• Tracheostomy/economics
• Tracheostomy/methods
• Humans
• Cost-Benefit Analysis
• Operating Rooms/economics
• Markov Chains
• Quality-Adjusted Life Years
• Pneumonia/economics
• Postoperative Complications/economics
• Point-of-Care Systems/economics

• adult patients
• mechanical ventilation
• tracheostomy

• Critical Care
• Thoracic Surgery

• Humans
• Tracheostomy/methods
• Tracheostomy/adverse effects
• Tracheostomy/mortality
• Critical Illness/therapy
• Critical Illness/mortality
• Randomized Controlled Trials as Topic
• Systematic Reviews as Topic
• Pneumonia, Ventilator-Associated/epidemiology
• Respiration, Artificial/adverse effects
• Intensive Care Units
• Time Factors
• Time-to-Treatment
• Meta-Analysis as Topic

• FIPE-HCPA

• hypoxic‐ischaemic encephalopathy
• mechanical ventilation
• prognosis
• propensity score matching
• tracheostomy

• Humans
• Tracheostomy/methods
• Tracheostomy/statistics & numerical data
• Male
• Female
• Retrospective Studies
• Propensity Score
• Middle Aged
• Hypoxia-Ischemia, Brain/mortality
• Hypoxia-Ischemia, Brain/therapy
• Prognosis
• Respiration, Artificial/statistics & numerical data
• Length of Stay/statistics & numerical data
• Time Factors
• Aged
• Cohort Studies
• Intensive Care Units/statistics & numerical data
• Hospital Mortality
• Adult

• 2023YFQ0099 Key Research and Development project fund of the Department of Science and Technology of Sichuan Province

• intensive care unit (ICU)
• mechanical ventilation
• outcomes
• point prevalence
• tracheostomy

• Humans
• Tracheostomy/statistics & numerical data
• Tracheostomy/methods
• Tracheostomy/adverse effects
• Italy/epidemiology
• Male
• Intensive Care Units/statistics & numerical data
• Intensive Care Units/organization & administration
• Female
• Cross-Sectional Studies
• Middle Aged
• Aged
• Prevalence
• Adult
• Respiration, Artificial/methods
• Respiration, Artificial/statistics & numerical data
• Surveys and Questionnaires

• mechanical ventilation
• mortality
• outcomes
• tracheostomy
• trauma

• Humans
• Tracheostomy/methods
• Tracheostomy/statistics & numerical data
• Male
• Female
• Retrospective Studies
• Middle Aged
• Length of Stay/statistics & numerical data
• Respiration, Artificial/statistics & numerical data
• Wounds and Injuries/complications
• Wounds and Injuries/therapy
• Aged
• Time Factors
• Adult
• Intensive Care Units/statistics & numerical data
• Treatment Outcome
• Intubation, Intratracheal

• KARPET-21-03 The Research Program of Korean Association for Research, Procedures and Education on Trauma

• Humans
• Respiration, Artificial/statistics & numerical data
• Cross-Sectional Studies
• Intensive Care Units, Pediatric/statistics & numerical data
• Male
• Female
• Child, Preschool
• Infant
• Child
• Prospective Studies
• Prevalence
• Adolescent
• Time Factors

• critically ill patients
• early tracheostomy
• intensive care unit
• mechanical ventilation
• trial sequential analysis

• Intensive Care Unit
• Tracheostomy
• mortality
• percutaneous tracheostomy
• surgical tracheostomy

• optimal timing
• tracheostomy
• veteran

• Humans
• Tracheostomy/statistics & numerical data
• Tracheostomy/methods
• Male
• Retrospective Studies
• Female
• United States
• Aged
• Time Factors
• Middle Aged
• United States Department of Veterans Affairs/statistics & numerical data
• Length of Stay/statistics & numerical data
• Intensive Care Units/statistics & numerical data
• Propensity Score
• Veterans/statistics & numerical data
• Respiration, Artificial/statistics & numerical data
• Ventilator Weaning/statistics & numerical data
• Ventilator Weaning/methods
• Treatment Outcome

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

• fiber optic bronchoscopy
• obstructive ventilatory defect
• post tracheostomy tracheal stenosis
• tracheal ring fracture
• weaning failure

• Benefits
• Early medical intervention
• Outcome
• Severe brain injury
• Stroke
• TBI
• Tracheostomy

• Humans
• Tracheostomy
• Respiration, Artificial
• Pneumonia, Ventilator-Associated
• Brain Injuries, Traumatic/surgery
• Length of Stay
• Stroke
• Intensive Care Units

• Critical care
• Immune checkpoint inhibitor
• Immunotherapy
• Myasthenia gravis
• Myocarditis
• Myositis
• Oncology

• Humans
• Immune Checkpoint Inhibitors
• Myocarditis
• Myasthenia Gravis
• Myositis
• Immunosuppressive Agents
• Syndrome
• Respiratory Insufficiency/chemically induced
• Respiratory Insufficiency/therapy

• Airway
• anaesthesia
• anatomy
• ear, nose and throat, anaesthesia
• gastrointestinal
• laryngopharyngeal reflux
• reflux
• surgery

• Humans
• Prospective Studies
• Laryngopharyngeal Reflux/complications
• Laryngeal Diseases/etiology
• Intubation, Intratracheal/adverse effects
• Respiration, Artificial/adverse effects

• clinical outcomes
• extubation
• intensive care unit
• mechanical ventilation
• tracheostomy

• intensive care
• intensive care unit
• mechanical ventilation
• tracheostomy

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

• Mechanical ventilation
• Prolonged ventilation
• Tracheostomy

• acute spinal cord injury
• traumatic spinal cord injury
• critical care
• tracheostomy timing
• mechanical ventilation

• Cervical Cord/injuries
• Humans
• Patient Selection
• Respiration, Artificial/methods
• Spinal Cord Injuries/therapy
• Time-to-Treatment
• Tracheostomy/methods
• Ventilator Weaning

• COVID-19
• SARS-CoV-2
• critical care capacity
• percutaneous dilational tracheostomy
• resource utilization
• tracheostomy

• COVID-19
• Decannulation
• Percutaneous tracheostomy
• Surgical tracheostomy
• Tracheostomy
• Ventilatory weaning

• Active exercise
• Burns
• Intensive care
• Physiotherapy
• Tracheostomy

• Critical care
• critical illness
• respiratory insufficiency
• tracheostomy

Percutaneous dilatational tracheotomy (PDT) has become an established procedure in intensive care units (ICU). However, the safety of this method has been under debate given the growing number of critically ill patients with high bleeding risk receiving anticoagulation, dual antiplatelet therapy (DAPT) or even a combination of both, i.e. triple therapy. Therefore, the purpose of this study, including such a high proportion of patients on antithrombotic therapy, was to investigate whether PDT in high-risk ICU patients is associated with elevated procedural complications and to analyse the risk factors for bleeding occurring during and after PDT.

PDT interventions conducted in ICUs at 12 European sites between January 2016 and October 2019 were retrospectively analysed for procedural complications. For subgroup analyses, patient stratification into clinically relevant risk groups based on anticoagulation and antiplatelet treatment regimens was performed and the predictors of bleeding occurrence were analysed.

In total, 671 patients receiving PDT were included and stratified into four clinically relevant antithrombotic treatment groups: (1) intravenous unfractionated heparin (iUFH, prophylactic dosage) (n = 101); (2) iUFH (therapeutic dosage) (n = 131); (3) antiplatelet therapy (aspirin and/or P2Y₁₂ receptor inhibitor) with iUFH (prophylactic or therapeutic dosage) except for triple therapy (n = 290) and (4) triple therapy (DAPT with iUFH in therapeutic dosage) (n = 149). Within the whole cohort, 74 (11%) bleedings were reported to be procedure-related. Bleeding occurrence during and after PDT was independently associated with low platelet count (OR 0.73, 95% CI [0.56, 0.92], p = 0.009), chronic kidney disease (OR 1.75, 95% CI [1.01, 3.03], p = 0.047) and previous stroke (OR 2.13, 95% CI [1.1, 3.97], p = 0.02).

In this international, multicenter study bronchoscopy-guided PDT was a safe and low-complication airway management option, even in a cohort of high risk for bleeding on cardiovascular ICUs. Low platelet count, chronic kidney disease and previous stroke were identified as independent risk factors of bleeding during and after PDT but not triple therapy.

The online version contains supplementary material available at 10.1186/s13613-021-00906-5.

• Airway management
• Anticoagulation
• Bleeding
• Dual antiplatelet therapy
• Percutaneous dilatational tracheotomy

Introduction. Tracheostomy can help weaning in long-term ventilated patients, reducing the duration of mechanical ventilation and intensive care unit length of stay, and decreasing complications from prolonged tracheal intubation. In traumatic brain injury (TBI), ideal timing for tracheostomy is still debated. We performed a systematic review and meta-analysis to evaluate the effects of timing (early vs. late) of tracheostomy on mortality and incidence of VAP in traumatic brain-injured patients. Methods. This study was conducted in conformity with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. We performed a search in PubMed, using an association between heading terms: early, tracheostomy, TBI, prognosis, recovery, impact, mortality, morbidity, and brain trauma OR brain injury. Two reviewers independently assessed the methodological quality of eligible studies using the Newcastle–Ottawa Scale (NOS). Comparative analyses were made among Early Tracheostomy (ET) and late tracheostomy (LT) groups. Our primary outcome was the odds ratio of mortality and incidence of VAP between the ET and LT groups in acute brain injury patients. Secondary outcomes included the standardized mean difference (MD) of the duration of mechanical ventilation, ICU length of stay (LOS), and hospital LOS. Results. We included two randomized controlled trials, three observational trials, one cross-sectional study, and three retrospective cohort studies. The total number of participants in the ET group was 2509, while in the LT group it was 2597. Early tracheostomy reduced risk for incidence of pneumonia, ICU length of stay, hospital length of stay and duration of mechanical ventilation, but not mortality. Conclusions. In TBI patients, early tracheostomy compared with late tracheostomy might reduce risk for VAP, ICU and hospital LOS, and duration of mechanical ventilation, but increase the risk of mortality.

• acute brain injury
• early tracheostomy
• late tracheostomy
• mortality
• tracheostomy timing
• ventilatory acquired pneumonia

Meta-analyses typically consider multiple outcomes and report univariate effect sizes considered as independent. Multivariate meta-analysis (MVMA) incorporates outcome correlation and synthesises direct evidence and related outcome estimates within a single analysis. In a series of meta-analyses from the critically ill literature, the current study contrasts multiple univariate effect estimates and their precision with those derived from MVMA.

A previous meta-epidemiological study was used to identify meta-analyses with either one or two secondary outcomes providing sufficient detail to structure bivariate or tri-variate MVMA, with mortality as primary outcome. Analysis was performed using a random effects model for both odds ratio (OR) and risk ratio (RR); borrowing of strength (BoS) between multivariate outcome estimates was reported. Estimate comparisons, β coefficients, standard errors (SE) and confidence interval (CI) width, univariate versus multivariate, were performed using Lin’s concordance correlation coefficient (CCC).

In bivariate meta-analyses, for OR (n = 49) and RR (n = 48), there was substantial concordance (≥ 0.69) between estimates; but this was less so for tri-variate meta-analyses for both OR (n = 25; ≥ 0.38) and RR (≥ -0.10; n = 22). A variable change in the multivariate precision of primary mortality outcome estimates compared with univariate was present for both bivariate and tri-variate meta-analyses and for metrics. For second outcomes, precision tended to decrease and CI width increase for bivariate meta-analyses, but was variable in the tri-variate. For third outcomes, precision increased and CI width decreased. In bivariate meta-analyses, OR coefficient significance reversal, univariate versus MVMA, occurred once for mortality and 6 cases for second outcomes. RR coefficient significance reversal occurred in 4 cases; 2 were discordant with OR. For tri-variate OR meta-analyses reversal of coefficient estimate significance occurred in two cases for mortality, nine cases for second and 7 cases for third outcomes. In RR meta-analyses significance reversals occurred for mortality in 2 cases, 6 cases for second and 3 cases for third; there were 7 discordances with OR. BoS was greater in trivariate MVMAs compared with bivariate and for OR versus RR.

MVMA would appear to be the preferred solution to multiple univariate analyses; parameter significance changes may occur. Analytic metric appears to be a determinant.

• Borrowing of strength
• Critical care
• Metric
• Multivariate meta-analysis
• Random effects

La neumonía adquirida en la comunidad por COVID-19 ha sido una causa reciente y frecuente de ingreso en las unidades de cuidados intensivos en todo el mundo. Su rápida expansión y su elevado número de casos hace que existan muchas preguntas abiertas en cuanto a su manejo, tratamiento y seguimiento. Uno de estos es la realización de traqueostomía en los pacientes afectados por esta neumonía ingresados en cuidados intensivos.

Se realiza un estudio retrospectivo, observacional, con todos los enfermos que ingresan en el servicio de medicina intensiva en un hospital universitario con el diagnóstico clínico o analítico de neumonía por COVID-19. Se analizan todos los pacientes que durante su ingreso requieren conexión a ventilación mecánica y realización de traqueostomía durante su manejo.

Se analizan un total de 37 pacientes. El 70,3% de la muestra son varones (26/37); edad media 59,4 ± 9,4 y APACHE II 14,8 ± 4,67. Los días medios de ventilación mecánica previa a la realización de traqueostomía fue de 11 ± 2,66. Se realizó traqueostomía percutánea en el 86,5% (32/37) de los casos. En 3 ocasiones se realizó en la primera semana. En 3 tras los primeros 14 días, y en 31/37 en el trascurso de la segunda semana. Diecisiete pacientes han sido decanulados (46%). Los días medios desde realización de traqueostomía hasta la decanulación ha sido de 17,7 ± 10,6 días. Dieciséis de estos 17 pacientes ha sido dado de alta del hospital. En nuestra muestra, el tipo de técnica no se asocia con una mayor mortalidad o tasa de complicaciones.

Presentamos los resultados de 37 pacientes que requieren traqueostomía como parte del manejo de neumonía por COVID-19 en un hospital universitario. Descripción de la técnica realizada y pronóstico.

Among patients with acute respiratory failure requiring prolonged mechanical ventilation, tracheostomies are typically placed after approximately 7 to 10 days. Yet half of patients admitted to the intensive care unit receiving tracheostomy will die within a year, often within three months. Existing mortality prediction models for prolonged mechanical ventilation, such as the ProVent Score, have poor sensitivity and are not applied until after 14 days of mechanical ventilation. We developed a model to predict 3-month mortality in patients requiring more than 7 days of mechanical ventilation using deep learning techniques and compared this to existing mortality models.

Retrospective cohort study. Setting: The Medical Information Mart for Intensive Care III Database. Patients: All adults requiring ≥ 7 days of mechanical ventilation. Measurements: A neural network model for 3-month mortality was created using process-of-care variables, including demographic, physiologic and clinical data. The area under the receiver operator curve (AUROC) was compared to the ProVent model at predicting 3 and 12-month mortality. Shapley values were used to identify the variables with the greatest contributions to the model.

There were 4,334 encounters divided into a development cohort (n = 3467) and a testing cohort (n = 867). The final deep learning model included 250 variables and had an AUROC of 0.74 for predicting 3-month mortality at day 7 of mechanical ventilation versus 0.59 for the ProVent model. Older age and elevated Simplified Acute Physiology Score II (SAPS II) Score on intensive care unit admission had the largest contribution to predicting mortality.

We developed a deep learning prediction model for 3-month mortality among patients requiring ≥ 7 days of mechanical ventilation using a neural network approach utilizing readily available clinical variables. The model outperforms the ProVent model for predicting mortality among patients requiring ≥ 7 days of mechanical ventilation. This model requires external validation.

• Aged
• Deep Learning
• Female
• Hospital Mortality
• Humans
• Intensive Care Units
• Male
• Middle Aged
• Models, Biological
• Predictive Value of Tests
• Respiration, Artificial
• Time Factors

• COVID-19
• Humans
• Respiration, Artificial
• SARS-CoV-2
• Tracheostomy

• R01 NR017433 NINR NIH HHS

The rapidly spreading Novel Coronavirus 2019 (COVID-19) appeared to be a highly transmissible pathogen in healthcare environments and had resulted in a significant number of patients with respiratory failure requiring tracheostomy, an aerosol-generating procedure that places healthcare workers at high risk of contracting the infection. Instead of deferring or delaying the procedure, we developed and implemented a novel percutaneous dilatational tracheostomy (PDT) protocol aimed at minimizing the risk of transmission while maintaining favorable procedural outcome. Patients and Methods. All patients who underwent PDT per novel protocol were included in the study. The key element of the protocol was the use of apnea during the critical part of the insertion and upon any opening of the ventilator circuit. This was coupled with the use of enhanced personnel protection equipment (PPE) with a powered air-purifying respirator (PAPR). The operators underwent antibody serology testing and were evaluated for COVID-19 symptoms two weeks from the last procedure included in the study.

Between March 12th and June 30th, 2020, a total of 32 patients underwent PDT per novel protocol. The majority (80%) were positive for COVID-19 at the time of the procedure. The success rate was 94%. Only one patient developed minor self-limited bleeding. None of the proceduralists developed positive serology or any symptoms compatible with COVID-19 infection.

A novel protocol that uses periods of apnea during opening of the ventilator circuit along with PAPR-enhanced PPE for PDT on COVID-19 patients appears to be effective and safe for patients and healthcare providers.

• End of life
• Epidemiology
• Mechanical ventilation
• Neurorehabilitation
• Pathophysiology
• Prolonged weaning
• Pulmonary rehabilitation

Data regarding safety of bedside surgical tracheostomy in novel coronavirus 2019 (COVID-19) mechanically ventilated patients admitted to the intensive care unit (ICU) are lacking. We performed this study to assess the safety of bedside surgical tracheostomy in COVID-19 patients admitted to ICU. This retrospective, single-center, cohort observational study (conducted between February, 23 and April, 30, 2020) was performed in our 45-bed dedicated COVID-19 ICU. Inclusion criteria were: a) age over 18 years; b) confirmed diagnosis of COVID-19 infection (with nasopharyngeal/oropharyngeal swab); c) invasive mechanical ventilation and d) clinical indication for tracheostomy. The objectives of this study were to describe: 1) perioperative complications, 2) perioperative alterations in respiratory gas exchange and 3) occurrence of COVID-19 infection among health-care providers involved into the procedure. A total of 125 COVID-19 patients were admitted to the ICU during the study period. Of those, 66 (53%) underwent tracheostomy. Tracheostomy was performed after a mean of 6.1 (± 2.1) days since ICU admission. Most of tracheostomies (47/66, 71%) were performed by intensivists and the mean time of the procedure was 22 (± 4.4) minutes. No intraprocedural complications was reported. Stoma infection and bleeding were reported in 2 patients and 7 patients, respectively, in the post-procedure period, without significant clinical consequences. The mean PaO₂ / FiO₂ was significantly lower at the end of tracheostomy (117.6 ± 35.4) then at the beginning (133.4 ± 39.2) or 24 hours before (135.8 ± 51.3) the procedure. However, PaO₂/FiO₂ progressively increased at 24 hours after tracheostomy (142 ± 50.7). None of the members involved in the tracheotomy procedures developed COVID-19 infection. Bedside surgical tracheostomy appears to be feasible and safe, both for patients and for health care workers, during COVID-19 pandemic in an experienced center.

• Aged
• Betacoronavirus
• COVID-19
• Coronavirus Infections/prevention & control
• Coronavirus Infections/transmission
• Female
• Humans
• Infectious Disease Transmission, Patient-to-Professional/prevention & control
• Intensive Care Units
• Male
• Middle Aged
• Pandemics/prevention & control
• Pneumonia, Viral/prevention & control
• Pneumonia, Viral/transmission
• Respiration, Artificial
• Retrospective Studies
• SARS-CoV-2
• Safety
• Tracheostomy

• Adverse events
• Clinical outcomes
• Critical care
• Infratentorial lesions
• Timing of tracheostomy

The role of tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic remains unknown. The goal of this consensus statement is to examine the current evidence for performing tracheostomy in patients with respiratory failure from COVID-19 and offer guidance to physicians on the preparation, timing, and technique while minimizing the risk of infection to health care workers (HCWs).

A panel including intensivists and interventional pulmonologists from three professional societies representing 13 institutions with experience in managing patients with COVID-19 across a spectrum of health-care environments developed key clinical questions addressing specific topics on tracheostomy in COVID-19. A systematic review of the literature and an established modified Delphi consensus methodology were applied to provide a reliable evidence-based consensus statement and expert panel report.

Eight key questions, corresponding to 14 decision points, were rated by the panel. The results were aggregated, resulting in eight main recommendations and five additional remarks intended to guide health-care providers in the decision-making process pertinent to tracheostomy in patients with COVID-19-related respiratory failure.

This panel suggests performing tracheostomy in patients expected to require prolonged mechanical ventilation. A specific timing of tracheostomy cannot be recommended. There is no evidence for routine repeat reverse transcription polymerase chain reaction testing in patients with confirmed COVID-19 evaluated for tracheostomy. To reduce the risk of infection in HCWs, we recommend performing the procedure using techniques that minimize aerosolization while wearing enhanced personal protective equipment. The recommendations presented in this statement may change as more experience is gained during this pandemic.

• COVID-19
• SARS-CoV-2
• aerosol generating procedure
• open surgical tracheostomy
• percutaneous dilatational tracheostomy
• tracheostomy

An increasing number of COVID‐19 patients worldwide will probably need tracheostomy in an emergency or at the recovering stage of COVID‐19. We explored the safe and effective management of tracheostomy in COVID‐19 patients, to benefit patients and protect health care workers at the same time.

We retrospectively analyzed 11 hospitalized COVID‐19 patients undergoing tracheostomy. Clinical features of patients, ventilator withdrawal after tracheostomy, surgical complications, and nosocomial infection of the health care workers associated with the tracheostomy were analyzed.

The tracheostomy of all the 11 cases (100%) was performed successfully, including percutaneous tracheostomy of 6 cases (54.5%) and conventional open tracheostomy of 5 cases (45.5%). No severe postoperative complications occurred, and no health care workers associated with the tracheostomy are confirmed to be infected by SARS‐CoV‐2.

Comprehensive evaluation before tracheostomy, optimized procedures during tracheostomy, and special care after tracheostomy can make the tracheostomy safe and beneficial in COVID‐19 patients.

• COVID-19
• nosocomial infection
• open
• percutaneous
• tracheostomy

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