Early tracheostomy non-inferior to late tracheostomy in COVID 19 patients: JAMA
A recent study suggests that in patients with COVID-19, early tracheostomy is non-inferior to late tracheostomy and may be associated with improvement in some outcomes. It also suggests that early tracheostomy did not contribute to increased infections of clinicians. The study details were published in the JAMA Otolaryngology-Head & Neck Surgery on December 17, 2020.
Within the first weeks of the pandemic, at least 7 sets of guidelines emerged from academic journals in otolaryngology, anesthesia, and thoracic surgery, rooted in expert consensus and opinion. Most recommended delaying or avoiding tracheostomy to minimize the risk of infection to clinicians and because the pulmonary manifestations and clinical trajectory of the disease, and therefore the anticipated benefit of tracheostomy, were unclear. Multiple consensus guidelines recommend avoiding or delaying tracheostomy, without evidence to indicate anticipated improvement in outcomes as a result. For this purpose, a multidisciplinary team of surgeons from NYU Langone Health, New York began to identify patients who would benefit from earlier tracheostomy and assessed the outcomes from an early tracheostomy in the airway management of patients with COVID-19 requiring mechanical ventilation.
It was a retrospective medical records review study of 148 patients (120 men and 28 women) with reverse transcriptase-polymerase chain reaction–confirmed COVID-19 requiring mechanical ventilation at a single tertiary-care medical center in New York City from March 1 to May 7, 2020. Surgeons performed open or percutaneous tracheostomy at the bedside in ICU. The major outcomes assessed were:
♦Time from symptom onset to (1) endotracheal intubation, (2) tracheostomy;
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