.O.); (C.C.P.); (D.V.); (D.M.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Diana Velescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.S.M.); (O.F.-M.); (C.O.); (C.C.P.); (D.V.); (D.M.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Norbert Wellmann
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (F.B.); (N.W.)
| | - Alexandru Catalin Motofelea
- Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Ioana Mihaiela Ciuca
- Department of Pediatrics, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
- Pediatric Pulmonology Unit, Clinical County Hospital, Evliya Celebi 1-3, 300226 Timisoara, Romania
| | - Karina Saracin
- Emergency County Hospital Craiova, Strada Tabaci 1, 200642 Craiova, Romania;
| | - Diana Manolescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.S.M.); (O.F.-M.); (C.O.); (C.C.P.); (D.V.); (D.M.)
- Department of Radiology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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Bhasarkar A, Dolma K. Utility of Early Tracheostomy in Critically Ill Covid-19 Patients: A Systematic Review. Indian J Otolaryngol Head Neck Surg 2023; 75:1-11. [PMID: 37362113 PMCID: PMC10016177 DOI: 10.1007/s12070-022-03280-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/11/2022] [Indexed: 03/17/2023] Open
Abstract
COVID 19 has proven itself to be an agent of cataclysm and caused an uproar worldwide due to consistent strain on the finite resources available to tackle the situation. With the rapidly mutating viral nature, resultant disease is becoming more severe over time, causing significant numbers of critical cases needing invasive ventilatory support. Available literature dictates that tracheostomy might reduce the stress over healthcare infrastructure. Our systematic review is aimed towards understanding the influence of tracheostomy timing, over the course of the illness, by analyzing the relevant literature, thus aiding in decision making while managing critical COVID 19 patients. With predefined inclusion and exclusion criteria, PubMed data was explored using search terms like 'timing', 'tracheotomy'/'tracheostomy' and 'COVID'/'COVID-19'/'SARS CoV2' and 26 articles were finalised for formal review. 26 studies (3527 patients) were systematically reviewed. 60.3% and 39.5% patients underwent percutaneous dilational tracheostomy and open surgical tracheostomy respectively. We report 7.62%, 21.3%, 56% and 46.53% as approximate estimates, of complication rate, mortality rate, rate of mechanical ventilation weaning and rate of decannulation following tracheostomy in COVID 19 patients, respectively taking into account underestimation of the data. Provided that appropriate preventive measures and safety guidelines are strictly followed, moderately early tracheostomy (between 10 and 14 days of intubation) can prove quite efficacious in management of critical COVID 19 patients. Also, early tracheostomy was associated with early weaning and decannulation, thus reducing the enormous competition for intensive care unit beds.
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Affiliation(s)
- Ashwin Bhasarkar
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Kunzes Dolma
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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McCauley P, Mohammed A, Casey M, Ramadan E, Galvin S, O'Neill JP, Curley G, Sulaiman I, O'Brien ME, O'Rourke J. Tracheostomy insertion in COVID-19: insertion practice and factors leading to unplanned tube exchange. J Thorac Dis 2023; 15:410-422. [PMID: 36910100 PMCID: PMC9992599 DOI: 10.21037/jtd-22-896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/12/2022] [Indexed: 02/10/2023]
Abstract
Background Tracheostomy insertion in patients with coronavirus disease 2019 (COVID-19) presents unique challenges. Patients frequently have high ventilatory requirements, and as an aerosol generating procedure, tracheostomy insertion creates the potential for staff transmission. Problems with tracheostomies contribute to morbidity and mortality, and tracheostomy changes may increase risks of staff transmission. We sought to quantify the incidence of clinically necessitated tracheostomy changes, establish the indications for change and investigate the incidence of staff transmission. Methods We conducted a single institution, retrospective, observational cohort study of all intensive care unit (ICU) patients with COVID-19 who had a tracheostomy between March 2020 and April 2021. The institution is a large tertiary referral centre in Ireland. Results Forty-three patients had a tracheostomy during the study period. All were a Shiley™ Flexible Adult Taperguard or Shiley™ XLT Tracheostomy. 14 patients (33%) required a tracheostomy change, with the majority (57%) involving a change from a standard size to an extended length tracheostomy. Persistent leak was the most common indication for change (71.6%). Other indications included patient-ventilator dyssynchrony, persistent cough and accidental decannulation. No staff transmission of COVID-19 occurred during this study. Conclusions The incidence of tracheostomy change was 33%, highlighting the importance of selecting the right tracheostomy for each patient. We discuss how key characteristics of tracheostomies such as type, size, length and inner diameter may impact flow, resistance and work of breathing, leading to unplanned tracheostomy change. No staff transmission occurred arising from tracheostomy insertion, adding to increasing evidence that tracheostomy insertion in COVID-19 appears safe with adherence to guidelines describing the correct use of personal protective equipment.
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Affiliation(s)
- Peter McCauley
- Department of Anaesthesia and Critical Care Medicine, Beaumont Hospital, Dublin, Ireland
| | - Amr Mohammed
- Department of Anaesthesia and Critical Care Medicine, Beaumont Hospital, Dublin, Ireland
| | - Michelle Casey
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Eslam Ramadan
- Department of Anaesthesia and Critical Care Medicine, Beaumont Hospital, Dublin, Ireland
| | - Sinéad Galvin
- Department of Anaesthesia and Critical Care Medicine, Beaumont Hospital, Dublin, Ireland
| | - James Paul O'Neill
- Department of Ear, Nose and Throat Surgery, Beaumont Hospital, Dublin, Ireland
| | - Gerard Curley
- Department of Anaesthesia and Critical Care Medicine, Beaumont Hospital, Dublin, Ireland
| | - Imran Sulaiman
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | | | - James O'Rourke
- Department of Anaesthesia and Critical Care Medicine, Beaumont Hospital, Dublin, Ireland
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Tucker J, Ruszkay N, Goyal N, Gniady JP, Goldenberg D. Quality tracheotomy care can be maintained for non-COVID patients during the COVID-19 pandemic. Laryngoscope Investig Otolaryngol 2022; 7:LIO2885. [PMID: 36249086 PMCID: PMC9538406 DOI: 10.1002/lio2.885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/13/2022] [Accepted: 07/23/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives To analyze changes in tracheotomy practices at the onset of the COVID-19 pandemic, and determine if quality patient care was maintained. Methods This was a single institution retrospective study that included patients undergoing tracheotomy from May 2019 to January 2021. Patients were divided into two groups, pre-COVID and post-COVID. Only three patients tested positive for COVID-19, and they were excluded from the study. Data were collected from the electronic medical record. Statistical analyses were performed using 2-tailed independent t tests, Wilcoxon Rank Sum tests, Chi-Square tests, and Kaplan-Meier curves. Results There were 118 patients in the pre-COVID group and 91 patients in the post-COVID group. The main indication for tracheotomy in both groups was prolonged intubation. There were no significant differences in overall length of stay, time to tracheotomy, duration of tracheotomy procedure, or time to initial tracheotomy change between the two groups. Due to protocols implemented at our institution to limit viral transmission, there were significant increases in the percent of tracheotomies performed in the OR (p = .02), and those performed via open technique (p = .04). Additionally, the median time to decannulation significantly decreased in the post-COVID group (p = .02). Conclusion Several variables regarding the timing of patient care showed no significant differences between groups which demonstrates that quality patient care was maintained. It is important to note that this data was collected early in the Pandemic, and additional trends may become apparent over time. Level of evidence 4.
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Affiliation(s)
- Jacqueline Tucker
- College of MedicinePennsylvania State UniversityHersheyPennsylvaniaUSA
| | - Nicole Ruszkay
- Department of Otolaryngology‐Head and Neck SurgeryPenn State Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Neerav Goyal
- College of MedicinePennsylvania State UniversityHersheyPennsylvaniaUSA
- Department of Otolaryngology‐Head and Neck SurgeryPenn State Hershey Medical CenterHersheyPennsylvaniaUSA
| | - John P. Gniady
- College of MedicinePennsylvania State UniversityHersheyPennsylvaniaUSA
- Department of Otolaryngology‐Head and Neck SurgeryPenn State Hershey Medical CenterHersheyPennsylvaniaUSA
| | - David Goldenberg
- College of MedicinePennsylvania State UniversityHersheyPennsylvaniaUSA
- Department of Otolaryngology‐Head and Neck SurgeryPenn State Hershey Medical CenterHersheyPennsylvaniaUSA
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Akroute AR, Brinchmann BS, Hovland A, Fredriksen STD. ICU nurses´ lived experience of caring for adult patients with a tracheostomy in ICU: a phenomenological-hermeneutic study. BMC Nurs 2022; 21:214. [PMID: 35927677 PMCID: PMC9354289 DOI: 10.1186/s12912-022-01005-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background The care of adult patients with a tracheostomy in intensive care unit is complex, challenging and requires skilled intensive care unit nurses. ICU nurses’ live experience is scarcely known. This study aimed to describe the lived experience of intensive care unit nurses of caring for adult patients with a tracheostomy in intensive care unit. Methods This study employs a qualitative design. In-depth interviews were conducted with a purposive sampling of 6 intensive care unit nurses from a medical-surgical ICU of a university hospital in Norway who were interviewed. Data was analyzed and interpreted using a phenomenological-hermeneutic approach. This study was reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results The interpretation yielded the following themes and subthemes: 1) theme: ‘challenges of caring for patients with a tracheostomy’ consisted of the sub-themes: ‘difficult to communicate/interpret and understand the patient’s different forms of expression’, ‘complicated professional assessments’, ‘caring with patience’, and ‘collaborating with patient regarding challenges. 2) theme: ‘the satisfaction from providing care to patients with a tracheostomy’ consisted of the sub-themes: ‘working with intensive care patients is instructive’ and ‘importance to motivate’. Conclusions ICU nurses experienced ambivalent feelings while caring for adult patients with a tracheostomy in ICU. They perceived caring as demanding owing to communication and collaboration at the same time, they experienced satisfaction while they strived to provide proper care and motivation. The identified challenges would lead to further improvement in nurses’ experiences and, in turn, the quality-of-care for patients with a tracheostomy. Awareness of these challenges is crucial to understand the need for an effective communication strategy to improve the quality and safety of adult patients with tracheostomy in ICU.
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Affiliation(s)
- Abder Rahim Akroute
- Department of Anesthesia and Intensive Care Medicine, Nordland Hospital, N-8049, Bodø, Norway.
| | - Berit Støre Brinchmann
- Faculty of Nursing and Health Sciences, Nord University, 8026, Bodø, Norway.,Nordland Hospital, 8076, Bodø, Norway
| | - Anders Hovland
- Department of Cardiology, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Sven-Tore Dreyer Fredriksen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway.,, Campus Harstad, Havnegata 5, 9480, Harstad, Norway.,Huntington network, Knorrebakken 2, 9411, Harstad, Norway
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Battaglini D, Premraj L, White N, Sutt AL, Robba C, Cho SM, Di Giacinto I, Bressan F, Sorbello M, Cuthbertson B, Bassi GL, Suen J, Fraser J, Pelosi P. Tracheostomy outcomes in critically ill COVID-19 patients: a systematic review, meta-analysis, and meta-regression. Br J Anaesth 2022; 129:679-692. [PMID: 36182551 PMCID: PMC9345907 DOI: 10.1016/j.bja.2022.07.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/12/2022] [Accepted: 07/12/2022] [Indexed: 11/22/2022] Open
Abstract
Background We performed a systematic review of mechanically ventilated patients with COVID-19, which analysed the effect of tracheostomy timing and technique (surgical vs percutaneous) on mortality. Secondary outcomes included intensive care unit (ICU) and hospital length of stay (LOS), decannulation from tracheostomy, duration of mechanical ventilation, and complications. Methods Four databases were screened between January 1, 2020 and January 10, 2022 (PubMed, Embase, Scopus, and Cochrane). Papers were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Population or Problem, Intervention or exposure, Comparison, and Outcome (PICO) guidelines. Meta-analysis and meta-regression for main outcomes were performed. Results The search yielded 9024 potentially relevant studies, of which 47 (n=5268 patients) were included. High levels of between-study heterogeneity were observed across study outcomes. The pooled mean tracheostomy timing was 16.5 days (95% confidence interval [CI]: 14.7–18.4; I2=99.6%). Pooled mortality was 22.1% (95% CI: 18.7–25.5; I2=89.0%). Meta-regression did not show significant associations between mortality and tracheostomy timing, mechanical ventilation duration, time to decannulation, and tracheostomy technique. Pooled mean estimates for ICU and hospital LOS were 29.6 (95% CI: 24.0–35.2; I2=98.6%) and 38.8 (95% CI: 32.1–45.6; I2=95.7%) days, both associated with mechanical ventilation duration (coefficient 0.8 [95% CI: 0.2–1.4], P=0.02 and 0.9 [95% CI: 0.4–1.4], P=0.01, respectively) but not tracheostomy timing. Data were insufficient to assess tracheostomy technique on LOS. Duration of mechanical ventilation was 23.4 days (95% CI: 19.2–27.7; I2=99.3%), not associated with tracheostomy timing. Data were insufficient to assess the effect of tracheostomy technique on mechanical ventilation duration. Time to decannulation was 23.8 days (95% CI: 19.7–27.8; I2=98.7%), not influenced by tracheostomy timing or technique. The most common complications were stoma infection, ulcers or necrosis, and bleeding. Conclusions In patients with COVID-19 requiring tracheostomy, the timing and technique of tracheostomy did not clearly impact on patient outcomes. Systematic Review Protocol PROSPERO CRD42021272220.
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Subramaniam A, Lim ZJ, Ponnapa Reddy M, Mitchell H, Shekar K. SARS-CoV-2 transmission risk to healthcare workers performing tracheostomies: a systematic review. ANZ J Surg 2022; 92:1614-1625. [PMID: 35655401 PMCID: PMC9347596 DOI: 10.1111/ans.17814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/10/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tracheostomy is a commonly performed procedure in patients with coronavirus disease 2019 (COVID-19) receiving mechanical ventilation (MV). This review aims to investigate the occurrence of SARS-CoV-2 transmission from patients to healthcare workers (HCWs) when tracheostomies are performed. METHODS This systematic review used the preferred reporting items for systematic reviews and meta-analysis framework. Studies reporting SARS-CoV-2 infection in HCWs involved in tracheostomy procedures were included. RESULTS Sixty-nine studies (between 01/11/2019 and 16/01/2022) reporting 3117 tracheostomy events were included, 45.9% (1430/3117) were performed surgically. The mean time from MV initiation to tracheostomy was 16.7 ± 7.9 days. Location of tracheostomy, personal protective equipment used, and anaesthesia technique varied between studies. The mean procedure duration was 14.1 ± 7.5 minutes; was statistically longer for percutaneous tracheostomies compared with surgical tracheostomies (mean duration 17.5 ± 7.0 versus 15.5 ± 5.6 minutes, p = 0.02). Across 5 out of 69 studies that reported 311 tracheostomies, 34 HCWs tested positive for SARS-CoV-2 and 23/34 (67.6%) were associated with percutaneous tracheostomies. CONCLUSIONS In this systematic review we found that SARS-CoV-2 transmission to HCWs performing or assisting with a tracheostomy procedure appeared to be low, with all reported transmissions occurring in 2020, prior to vaccinations and more recent strains of SARS-CoV-2. Transmissions may be higher with percutaneous tracheostomies. However, an accurate estimation of infection risk was not possible in the absence of the actual number of HCWs exposed to the risk during the procedure and the inability to control for multiple confounders related to variable timing, technique, and infection control practices.
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Affiliation(s)
- Ashwin Subramaniam
- Department of Intensive Care MedicinePeninsula HealthMelbourneVictoria
- Monash University, Peninsula Clinical SchoolMelbourneVictoriaAustralia
- Australian and New Zealand Intensive Care Research Centre (ANZIC RC), Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Zheng Jie Lim
- Department of AnaesthesiaAustin HospitalHeidelbergVictoriaAustralia
| | - Mallikarjuna Ponnapa Reddy
- Department of Intensive Care MedicinePeninsula HealthMelbourneVictoria
- Department of Intensive Care MedicineCalvary HospitalCanberraAustralian Capital TerritoryAustralia
| | - Hayden Mitchell
- Department of MedicinePeninsula HealthFrankstonVictoriaAustralia
| | - Kiran Shekar
- Adult Intensive Care ServicesThe Prince Charles HospitalBrisbaneQueenslandAustralia
- School of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
- Institute of Health and Biomedical innovationUniversity of Technology BrisbaneBrisbaneQueenslandAustralia
- School of MedicineBond UniversityGold CoastQueenslandAustralia
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Ruszkay N, Tucker J, Choi KY. Otolaryngology in the face of A pandemic. OPERATIVE TECHNIQUES IN OTOLARYNGOLOGY--HEAD AND NECK SURGERY 2022; 33:74-83. [PMID: 35502270 PMCID: PMC9045873 DOI: 10.1016/j.otot.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although infrequent, pandemics are serious public health concerns with unpredictable courses. The COVID-19 pandemic began over 2 years ago and is far from over. This pandemic has spread rapidly throughout the world and led to several million deaths, making it commonly compared to the deadly Spanish influenza pandemic. Policy and safety measures are constantly being adapted to reduce transmission rates. The pandemic places stress on all healthcare workers, but especially otolaryngology providers due to their direct contact with airway connected cavities. This puts them at high risk for infection and has impacted inpatient and outpatient otolaryngology care, as well as education, research, and mental health.
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Affiliation(s)
- Nicole Ruszkay
- Department of Otolaryngology - Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Jacqueline Tucker
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Karen Y Choi
- Department of Otolaryngology - Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania
- College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
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Tüzemen G, Kaya PK. Aerosol-generating procedure; percutaneous versus surgical tracheostomy. Am J Otolaryngol 2022; 43:103401. [PMID: 35210114 DOI: 10.1016/j.amjoto.2022.103401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aims to compare percutaneous tracheostomy (PCT) and surgical tracheostomy's aerosol and droplet scattering by using a particle counter. MATERIALS AND METHODS This study was carried out with 35 patients between October 2020 and June 2021. All personal protective equipment was provided to protect healthcare workers. Measurements were made in the 5 s period before the tracheal incision and the 5 s period after the tracheal incision. RESULTS The mean age of the 15 female and 20 male patients in this study was 68.88 ± 13.48 years old (range: 33-95 years old). Patients were intubated for an average of 22 days. Particle amounts were found to be significantly higher at 5 μm (p = 0.003) and 10 μm (p = 0.012) during PCT. In surgical tracheostomy, there was no significant increase in the number of particles. When the particle measurement values of both methods were compared with each other, there was a significantly more particle scattering in PCT than in surgical tracheotomy at 0.3 μm (p = 0.034), 5 μm (p = 0.001), and 10 μm (p = 0.003). CONCLUSION According to the data in our study, a surgical tracheotomy was not identified as an aerosol-generating procedure. Considering the risk of airborne transmission may increase due to viral mutations, we have shown that surgical tracheostomy may be more appropriate in patients who need a tracheostomy. Of course, the use of personal protective equipment during these processes is very important.
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Long SM, Feit NZ, Chern A, Cooley V, Hill SS, Rajwani K, Schenck EJ, Stiles B, Tassler AB. Percutaneous and Open Tracheostomy in Patients With COVID-19: The Weill Cornell Experience in New York City. Laryngoscope 2021; 131:E2849-E2856. [PMID: 34037983 PMCID: PMC8242792 DOI: 10.1002/lary.29669] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/09/2021] [Accepted: 05/20/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Report long-term tracheostomy outcomes in patients with COVID-19. STUDY DESIGN Review of prospectively collected data. METHODS Prospectively collected data were extracted for adults with COVID-19 undergoing percutaneous or open tracheostomy between April 4, 2020 and June 2, 2020 at a major medical center in New York City. The primary endpoint was weaning from mechanical ventilation. Secondary outcomes included sedation weaning, decannulation, and discharge. RESULTS One hundred one patients underwent tracheostomy, including 48 percutaneous (48%) and 53 open (52%), after a median intubation time of 24 days (IQR 20, 31). The most common complication was minor bleeding (n = 18, 18%). The all-cause mortality rate was 15% and no deaths were attributable to the tracheostomy. Eighty-three patients (82%) were weaned off mechanical ventilation, 88 patients (87%) were weaned off sedation, and 72 patients (71%) were decannulated. Censored median times from tracheostomy to sedation and ventilator weaning were 8 (95% CI 6-11) and 18 (95% CI 14-22) days, respectively (uncensored: 7 and 15 days). Median time from tracheostomy to decannulation was 36 (95% CI 32-47) days (uncensored: 32 days). Of those decannulated, 82% were decannulated during their index admission. There were no differences in outcomes or complication rates between percutaneous and open tracheostomy. Likelihood of discharge from the ICU was inversely related to intubation time, though the clinical relevance of this was small (HR 0.97, 95% CI 0.943-0.998; P = .037). CONCLUSION Tracheostomy by either percutaneous or open technique facilitated sedation and ventilator weaning in patients with COVID-19 after prolonged intubation. Additional study on the optimal timing of tracheostomy in patients with COVID-19 is warranted. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E2849-E2856, 2021.
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Affiliation(s)
- Sallie M. Long
- Department of Otolaryngology—Head and Neck SurgeryNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Noah Z. Feit
- Weill Cornell Medical CollegeNew YorkNew YorkU.S.A.
| | - Alexander Chern
- Department of Otolaryngology—Head and Neck SurgeryNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Victoria Cooley
- Division of Biostatistics and EpidemiologyWeill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Shanna S. Hill
- Department of AnesthesiologyNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Kapil Rajwani
- Division of Pulmonary and Critical Care MedicineNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Edward J. Schenck
- Division of Pulmonary and Critical Care MedicineNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Brendon Stiles
- Department of Cardiothoracic SurgeryNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
| | - Andrew B. Tassler
- Department of Otolaryngology—Head and Neck SurgeryNewYork‐Presbyterian Hospital/Weill Cornell MedicineNew YorkNew YorkU.S.A.
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11
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Ferro A, Kotecha S, Auzinger G, Yeung E, Fan K. Systematic review and meta-analysis of tracheostomy outcomes in COVID-19 patients. Br J Oral Maxillofac Surg 2021; 59:1013-1023. [PMID: 34294476 PMCID: PMC8130586 DOI: 10.1016/j.bjoms.2021.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/07/2021] [Indexed: 01/04/2023]
Abstract
A systematic review and meta-analysis of the entire COVID-19 Tracheostomy cohort was conducted to determine the cumulative incidence of complications, mortality, time to decannulation and ventilatory weaning. Outcomes of surgical versus percutaneous and outcomes relative to tracheostomy timing were also analysed. Studies reporting outcome data on patients with COVID-19 undergoing tracheostomy were identified and screened by 2 independent reviewers. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Outcome data were analysed using a random-effects model. From 1016 unique studies, 39 articles reporting outcomes for a total of 3929 patients were included for meta-analysis. Weighted mean follow-up time was 42.03±26 days post-tracheostomy. Meta-analysis showed that 61.2% of patients were weaned from mechanical ventilation [95%CI 52.6%-69.5%], 44.2% of patients were decannulated [95%CI 33.96%-54.67%], and cumulative mortality was found to be 19.23% [95%CI 15.2%-23.6%] across the entire tracheostomy cohort. The cumulative incidence of complications was 14.24% [95%CI 9.6%-19.6%], with bleeding accounting for 52% of all complications. No difference was found in incidence of mortality (RR1.96; p=0.34), decannulation (RR1.35, p=0.27), complications (RR0.75, p=0.09) and time to decannulation (SMD 0.46, p=0.68) between percutaneous and surgical tracheostomy. Moreover, no difference was found in mortality (RR1.57, p=0.43) between early and late tracheostomy, and timing of tracheostomy did not predict time to decannulation. Ten confirmed nosocomial staff infections were reported from 1398 tracheostomies. This study provides an overview of outcomes of tracheostomy in COVID-19 patients, and contributes to our understanding of tracheostomy decisions in this patient cohort.
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Affiliation(s)
- A. Ferro
- Oral and Maxillofacial Surgery Department, King's College Hospital NHS Foundation Trust, Denmark Hill, SE1 9RT London, United Kingdom
| | - S. Kotecha
- Oral and Maxillofacial Surgery Department, King's College Hospital NHS Foundation Trust, Denmark Hill, SE1 9RT London, United Kingdom
| | - G. Auzinger
- Liver Intensive Care Unit, Department of Critical Care, King's College Hospital NHS Foundation Trust, Denmark Hill, SE1 9RT London, United Kingdom
| | - E. Yeung
- Oral and Maxillofacial Surgery Department, King's College Hospital NHS Foundation Trust, Denmark Hill, SE1 9RT London, United Kingdom
| | - K. Fan
- Oral and Maxillofacial Surgery Department, King's College Hospital NHS Foundation Trust, Denmark Hill, SE1 9RT London, United Kingdom,Corresponding author at: King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, United Kingdom. Tel.: +4420 3299 5754
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12
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Tsonas AM, Botta M, Horn J, Brenner MJ, Teng MS, McGrath BA, Schultz MJ, Paulus F, Serpa Neto A. Practice of tracheostomy in patients with acute respiratory failure related to COVID-19 - Insights from the PRoVENT-COVID study. Pulmonology 2021; 28:18-27. [PMID: 34836830 PMCID: PMC8450072 DOI: 10.1016/j.pulmoe.2021.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 01/16/2023] Open
Abstract
Objective Invasively ventilated patients with acute respiratory failure related to coronavirus disease 2019 (COVID–19) potentially benefit from tracheostomy. The aim of this study was to determine the practice of tracheostomy during the first wave of the pandemic in 2020 in the Netherlands, to ascertain whether timing of tracheostomy had an association with outcome, and to identify factors that had an association with timing. Methods Secondary analysis of the ‘PRactice of VENTilation in COVID–19’ (PRoVENT–COVID) study, a multicenter observational study, conducted from March 1, 2020 through June 1, 2020 in 22 Dutch intensive care units (ICU) in the Netherlands. The primary endpoint was the proportion of patients receiving tracheostomy; secondary endpoints were timing of tracheostomy, duration of ventilation, length of stay in ICU and hospital, mortality, and factors associated with timing. Results Of 1023 patients, 189 patients (18.5%) received a tracheostomy at median 21 [17 to 28] days from start of ventilation. Timing was similar before and after online publication of an amendment to the Dutch national guidelines on tracheostomy focusing on COVID–19 patients (21 [17–28] vs. 21 [17–26] days). Tracheostomy performed ≤ 21 days was independently associated with shorter duration of ventilation (median 26 [21 to 32] vs. 40 [34 to 47] days) and higher mortality in ICU (22.1% vs. 10.2%), hospital (26.1% vs. 11.9%) and at day 90 (27.6% vs. 14.6%). There were no patient demographics or ventilation characteristics that had an association with timing of tracheostomy. Conclusions Tracheostomy was performed late in COVID–19 patients during the first wave of the pandemic in the Netherlands and timing of tracheostomy possibly had an association with outcome. However, prospective studies are needed to further explore these associations. It remains unknown which factors influenced timing of tracheostomy in COVID–19 patients.
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Affiliation(s)
- A M Tsonas
- Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, the Netherlands.
| | - M Botta
- Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, the Netherlands
| | - J Horn
- Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam UMC Research Institute, Amsterdam, the Netherlands
| | - M J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA; Global Tracheostomy Collaborative, Raleigh, North Carolina, USA
| | - M S Teng
- Department of Otolaryngology-Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - B A McGrath
- Anaesthesia & Intensive Care Medicine, University NHS Foundation Trust, Manchester, UK
| | - M J Schultz
- Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, the Netherlands; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - F Paulus
- Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, the Netherlands; ACHIEVE, Centre of Applied Research, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, the Netherlands
| | - A Serpa Neto
- Department of Intensive Care, Amsterdam UMC, location 'AMC', Amsterdam, the Netherlands; Department of Critical Care Medicine, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia
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13
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Benito DA, Bestourous DE, Tong JY, Pasick LJ, Sataloff RT. Tracheotomy in COVID-19 Patients: A Systematic Review and Meta-analysis of Weaning, Decannulation, and Survival. Otolaryngol Head Neck Surg 2021; 165:398-405. [PMID: 33399526 DOI: 10.1177/0194599820984780] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/09/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES A systematic review and meta-analysis was conducted to determine the cumulative incidences of decannulation and mechanical ventilation weaning in patients with coronavirus disease 2019 (COVID-19) who have undergone a tracheotomy. Weighted average mean times to tracheotomy, to decannulation, and to death were calculated from reported or approximated means. DATA SOURCES PubMed, SCOPUS, CINAHL, and the Cochrane library. REVIEW METHODS Studies were screened by 3 investigators independently. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. Studies including patients with COVID-19 who underwent a tracheotomy were identified. Studies without reported mechanical ventilation weaning or decannulation were excluded. Data were pooled using a random-effects model. RESULTS After identifying 232 unique studies, 18 articles encompassing outcomes for 3234 patients were ultimately included for meta-analysis, with a weighted mean follow-up time of 28.6 ± 6.2 days after tracheotomy. Meta-analysis revealed that 55.0% of tracheotomized patients were weaned successfully from mechanical ventilation (95% CI, 47.4%-62.2%). Approximately 34.9% of patients were decannulated successfully, with a mean decannulation time of 18.6 ± 5.7 days after tracheotomy. The pooled mortality in tracheotomized patients with COVID-19 was 13.1%, with a mean time of death of 13.0 ± 4.0 days following tracheotomy. CONCLUSION At the current state of the coronavirus pandemic, over half of patients who have required tracheotomies are being weaned off of mechanical ventilation. While 13.1% patients have died prior to decannulation, over a third of all tracheotomized patients with COVID-19 reported in the literature have undergone successful decannulation.
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Affiliation(s)
- Daniel A Benito
- Division of Otolaryngology-Head & Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Daniel E Bestourous
- Division of Otolaryngology-Head & Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Jane Y Tong
- Department of Otolaryngology-Head & Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Luke J Pasick
- Department of Otolaryngology-Head & Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert T Sataloff
- Department of Otolaryngology-Head & Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
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14
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Carlson ER, Heidel RE, Houston K, Vahdani S, Winstead M. Tracheotomies in COVID-19 Patients: Protocols and Outcomes. J Oral Maxillofac Surg 2021; 79:1629-1642. [PMID: 33901449 PMCID: PMC7952266 DOI: 10.1016/j.joms.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/05/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Approximately 3-15% of COVID-19 patients will require prolonged mechanical ventilation thereby requiring consideration for tracheotomy. Guidelines for tracheotomy in this cohort of patients are therefore required with assessed outcomes of tracheotomies. PATIENTS AND METHODS A retrospective chart review was performed of COVID-19 patients undergoing tracheotomy. Inclusion criteria were the performance of a tracheotomy in COVID-19 positive patients between March 11 and December 31, 2020. Exclusion criteria were lack of consent, extubation prior to the performance of a tracheotomy, death prior to the performance of the tracheotomy, and COVID-19 patients undergoing tracheotomy who tested negative twice after medical treatment. The primary predictor variable was the performance of a tracheotomy in COVID-19 positive patients and the primary outcome variable was the time to cessation of mechanical ventilation with the institution of supplemental oxygen via trach mask. RESULTS Seventeen tracheotomies were performed between 4-25 days following intubation (mean = 17 days). Seven patients died between 4 and 16 days (mean = 8.7 days) following tracheotomy and 10 living patients realized cessation of mechanical ventilation from 4 hours to 61 days following tracheotomy (mean = 19.3 days). These patients underwent tracheotomy between 4 and 22 days following intubation (mean = 14 days). The 7 patients who died following tracheotomy underwent the procedure between 7 and 25 days following intubation (mean = 18.2 days). Seven patients underwent tracheotomy on or after 20 days of intubation and 3 survived (43%). Ten patients underwent tracheotomy before 20 days of intubation and 7 patients survived (70%). Significant differences between the mortality groups were detected for age (P = .006), and for P/F ratio at time of consult (P = .047) and the time of tracheotomy (P = .03). CONCLUSIONS Tracheotomies are safely performed in COVID-19 patients with a standardized protocol. The timing of tracheotomy in COVID-19 patients is based on ventilator parameters, P/F ratio, patient prognosis, patient advanced directives, and family wishes.
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Affiliation(s)
- Eric R Carlson
- Professor and Kelly L. Krahwinkel Chairman, Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN.
| | - R Eric Heidel
- Associate Professor of Biostatistics, Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Kyle Houston
- Chief Resident, Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Soheil Vahdani
- Fellow, Oral/Head and Neck Oncologic Surgery, Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Michael Winstead
- Chief Resident, Department of Oral and Maxillofacial Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN
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15
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16
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Assessment of the harms and potential benefits of tracheostomy in COVID-19 patients: Narrative review of outcomes and recommendations. Am J Otolaryngol 2021; 42:102972. [PMID: 33730594 PMCID: PMC7914376 DOI: 10.1016/j.amjoto.2021.102972] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/14/2021] [Indexed: 02/07/2023]
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17
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Staibano P, Levin M, McHugh T, Gupta M, Sommer DD. Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2021; 147:646-655. [PMID: 34042963 PMCID: PMC8160928 DOI: 10.1001/jamaoto.2021.0930] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/08/2021] [Indexed: 12/16/2022]
Abstract
Importance Approximately 5% to 15% of patients with COVID-19 require invasive mechanical ventilation (IMV) and, at times, tracheostomy. Details regarding the safety and use of tracheostomy in treating COVID-19 continue to evolve. Objective To evaluate the association of tracheostomy with COVID-19 patient outcomes and the risk of SARS-CoV-2 transmission among health care professionals (HCPs). Data Sources EMBASE (Ovid), Medline (Ovid), and Web of Science from January 1, 2020, to March 4, 2021. Study Selection English-language studies investigating patients with COVID-19 who were receiving IMV and undergoing tracheostomy. Observational and randomized clinical trials were eligible (no randomized clinical trials were found in the search). All screening was performed by 2 reviewers (P.S. and M.L.). Overall, 156 studies underwent full-text review. Data Extraction and Synthesis We performed data extraction in accordance with Meta-analysis of Observational Studies in Epidemiology guidelines. We used a random-effects model, and ROBINS-I was used for the risk-of-bias analysis. Main Outcomes and Measures SARS-CoV-2 transmission between HCPs and levels of personal protective equipment, in addition to complications, time to decannulation, ventilation weaning, and intensive care unit (ICU) discharge in patients with COVID-19 who underwent tracheostomy. Results Of the 156 studies that underwent full-text review, only 69 were included in the qualitative synthesis, and 14 of these 69 studies (20.3%) were included in the meta-analysis. A total of 4669 patients were included in the 69 studies, and the mean (range) patient age across studies was 60.7 (49.1-68.8) years (43 studies [62.3%] with 1856 patients). We found that in all studies, 1854 patients (73.8%) were men and 658 (26.2%) were women. We found that 28 studies (40.6%) investigated either surgical tracheostomy or percutaneous dilatational tracheostomy. Overall, 3 of 58 studies (5.17%) identified a small subset of HCPs who developed COVID-19 that was associated with tracheostomy. Studies did not consistently report the number of HCPs involved in tracheostomy. Among the patients, early tracheostomy was associated with faster ICU discharge (mean difference, 6.17 days; 95% CI, -11.30 to -1.30), but no change in IMV weaning (mean difference, -2.99 days; 95% CI, -8.32 to 2.33) or decannulation (mean difference, -3.12 days; 95% CI, -7.35 to 1.12). There was no association between mortality or perioperative complications and type of tracheostomy. A risk-of-bias evaluation that used ROBINS-I demonstrated notable bias in the confounder and patient selection domains because of a lack of randomization and cohort matching. There was notable heterogeneity in study reporting. Conclusions and Relevance The findings of this systematic review and meta-analysis indicate that enhanced personal protective equipment is associated with low rates of SARS-CoV-2 transmission during tracheostomy. Early tracheostomy in patients with COVID-19 may reduce ICU stay, but this finding is limited by the observational nature of the included studies.
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Affiliation(s)
- Phillip Staibano
- Department of Surgery, Otolaryngology–Head and Neck Division, McMaster University, Hamilton, Ontario, Canada
| | - Marc Levin
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tobial McHugh
- Department of Surgery, Otolaryngology–Head and Neck Division, McMaster University, Hamilton, Ontario, Canada
| | - Michael Gupta
- Department of Surgery, Otolaryngology–Head and Neck Division, McMaster University, Hamilton, Ontario, Canada
| | - Doron D. Sommer
- Department of Surgery, Otolaryngology–Head and Neck Division, McMaster University, Hamilton, Ontario, Canada
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18
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Battaglini D, Missale F, Schiavetti I, Filauro M, Iannuzzi F, Ascoli A, Bertazzoli A, Pascucci F, Grasso S, Murgolo F, Binda S, Maraggia D, Montrucchio G, Sales G, Pascarella G, Agrò FE, Faccio G, Ferraris S, Spadaro S, Falò G, Mereto N, Uva A, Maugeri JG, Agrippino B, Vargas M, Servillo G, Robba C, Ball L, Mora F, Signori A, Torres A, Giacobbe DR, Vena A, Bassetti M, Peretti G, Rocco PRM, Pelosi P. Tracheostomy Timing and Outcome in Severe COVID-19: The WeanTrach Multicenter Study. J Clin Med 2021; 10:jcm10122651. [PMID: 34208672 PMCID: PMC8235219 DOI: 10.3390/jcm10122651] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Tracheostomy can be performed safely in patients with coronavirus disease 2019 (COVID-19). However, little is known about the optimal timing, effects on outcome, and complications. METHODS A multicenter, retrospective, observational study. This study included 153 tracheostomized COVID-19 patients from 11 intensive care units (ICUs). The primary endpoint was the median time to tracheostomy in critically ill COVID-19 patients. Secondary endpoints were survival rate, length of ICU stay, and post-tracheostomy complications, stratified by tracheostomy timing (early versus late) and technique (surgical versus percutaneous). RESULTS The median time to tracheostomy was 15 (1-64) days. There was no significant difference in survival between critically ill COVID-19 patients who received tracheostomy before versus after day 15, nor between surgical and percutaneous techniques. ICU length of stay was shorter with early compared to late tracheostomy (p < 0.001) and percutaneous compared to surgical tracheostomy (p = 0.050). The rate of lower respiratory tract infections was higher with surgical versus percutaneous technique (p = 0.007). CONCLUSIONS Among critically ill patients with COVID-19, neither early nor percutaneous tracheostomy improved outcomes, but did shorten ICU stay. Infectious complications were less frequent with percutaneous than surgical tracheostomy.
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Affiliation(s)
- Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (F.I.); (C.R.); (L.B.); (P.P.)
- Department of Medicine, University of Barcelona, 08007 Barcelona, Spain
- Correspondence:
| | - Francesco Missale
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (F.M.); (M.F.); (A.A.); (F.M.); (G.P.)
| | - Irene Schiavetti
- Department of Health Sciences, Section of Biostatistics, University of Genoa, 16132 Genoa, Italy; (I.S.); (A.S.)
| | - Marta Filauro
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (F.M.); (M.F.); (A.A.); (F.M.); (G.P.)
| | - Francesca Iannuzzi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (F.I.); (C.R.); (L.B.); (P.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Alessandro Ascoli
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (F.M.); (M.F.); (A.A.); (F.M.); (G.P.)
| | - Alberto Bertazzoli
- First Division of Anesthesiology and Intensive Care Unit, ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (A.B.); (F.P.)
| | - Federico Pascucci
- First Division of Anesthesiology and Intensive Care Unit, ASST Spedali Civili di Brescia, 25123 Brescia, Italy; (A.B.); (F.P.)
| | - Salvatore Grasso
- Dipartimento dell’Emergenza e Trapianti d’Organo (DETO), Sezione di Anestesiologia e Rianimazione, Università degli Studi di Bari “Aldo Moro”, Ospedale Policlinico, 70124 Bari, Italy; (S.G.); (F.M.)
| | - Francesco Murgolo
- Dipartimento dell’Emergenza e Trapianti d’Organo (DETO), Sezione di Anestesiologia e Rianimazione, Università degli Studi di Bari “Aldo Moro”, Ospedale Policlinico, 70124 Bari, Italy; (S.G.); (F.M.)
| | - Simone Binda
- Anaesthesia and Intensive Care Department, University Hospital, Ospedale di Circolo, 21100 Varese, Italy; (S.B.); (D.M.)
| | - Davide Maraggia
- Anaesthesia and Intensive Care Department, University Hospital, Ospedale di Circolo, 21100 Varese, Italy; (S.B.); (D.M.)
| | - Giorgia Montrucchio
- Anestesia e Rianimazione 1U, Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, 10121 Turin, Italy; (G.M.); (G.S.)
| | - Gabriele Sales
- Anestesia e Rianimazione 1U, Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, 10121 Turin, Italy; (G.M.); (G.S.)
| | - Giuseppe Pascarella
- Department of Anaesthesia, Intensive Care and Pain Management, Universita Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (G.P.); (F.E.A.)
| | - Felice Eugenio Agrò
- Department of Anaesthesia, Intensive Care and Pain Management, Universita Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy; (G.P.); (F.E.A.)
| | - Gaia Faccio
- U.O. di Anestesia e Rianimazione, Ospedale di Treviglio-Caravaggio, 24047 Treviglio, Italy; (G.F.); (S.F.)
| | - Sandra Ferraris
- U.O. di Anestesia e Rianimazione, Ospedale di Treviglio-Caravaggio, 24047 Treviglio, Italy; (G.F.); (S.F.)
| | - Savino Spadaro
- Department of Morphology, Surgery and Experimental Medicine, Faculty of Medicine, University of Ferrara, 44121 Ferrara, Italy; (S.S.); (G.F.)
| | - Giulia Falò
- Department of Morphology, Surgery and Experimental Medicine, Faculty of Medicine, University of Ferrara, 44121 Ferrara, Italy; (S.S.); (G.F.)
| | - Nadia Mereto
- Anestesia e Rianimazione, Ospedale Villa Scassi, 16132 Genoa, Italy; (N.M.); (A.U.)
| | - Alessandro Uva
- Anestesia e Rianimazione, Ospedale Villa Scassi, 16132 Genoa, Italy; (N.M.); (A.U.)
| | - Jessica Giuseppina Maugeri
- Anesthesia and Intensive Care, “Garibaldi Centro” Hospital, ARNAS Garibaldi, 95100 Catania, Italy; (J.G.M.); (B.A.)
| | - Bellissima Agrippino
- Anesthesia and Intensive Care, “Garibaldi Centro” Hospital, ARNAS Garibaldi, 95100 Catania, Italy; (J.G.M.); (B.A.)
| | - Maria Vargas
- Dipartimento di Neuroscienze, Scienze Riproduttive e Odontostomatologiche, Università degli Studi di Napoli Federico II, 80126 Napoli, Italy; (M.V.); (G.S.)
| | - Giuseppe Servillo
- Dipartimento di Neuroscienze, Scienze Riproduttive e Odontostomatologiche, Università degli Studi di Napoli Federico II, 80126 Napoli, Italy; (M.V.); (G.S.)
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (F.I.); (C.R.); (L.B.); (P.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (F.I.); (C.R.); (L.B.); (P.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
| | - Francesco Mora
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (F.M.); (M.F.); (A.A.); (F.M.); (G.P.)
| | - Alessio Signori
- Department of Health Sciences, Section of Biostatistics, University of Genoa, 16132 Genoa, Italy; (I.S.); (A.S.)
| | - Antoni Torres
- Department of Pulmonology, Hospital Clinic of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, SGR 911-Ciber de Enfermedades Respiratorias (CIBERES), 08007 Barcelona, Spain;
| | - Daniele Roberto Giacobbe
- Dipartimento di Scienze della Salute (DISSAL), Università degli Studi di Genova, 16132 Genova, Italy; (D.R.G.); (M.B.)
- Clinica Malattie Infettive, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) per l’Oncologia e le Neuroscienze, 16132 Genova, Italy;
| | - Antonio Vena
- Clinica Malattie Infettive, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) per l’Oncologia e le Neuroscienze, 16132 Genova, Italy;
| | - Matteo Bassetti
- Dipartimento di Scienze della Salute (DISSAL), Università degli Studi di Genova, 16132 Genova, Italy; (D.R.G.); (M.B.)
- Clinica Malattie Infettive, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) per l’Oncologia e le Neuroscienze, 16132 Genova, Italy;
| | - Giorgio Peretti
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (F.M.); (M.F.); (A.A.); (F.M.); (G.P.)
| | - Patricia R. M. Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro 21941, Brazil;
- COVID-19 Virus Network (RedeVírus MCTI), Ministry of Science, Technology, and Innovation, Brasília 70007, Brazil
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy; (F.I.); (C.R.); (L.B.); (P.P.)
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy
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19
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Rovira A, Tricklebank S, Surda P, Whebell S, Zhang J, Takhar A, Yeung E, Fan K, Ahmed I, Hopkins P, Dawson D, Ball J, Kumar R, Khaliq W, Simo R, Arora A. Response to comments to "Open versus percutaneous tracheostomy in COVID-19: a multicentre comparison and recommendationfor future resource utilisation". Eur Arch Otorhinolaryngol 2021; 278:2165-2166. [PMID: 33830366 PMCID: PMC8026387 DOI: 10.1007/s00405-021-06775-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/20/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Aleix Rovira
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK.
| | - Stephen Tricklebank
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Pavol Surda
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Stephen Whebell
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joe Zhang
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Arun Takhar
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Elizabeth Yeung
- Department of Oral and Maxillofacial Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - Kathleen Fan
- Department of Oral and Maxillofacial Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - Imran Ahmed
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Phillip Hopkins
- Department of Critical Care, Kings College Hospital NHS Foundation Trust, London, UK
| | - Deborah Dawson
- Department of Critical Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jonathan Ball
- Department of Critical Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ram Kumar
- Department of Critical Care, Kingston Hospital NHS Foundation Trust, London, UK
| | - Waqas Khaliq
- Department of Critical Care, Lewisham and Greenwich NHS Trust, London, UK
| | - Ricard Simo
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Asit Arora
- Department of Otolaryngology and Head and Neck Surgery, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
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20
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Nishio N, Hiramatsu M, Goto Y, Shindo Y, Yamamoto T, Jingushi N, Wakahara K, Sone M. Surgical strategy and optimal timing of tracheostomy in patients with COVID-19: Early experiences in Japan. Auris Nasus Larynx 2021; 48:518-524. [PMID: 33272716 PMCID: PMC7674116 DOI: 10.1016/j.anl.2020.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 10/23/2020] [Accepted: 11/12/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Tracheostomy is an important surgical procedure for coronavirus disease-2019 (COVID-19) patients who underwent prolonged tracheal intubation. Surgical indication of tracheostomy is greatly affected by the general condition of the patient, comorbidity, prognosis, hospital resources, and staff experience. Thus, the optimal timing of tracheostomy remains controversial. METHODS We reviewed our early experience with COVID-19 patients who underwent tracheostomy at one tertiary hospital in Japan from February to September 2020 and analyzed the timing of tracheostomy, operative results, and occupational infection in healthcare workers (HCWs). RESULTS Of 16 patients received tracheal intubation with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, five patients (31%) received surgical tracheostomy in our hospital. The average consultation time for surgical tracheostomy was 7.4 days (range, 6 - 9 days) from the COVID-19 team to the otolaryngologist. The duration from tracheal intubation to tracheostomy ranged from 14 to 27 days (average, 20 days). The average time of tracheostomy was 27 min (range, 17 - 39 min), and post-wound bleeding occurred in only one patient. No significant differences in hemoglobin (Hb) levels were found between the pre- and postoperative periods (mean: 10.2 vs. 10.2 g/dl, p = 0.93). Similarly, no difference was found in white blood cell (WBC) count (mean: 12,200 vs. 9,900 cells /µl, p = 0.25). After the tracheostomy, there was no occupational infection among the HCWs who assisted the tracheostomy patients during the perioperative period. CONCLUSION We proposed a modified weaning protocol and surgical indications of tracheostomy for COVID-19 patients and recommend that an optimal timing for tracheostomy in COVID-19 patients of 2 - 3 weeks after tracheal intubation, from our early experiences in Japan. An experienced multi-disciplinary tracheostomy team is essential to perform a safe tracheostomy in patients with COVID-19 and to minimize the risk of occupational infection in HCWs.
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Affiliation(s)
- Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Mariko Hiramatsu
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Yukari Goto
- Department of Emergency and Critical Care Medicine, Nagoya University Hospital, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Yuichiro Shindo
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Takanori Yamamoto
- Department of Emergency and Critical Care Medicine, Nagoya University Hospital, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Naruhiro Jingushi
- Department of Emergency and Critical Care Medicine, Nagoya University Hospital, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Keiko Wakahara
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
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21
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Hayward SE, Deal A, Cheng C, Crawshaw A, Orcutt M, Vandrevala TF, Norredam M, Carballo M, Ciftci Y, Requena-Méndez A, Greenaway C, Carter J, Knights F, Mehrotra A, Seedat F, Bozorgmehr K, Veizis A, Campos-Matos I, Wurie F, McKee M, Kumar B, Hargreaves S. Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: A systematic review. J Migr Health 2021; 3:100041. [PMID: 33903857 PMCID: PMC8061095 DOI: 10.1016/j.jmh.2021.100041] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Migrants in high-income countries may be at increased risk of COVID-19 due to their health and social circumstances, yet the extent to which they are affected and their predisposing risk factors are not clearly understood. We did a systematic review to assess clinical outcomes of COVID-19 in migrant populations, indirect health and social impacts, and to determine key risk factors. METHODS We did a systematic review following PRISMA guidelines (PROSPERO CRD42020222135). We searched multiple databases to 18/11/2020 for peer-reviewed and grey literature on migrants (foreign-born) and COVID-19 in 82 high-income countries. We used our international networks to source national datasets and grey literature. Data were extracted on primary outcomes (cases, hospitalisations, deaths) and we evaluated secondary outcomes on indirect health and social impacts and risk factors using narrative synthesis. RESULTS 3016 data sources were screened with 158 from 15 countries included in the analysis (35 data sources for primary outcomes: cases [21], hospitalisations [4]; deaths [15]; 123 for secondary outcomes). We found that migrants are at increased risk of infection and are disproportionately represented among COVID-19 cases. Available datasets suggest a similarly disproportionate representation of migrants in reported COVID-19 deaths, as well as increased all-cause mortality in migrants in some countries in 2020. Undocumented migrants, migrant health and care workers, and migrants housed in camps have been especially affected. Migrants experience risk factors including high-risk occupations, overcrowded accommodation, and barriers to healthcare including inadequate information, language barriers, and reduced entitlement. CONCLUSIONS Migrants in high-income countries are at high risk of exposure to, and infection with, COVID-19. These data are of immediate relevance to national public health and policy responses to the pandemic. Robust data on testing uptake and clinical outcomes in migrants, and barriers and facilitators to COVID-19 vaccination, are urgently needed, alongside strengthening engagement with diverse migrant groups.
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Affiliation(s)
- Sally E Hayward
- Institute for Infection and Immunity, St George's University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Deal
- Institute for Infection and Immunity, St George's University of London, London, UK
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Cherie Cheng
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Alison Crawshaw
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Miriam Orcutt
- Institute for Global Health, University College London, London, UK
| | | | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen; Department of Infectious Diseases at Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
| | - Manuel Carballo
- International Centre for Migration, Health, and Development, Geneva, Switzerland
| | | | - Ana Requena-Méndez
- Department of Medicine, Karolinska Insitutet, Solna, Sweden; and Barcelona Insitute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
| | | | - Jessica Carter
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Felicity Knights
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - Anushka Mehrotra
- Institute for Infection and Immunity, St George's University of London, London, UK
| | | | - Kayvan Bozorgmehr
- Department of Population Medicine and Health and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany; Section for Health Equity Studies & Migration, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Ines Campos-Matos
- Public Health England; and UCL Collaborative Centre for Inclusion Health, London, UK
| | - Fatima Wurie
- Public Health England; and UCL Research Department of Epidemiology and Public Health, London, UK
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Sally Hargreaves
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - on behalf of the ESCMID Study Group for Infections in Travellers and Migrants (ESGITM)
- Institute for Infection and Immunity, St George's University of London, London, UK
- Institute for Global Health, University College London, London, UK
- Faculty of Business and Social Sciences, Kingston University, London, UK
- Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen; Department of Infectious Diseases at Copenhagen University Hospital, Amager and Hvidovre, Copenhagen, Denmark
- International Centre for Migration, Health, and Development, Geneva, Switzerland
- Doctors of the World UK, London, UK
- Department of Medicine, Karolinska Insitutet, Solna, Sweden; and Barcelona Insitute for Global Health (ISGlobal), University of Barcelona, Barcelona, Spain
- Department of Medicine, McGill University, Montreal, Canada
- Department of Population Medicine and Health and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany; Section for Health Equity Studies & Migration, Heidelberg University Hospital, Heidelberg, Germany
- Medecins Sans Frontieres Greece, Athens, Greece
- Public Health England, London, UK
- Public Health England; and UCL Collaborative Centre for Inclusion Health, London, UK
- Public Health England; and UCL Research Department of Epidemiology and Public Health, London, UK
- Norwegian Institute of Public Health, Oslo, Norway
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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22
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West TE, Schultz MJ, Ahmed HY, Shrestha GS, Papali A. Pragmatic Recommendations for Tracheostomy, Discharge, and Rehabilitation Measures in Hospitalized Patients Recovering From Severe COVID-19 in Low- and Middle-Income Countries. Am J Trop Med Hyg 2021; 104:110-119. [PMID: 33534772 PMCID: PMC7957235 DOI: 10.4269/ajtmh.20-1173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/04/2021] [Indexed: 12/14/2022] Open
Abstract
New studies of COVID-19 are constantly updating best practices in clinical care. However, research mainly originates in resource-rich settings in high-income countries. Often, it is impractical to apply recommendations based on these investigations to resource-constrained settings in low- and middle-income countries (LMICs). We report on a set of pragmatic recommendations for tracheostomy, discharge, and rehabilitation measures in hospitalized patients recovering from severe COVID-19 in LMICs. We recommend that tracheostomy be performed in a negative pressure room or negative pressure operating room, if possible, and otherwise in a single room with a closed door. We recommend using the technique that is most familiar to the institution and that can be conducted most safely. We recommend using fit-tested enhanced personal protection equipment, with the fewest people required, and incorporating strategies to minimize aerosolization of the virus. For recovering patients, we suggest following local, regional, or national hospital discharge guidelines. If these are lacking, we suggest deisolation and hospital discharge using symptom-based criteria, rather than with testing. We likewise suggest taking into consideration the capability of primary caregivers to provide the necessary care to meet the psychological, physical, and neurocognitive needs of the patient.
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Affiliation(s)
- T. Eoin West
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - Marcus J. Schultz
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Department of Intensive Care, Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Hanan Y. Ahmed
- Division of Pulmonary and Critical Care Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gentle S. Shrestha
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Alfred Papali
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
| | - for the COVID-LMIC Task Force and the Mahidol-Oxford Research Unit (MORU)
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Department of Intensive Care, Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
- Division of Pulmonary and Critical Care Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
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23
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Balaji SM. Emergency Maxillofacial Procedures for COVID-Positive Patients. Ann Maxillofac Surg 2020; 10:285-286. [PMID: 33708568 PMCID: PMC7943985 DOI: 10.4103/ams.ams_451_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- S M Balaji
- Department of Oral and Maxillofacial Surgery, Balaji Dental and Craniofacial Hospital, Chennai, Tamil Nadu, India. E-mail:
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