Article Figures & Data
- Figure 1
Flow diagram of patients included in the study, outcomes, and discharge disposition. Average time from the tracheostomy procedure to each outcome is reported. COVID-19, coronavirus disease 2019; ICU, intensive care unit; LTAC, long-term acute care; SNF, skilled nursing facility.
- Figure 2
(A) Percentage of patients on multiple intravenous infusions for sedation, single intravenous infusion, or no intravenous infusions during the 24-hour period prior to tracheostomy, day of tracheostomy (POD0), and first 7 days after tracheostomy (POD1 to POD7). (B) Corresponding proportion of patients on different degrees of ventilator support across the same timeframe. Stars denote significant change in distribution across groups as compared with distribution at baseline according to Fisher’s exact test (*p<0.05, **p<0.01, ***p<0.001). POD, postoperative day.
- Figure 3
Average rates of intravenous sedation agents: (A) propofol (mg/kg/minute), (B) dexmedetomidine (mcg/kg/hour), and (C) midazolam (mg/hour) during the 24-hour period prior to tracheostomy, day of tracheostomy (POD0) and first 7 days after tracheostomy (POD1 to POD7). Also displayed are average daily cumulative doses of opioid medications given (D) via intravenous infusion or injection and (E) orally. Results of repeated-measures ANOVA across entire timeframe are displayed in top right corner of each figure. Stars denote significant decrease from baseline (day prior to tracheostomy) according to mixed-effects modeling (*p<0.05, **p<0.01, ***p<0.001). ANOVA, analysis of variance; MME, milligram morphine equivalent; POD, postoperative day.
- Table 1
Characteristics of the population as well as comparison of patients who were or were not ventilator-dependent at 15 days post-tracheostomy
All patients
(n=26)Ventilator dependence at 15 days (n=9) No ventilator dependence at 15 days (n=17) P value Age in years (mean±SD) 55±12 55±11 55±13 0.96 Male sex, n (%) 21 (81%) 5 (56%) 16 (94%) 0.06 Obesity (BMI >30), n (%) 8 (31%) 3 (33%) 5 (29%) 1.00 At least one major medical comorbidity, n (%) 20 (77%) 8 (89%) 12 (71%) 0.57 Diabetes, n (%) 12 (46%) 4 (44%) 8 (47%) 1.00 Hypertension, n (%) 11 (42%) 4 (44%) 6 (35%) 0.97 ECMO prior to tracheostomy, n (%) 8 (31%) 3 (33%) 5 (29%) 1.00 CRRT prior to or at time of tracheostomy, n (%) 11 (42%) 4 (44%) 7 (41%) 1.00 History of failed extubation/reintubation, n (%) 13 (50%) 2 (22%) 11 (65%) 0.10 Days of MV before tracheostomy (mean±SD) 24±5 24±6 25±5 0.43 FiO2 >40% at time of tracheostomy, n (%) 8 (31%) 5 (56%) 3 (18%) 0.12 PEEP >8 cm H20 at time of tracheostomy, n (%) 4 (15%) 2 (22%) 2 (12%) 0.90 PaO2 to FiO2 ratio <200, n (%) 9 (35%) 4 (44%) 5 (29%) 0.74 Impaired neurologic status with GCS<8, n (%) 7 (27%) 6 (67%) 1 (6%) <0.01 BMI, body mass index; CRRT, continuous renal replacement therapy; ECMO, extracorporeal membrane oxygenation; FiO2, fraction of inspired oxygen; GCS, Glasgow Coma Scale; MV, mechanical ventilation; PEEP, positive end-expiratory pressure.
- Table 2
Comparison of current study results to other published series in the literature
Turri-Zanoni et al20 Zhang et al21 Broderick et al22 Angel et al23 Chao et al29 Floyd et al24 Current study Study period 2/24–3/15 1/23–4/6 – 3/10–4/15 – 4/1–4/30 3/1–6/30 Study location Varese, Italy Wuhan, China Manchester, UK New York, USA Philadelphia, USA New York, USA Denver/Aurora, USA Number of patients 32 11 10 98 53 38 26 Time from intubation to tracheostomy in days (mean±SD or (range)) 15 (9–21) 17 (6–36) 17±5 11±5 20±7 24 (20–28) 25±5 Percutaneous 10 (31%) 6 (55%) 0 98 (100%)* 19 (55%) 0 26 (100%) Complications Bleeding 0 0 0 5 (5%) 1 (2%) 4 (11%) 2 (8%) Wound infection 0 2 (18%) 0 – 1 (2%) 0 0 Follow-up after tracheostomy in days (mean±SD or (range))) 21 (8–37) – 14±7 11±6 – – 49±23 Ventilator support at discharge or follow-up, n (%) Full support – – 1 (10%) 40 (41%) – – 3 (12%) Partial support – – 2 (20%) 19 (19%) – – 2 (8%) No ventilatory support – 9 (82%) 7 (70%) 32 (33%) 30 (57%) 21 (55%) 21 (81%) Time to liberation from ventilator (mean±SD or (range)) – 7 (2–19) – – 12±7 10 9±6 Tracheostomy status, n (%) Downsized – – – 19 (19%) 14 (26%) 7 (18%) 18 (73%) Decannulated 1 (3%) – 6 (60%) 8 (8%) 7 (13%) 16 (65%) Time to decannulation
(mean±SD)– – 10±4 17±5 14 20±10 Disposition Deceased 5 (16%) 0 0 7 (7%) 6 (11%) 2 (5%) 4 (15%) ICU – – 4 (40%) 76 (78%) – – 0 Non-critical care – – 4 (40%) 11 (11%) – – 0 Discharged – – 2 (20%) 4 (4%) 16 (30%) – 22 (85%) *Majority performed using a “novel” percutaneous dilation technique.
ICU, intensive care unit.
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