单位：[1]Huazhong Univ Sci & Technol, Union Hosp, Dept Crit Care Med, Tongji Med Coll, Wuhan, Peoples R China华中科技大学同济医学院附属协和医院[2]Wuhan Univ, Zhongnan Hosp, Dept Crit Care Med, Wuhan, Peoples R China[3]Wuhan Jinyin Tan Hosp, Res Ctr Translat Med, Wuhan, Peoples R China[4]Wuhan Univ, Renmin Hosp, Dept Crit Care Med, Wuhan, Peoples R China[5]Xiaogan Cent Hosp, Dept Crit Care Med, Xiaogan, Peoples R China[6]Wuhan Pulm Hosp, Dept Crit Care Med, Wuhan, Peoples R China[7]Hubei Univ Arts & Sci, Affiliated Hosp, Xiangyang Cent Hosp, Dept Crit Care Med, Xiangyang, Peoples R China[8]Third Peoples Hosp Yichang, Dept Crit Care, Yichang, Peoples R China[9]Hubei Univ Med, Affiliated Hosp, Xiangyang Peoples Hosp 1, Dept Crit Care Med, Xiangyang, Peoples R China[10]Hubei Univ Med, Taihe Hosp, Dept Crit Care Med, Shiyan, Peoples R China[11]Fifth Hosp Wuhan, Dept Crit Care Med, Wuhan, Peoples R China[12]Jianghan Univ, Affiliated Hosp, Dept Crit Care Med, Wuhan, Peoples R China[13]Wuhan 1 Hosp, Dept Crit Care, Wuhan, Peoples R China[14]Airforce Med Univ, Xijing Hosp, Intens Care Unit ICU Ctr, Xian, Peoples R China[15]Huanggang Cent Hosp, Dept Crit Care Med, Huanggang, Peoples R China[16]Hubei Polytech Univ, Edong Healthcare Grp, Affiliated Hosp, Dept Intens Care Unit ICU,Huangshi Cent Hosp, Huangshi, Hubei, Peoples R China[17]Yangtze Univ, Clin Med Coll 2, Jingzhou Cent Hosp, Dept Crit Care Med, Jingzhou, Peoples R China[18]2 Hosp Huangshi, Dept Crit Care Med, Huangshi, Hubei, Peoples R China[19]First Peoples Hosp Jingmen, Dept Crit Care Med, Jingmen, Peoples R China[20]Xiehe Wuhan Red Cross Hosp, Intens Care Unit, Wuhan, Peoples R China[21]Ezhou Cent Hosp, Dept Crit Care Med, Ezhou, Peoples R China[22]Wuhan Third Hosp, Dept Intens Care Unit ICU Emergency, Wuhan, Peoples R China[23]Huazhong Univ Sci & Technol,Tongji Hosp,Dept Crit Care Med,Tongji Med Coll,Wuhan,Peoples R China华中科技大学同济医学院附属同济医院急诊医学科
Background: The outbreak of coronavirus disease 2019 (COVID-19) has led to a large and increasing number of patients requiring prolonged mechanical ventilation and tracheostomy. The indication and optimal timing of tracheostomy in COVID-19 patients are still unclear, and the outcomes about tracheostomy have not been extensively reported. We aimed to describe the clinical characteristics and outcomes of patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia who underwent elective tracheostomies. Methods: The multi-center, retrospective, observational study investigated all the COVID-19 patients who underwent elective tracheostomies in intensive care units (ICUs) of 23 hospitals in Hubei province, China, from January 8, 2020 to March 25, 2020. Demographic information, clinical characteristics, treatment, details of the tracheostomy procedure, successful weaning after tracheostomy, and living status were collected and analyzed. Data were compared between early tracheostomy patients (tracheostomy performed within 14 days of intubation) and late tracheostomy patients (tracheostomy performed after 14 days). Results: A total of 80 patients were included. The median duration from endotracheal intubation to tracheostomy was 17.5 [IQR 11.3-27.0] days. Most tracheotomies were performed by ICU physician [62 (77.5%)], and using percutaneous techniques [63 (78.8%)] at the ICU bedside [76 (95.0%)]. The most common complication was tracheostoma bleeding [14 (17.5%)], and major bleeding occurred in 4 (5.0%) patients. At 60 days after intubation, 31 (38.8%) patients experienced successful weaning from ventilator, 17 (21.2%) patients discharged from ICU, and 43 (53.8%) patients had died. Higher 60 day mortality [22 (73.3%) vs. 21 (42.0%)] were identified in patients who underwent early tracheostomy. Conclusions: In patients with SARS-CoV-2 pneumonia, tracheostomies were feasible to conduct by ICU physician at bedside with few major complications. Compared with tracheostomies conducted after 14 days of intubation, tracheostomies within 14 days were associated with an increased mortality rate.
