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Outcomes of tracheostomy in COVID-19 patients in National Guard Health Affairs, Riyadh, Saudi Arabia

Salwa ALHumaid1, Mohammed A Elkrim1, Yazeed A AlOqaili1

  • 1From the Division of Otolaryngology-Head and Neck Surgery (ALHumaid, Elkrim, AlOqaili, AlObaid, AlSalem, AlQabasani), Department of Surgery; from the Department of Intensive Care Unit (Arabi, AlDorzi), King Abdulaziz Medical City and King Abdullah Specialist Children's Hospital National Guard Health Affairs, and from the College of Medicine (AlSowailmi), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.

Saudi Medical Journal
|November 4, 2021
PubMed

Insights

Tracheostomies in COVID-19 patients showed high mortality, linked to rising C-reactive protein levels before the procedure. Procedure timing did not impact survival rates in this study.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Surgical Outcomes

Background:

  • Tracheostomy is a critical intervention for prolonged mechanical ventilation in severe respiratory illnesses.
  • Outcomes of tracheostomy in coronavirus disease 2019 (COVID-19) patients require further investigation due to the pandemic's unique challenges.

Purpose of the Study:

  • To evaluate the outcomes of tracheostomy in patients with COVID-19.
  • To identify factors associated with mortality and mechanical ventilation weaning in this patient cohort.

Main Methods:

  • Retrospective analysis of COVID-19 patients who underwent tracheostomy at National Guard Hospital, Riyadh, Saudi Arabia (April-December 2020).
  • Data collected included patient demographics, indications for tracheostomy, intubation-to-tracheostomy duration, C-reactive protein (CRP) trends, and mortality.

Main Results:

  • A total of 45 COVID-19 patients underwent tracheostomy; 66.7% were male, with a mean age of 66.76 years.
  • The primary indication was anticipated prolonged weaning (88.9%). High mortality was observed, significantly associated with a pre-tracheostomy CRP uptrend (p=0.039).
  • Mortality was not significantly related to the intubation-to-tracheostomy duration. Among survivors, 68.8% were weaned from mechanical ventilation.

Conclusions:

  • COVID-19 patients undergoing tracheostomy have a high mortality rate, primarily driven by the disease itself.
  • A pre-tracheostomy C-reactive protein uptrend is a significant predictor of mortality.
  • Contrary to some prior studies, the duration from intubation to tracheostomy did not correlate with mortality in this COVID-19 cohort.
Abstract

Keywords:
COVID-19aerosol generating procedurepersonal protective equipmentprolonged intubationtracheostomy

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