• Early tracheostomy
• Late tracheostomy
• Mechanical ventilation
• Percutaneous dilatation tracheostomy
• Surgical tracheostomy
• Survival
• Tracheostomy
• Weaning

• Complications
• Neurosurgery
• Tracheostomy

• Humans
• Tracheostomy/statistics & numerical data
• Tracheostomy/methods
• Male
• Middle Aged
• Female
• Retrospective Studies
• Adult
• Cross-Sectional Studies
• Neurosurgical Procedures/statistics & numerical data
• Neurosurgical Procedures/methods
• Respiration, Artificial/statistics & numerical data
• Length of Stay/statistics & numerical data
• Intensive Care Units/statistics & numerical data
• Time Factors
• Aged

• APACHE II
• Intensive care unit
• Mortality
• Tracheostomy
• Ventilator

• airway management
• length of stay
• mechanical ventilators
• pandemics
• survival

• D43 TW009337 FIC NIH HHS
• P30 CA008748 NCI NIH HHS
• UL1 TR000424 NCATS NIH HHS

• Airway Management
• Clinical practice guidelines
• Quality improvement
• Root cause analysis
• Surgery

• Critical Care
• Humans
• Intensive Care Units
• Respiration, Artificial
• Time Factors
• Tracheostomy

Tracheostomy is commonly performed in critically ill patients because of its clinical advantages over prolonged translaryngeal endotracheal intubation. Early tracheostomy has been demonstrated to reduce the duration of mechanical ventilation and length of stay. However, its association with mortality remains ambiguous. This study aimed to evaluate the association between the timing of tracheostomy and mortality in patients receiving mechanical ventilation.

We performed a retrospective cohort analysis of adult patients who underwent tracheostomy during their intensive care unit (ICU) admission between April 2015 and March 2019. Patients who underwent tracheostomy before or after 29 days of ICU admission were excluded. Data were collected from the nationwide Japanese Intensive Care Patient Database. The primary outcome was hospital mortality. The timing of tracheostomy was stratified by quartile, and the association between patient outcomes was evaluated using regression analysis.

Among the 85558 patients admitted to 46 ICUs during the study period, 1538 patients were included in the analysis. The quartiles for tracheostomy were as follows: quartile 1, ≤ 6 days; quartile 2, 7–10 days; quartile 3, 11–14 days; and quartile 4, > 14 days. Hospital mortality was significantly higher in quartile 2 (adjusted odds ratio [aOR]: 1.52, 95% confidence interval [CI]: 1.08–2.13), quartile 3 (aOR: 1.82, 95% CI: 1.28–2.59), and quartile 4 (aOR: 2.26, 95% CI: 1.61–3.16) (p for trend < 0.001) than in quartile 1. A similar trend was observed in the subgroup analyses of patients with impaired consciousness (Glasgow Coma Scale score < 8) and respiratory failure (PaO₂:FiO₂ ≤ 300) at ICU admission (p for trend = 0.081 and 0.001, respectively).

This multi-institutional observational study demonstrated that the timing of tracheostomy was significantly and independently associated with hospital mortality in a stepwise manner. Thus, early tracheostomy may be beneficial for patient outcomes, including mortality, and warrants further investigation.

The online version contains supplementary material available at 10.1186/s40560-022-00610-x.

• bundle
• continuous control pressure
• risk factors
• subglottic secretion suction
• ventilator-associated pneumonia

• COVID-19
• healthcare
• intensive care units
• mechanical ventilation
• outcome assessment
• tracheostomy

• Mechanical ventilation
• Prolonged ventilation
• Tracheostomy

Tracheostomy is integral in long-term intensive care of coronavirus disease-2019 (COVID-19) patients. There is a paucity of studies on weaning outcomes and mortality after tracheostomy in COVID-19 in Indian scenario.

We conducted a retrospective, single-center, observational study of severe COVID-19 patients who underwent elective tracheostomy (n = 65) during critical care in a tertiary care institute in Central India from May 1, 2020, to April 30, 2021. Data were collected from Medical records, ICU charts, and follow-up visits by patient. A primary objective was to study the clinical characteristics, tracheostomy complications, weaning outcomes, and mortality at 28 and 60 days of ICU admission. We categorized the cohort into two groups (deceased and survivor) and studied association of clinical parameters with 28-day mortality. Cox Proportional regression analysis was applied to calculate the hazard ratio among the predictors of mortality with p value <0.05 as significant.

Elective tracheostomy was done in 69 of 436 (15.8%) patients on invasive mechanical ventilation, of which 65 were included. Tracheostomy was percutaneous in 45/65 (69%) and surgical in 20/65 (31%) with timing from intubation as early in 41/65 and late in 24/65 with most common indication as weaning failure followed by anticipated prolonged ventilation. Tracheostomy complications were present in 29/65 (45%) patients with no difference in complication rates between timing and type of tracheostomy. Downsizing, decannulation, and weaning were successful in 22%, 32 (49%), and 35/65 (54%) patients after tracheostomy. The 28-day mortality was 30/65 (46%). The fractional inspired oxygen concentration (FiO₂) requirement in survivors was lower (0.4–0.6, p = 0.015) with a higher PaO₂/FiO₂ ratio (118–200, p = 0.033). Early tracheostomy within 7 days of intubation was not associated with weaning or survival benefit.

We suggest that tracheostomy should be delayed to after 7 days of intubation, especially till FiO₂ reduces to 0.5 with improvement in PaO₂/FiO₂ for better outcomes and avoiding a wasted procedure (CTRI/2021/07/034768).

Tracheostomy is integral in care of COVID-19 patients needing prolonged ventilation. There is no difference in complications in early/late or percutaneous dilatational/surgical technique. We observed successful weaning post-tracheostomy in 54% patients. Mortality at 28 days was 46%. Early tracheostomy within 7 days of intubation did not improve weaning or survival.

Karna ST, Trivedi S, Singh P, Khurana A, Gouroumourty R, Dodda B, et al. Weaning Outcomes and 28-day Mortality after Tracheostomy in COVID-19 Patients in Central India: A Retrospective Observational Cohort Study. Indian J Crit Care Med 2022;26(1):85–93.

• Critical care
• critical illness
• respiratory insufficiency
• tracheostomy

• COVID-19
• D-dimer level
• SOFA score
• Tracheostomy

• Adult
• Aged
• Aged, 80 and over
• COVID-19
• Disease Outbreaks
• Female
• Humans
• Italy/epidemiology
• Male
• Middle Aged
• RNA, Viral
• Respiration, Artificial
• Retrospective Studies
• SARS-CoV-2
• Tracheostomy

• delirium
• intensive care unit
• mechanical ventilation
• prevention of ICU delirium
• tracheostomy

• Mechanical ventilation
• Outcome
• Tracheostomy

To respond to the new recommendations for delaying tracheostomy for coronavirus disease 2019 patients to day 21 post-intubation to ensure viral clearance.

Prospective observational cohort from April 1, 2020, to April 30, 2020, with 60 days follow-up.

Academic medical center with nine adult ICUs dedicated to caring for coronavirus disease 2019 patients requiring mechanical ventilation.

Mechanically ventilated patients with coronavirus disease 2019 pneumonia requiring tracheostomy for prolonged ventilatory support.

Adherence to the standard of care for timing of tracheostomy as deemed necessary by the intensivist without delay and utilizing the existing tracheostomy team in performing the needed procedures within 1 day of the request.

One hundred eleven patients with coronavirus disease 2019 received tracheostomy in the month of April 2020. Median time to tracheostomy was 11 days. All procedures were performed percutaneously at bedside under bronchoscopic guidance. Sixty-three percent of patients who received tracheostomy either weaned or discharged alive within 60 days of the procedure. Performing tracheostomy on these patients without delay did not lead to coronavirus disease 2019 viral transmission to the tracheostomy team as evident by lack of symptoms and negative antibody testing.

Adherence to standard of care in timing of tracheostomy is safe. Recommending delaying the procedure may lead to harmful consequences from prolonging mechanical ventilation and sedation without apparent benefit.

• coronavirus disease 2019
• timing
• tracheostomy

Objective

Tracheostomy is a commonly performed procedure amongst critically ill patients, especially in cases of prolonged mechanical ventilation (PMV). This study aimed to describe the indications, clinical characteristics, and outcomes of elective pediatric tracheostomies in critically ill children at our center.

Methods

A retrospective review of medical records of children who underwent elective tracheostomies in our pediatric intensive care unit (PICU) was conducted from January 2009 to June 2018. Data were extracted based on demographics, indications of tracheostomy, and patient outcomes. Results were reported as mean with standard deviation and as frequencies with percentage.

Results

Of the 3,200 patients admitted to the PICU during the study period, 1,130 were intubated. A total of 48 (4.2% of 1,130) children underwent an elective tracheostomy. 30/48 (62.5%) children had an early tracheostomy. 34/48 (71%) patients were males. Approximately 25% of our patients undergoing a tracheostomy had an underlying neurological condition as the primary diagnosis, followed by respiratory conditions (23%). The most common indications for elective tracheostomy were PMV (>7 days) (n=24, 50%) and extubation failure (n=9, 18.7%). Early tracheostomy (<14 days) had better patient outcomes in terms of ventilator-free days (8.57±4.64 in early tracheostomy vs. 6.38±6.17 days in late tracheostomy, P=0.04). The sedation-free days and ICU-free days were also significantly increased in the early tracheostomy group than in the late tracheostomy group. The successful weaning and ICU discharge rate were significantly higher in the early tracheostomy group than in the late tracheostomy group (78.1% vs. 59.7%, P<0.05; and 69.2% vs. 49.5%, P<0.05, respectively). Ventilator-associated pneumonia was more common in the late tracheostomy group (n= 14, 77%), compared to early tracheostomy group (n=12, 40%) (P=0.03). Two patients expired from tracheostomy-related complications.

Conclusion

PMV was the most common indication for an elective tracheostomy. Early tracheostomy is associated with improved patient outcomes; therefore, a standardized approach toward mechanically ventilated children is recommended.

• critically ill children
• elective
• outcomes
• prolonged ventilation
• timing
• tracheostomy

Percutaneous dilatational tracheostomy (PDT) is the most commonly used minimally invasive procedure in patients with prolonged mechanical ventilation. However, during the procedure withdrawal, the endotracheal tube (ET) may cause substantial gas leak and sometimes the airway could be lost, and the patient exposed to severe hypoxemia. In order to prevent hypoxemia during ET withdrawal and needle stuck in ET during PDT and also for performing the procedure more safe and easy.

In this study, we introduce a new instrument “downpipe endotracheal tube” that has been registered as a patent and examined it in eight patients to confirm practical advantage of this tube.

These patients were five female and three male, with a mean weight of 71.7 kg and the mean age of 65.12 years. The cause of tracheostomy was difficult weaning from mechanical ventilation.

The procedure was safe in all cases. We did not find any complications during the procedure.

• Airway management
• patient safety
• tracheostomy

• Coagulopathy
• Obesity
• Percutaneous dilatational
• Recommendations
• Tracheostomy
• Ultrasound