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Journal Article Epublish 1 citation

PubMed: 39941648 DOI: 10.3390/jcm14030978

Intubation Versus Tracheotomy Outcomes in Critically Ill COVID-19 Patients in Low-Resource Settings: What Do We Know?

J Clin Med 14(3)

Authors: Pedja Kovacevic, Goran Baric, Sasa Dragic, Danica Momcicevic, Biljana Zlojutro, Milka Jandric, Tijana Kovacevic, Daniel Lovric, Ivan Palibrk, Jihad Mallat

Affiliations

  • Medical Intensive Care Unit, University Clinical Centre of the Republic of Srpska, Dvanaest beba bb, 78000 Banja Luka, Bosnia and Herzegovina.
  • Faculty of Medicine, University of Banja Luka, Save Mrkalja 14, 78000 Banja Luka, Bosnia and Herzegovina.
  • Department of Pharmacy, University Clinical Centre Republic of Srpska, 78000 Banja Luka, Bosnia and Herzegovina.
  • Cardiology Clinic, University Hospital Center Zagreb, 10000 Zagreb, Croatia.
  • Department of Anesthesiology, Reanimatology and Intensive Care, Clinic for Abdominal Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia.
  • Division of Critical Care Medicine, Critical Care Institute, Cleveland Clinic Abu Dhabi, Al Maryah Island, Abu Dhabi 112412, United Arab Emirates.
  • Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA.

Abstract

: Patients undergoing prolonged mechanical ventilation commonly require tracheotomy. The main aim of this study was to evaluate the outcomes of tracheotomy for patients with acute respiratory distress syndrome (ARDS) associated with COVID-19 in low-resource settings. : A retrospective, single-center, observational cohort study was performed on patients with ARDS associated with COVID-19. Patients who underwent intubation alone were compared with those who received both intubation and subsequent tracheotomy. The analysis included patient demographics, comorbidities, and outcomes. : Patients undergoing tracheotomy ( = 89) were compared with intubated patients ( = 622). The median time from intubation to tracheotomy was 10 days (IQR: 6-15 days). Overall, 608 patients (85.5%) died in the hospital. Thirty-seven patients (35.9%) in the survival group had tracheostomy compared with fifty-two patients (8.5%) in the non-survival group ( < 0.001). The Kaplan-Meier curve shows a higher probability of survival in the tracheotomy group compared with the non-tracheotomy group (log-rank test: < 0.001). Tracheotomy was found to be independently associated with lower in-hospital mortality (HR = 0.16 [95% CI: 0.11-0.23], < 0.001) in the multivariable Cox proportional hazards regression analysis after adjusting for potential confounding factors. Furthermore, tracheotomy was associated with a higher cumulative incidence of being alive and off the ventilator at day 28 (SHR = 2.87 [95% CI: 1.88-4.38], < 0.001). : Tracheotomy was associated with reduced in-hospital mortality and longer ventilator-free days.

MeSH

Intubation, Mortality, Hospital Mortality, Covid-19, Critical Illness, Tracheotomy

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