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Tracheostomy, ventilatory wean, and decannulation in COVID-19 patients
Chrysostomos Tornari1, Pavol Surda2, Arunjit Takhar2
1Department of ENT - Head & Neck Surgery, Guy's & St Thomas' NHS Foundation Trust, London, UK. t.tornari@gmail.com.
Summary
Higher oxygen levels (FiO2) and peak cough flow in COVID-19 patients undergoing tracheostomy are linked to longer decannulation times. This research aids in planning tracheostomy care for future pandemic surges.
Area of Science:
- Critical Care Medicine
- Respiratory Medicine
- Infectious Diseases
Background:
- Mechanical ventilation for COVID-19 can strain healthcare resources.
- Understanding tracheostomy care trajectories is crucial for capacity planning and patient outcomes.
Purpose of the Study:
- To investigate factors influencing tracheostomy care duration in COVID-19 patients.
- To inform service planning for mechanical ventilation and tracheostomy management during the pandemic.
Main Methods:
- Observational cohort study of 69 COVID-19 patients undergoing tracheostomy for ventilatory weaning.
- Data collected from March to May 2020 in a UK high-volume center.
- Cox regression analysis used to determine factors associated with time to decannulation.
Main Results:
- 57.4% of patients were decannulated at a median of 17 days post-insertion.
- Higher fraction of inspired oxygen (FiO2) ≥ 0.4 at tracheostomy was associated with prolonged decannulation.
- Higher pre-tracheostomy peak cough flow independently predicted longer time to decannulation.
Conclusions:
- Increased FiO2 and peak cough flow at the time of tracheostomy are significant predictors of delayed decannulation in COVID-19 patients.
- These findings provide critical insights for optimizing tracheostomy service planning and resource allocation.
- This study offers comprehensive data on COVID-19 tracheostomy decannulation, aiding future pandemic preparedness.
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