Relationship Between Tracheostomization and Survival in Mechanically Ventilated Patients with Respiratory Symptoms Suggestive of COVID-19 in Cartagena, Colombia
Abstract
Introduction. COVID-19 has generated one of the highest disease burdens in the 21st century. To date, there are more than 280 million estimated cases globally. Many aspects of this condition are still unknown, which causes controversy in how to approach critically ill patients. Tracheostomy is an intervention that has been shown to be beneficial in the management of respiratory disease, however, there is an evidence gap on the effectiveness and safety of this intervention in critically ill COVID-19 patients. Consequently, the aim of this study was to relate the time elapsed from the onset of the clinical condition, during intubation and days of mechanical ventilation, to performing the tracheostomy, with the survival of patients with symptoms suggestive of COVID-19. Methodology. Retrospective cross-sectional study, conducted between March 2020 and February 2021 in two fourth-level hospitals in the city of Cartagena, Colombia. It included patients older than 18 years who were admitted to the intensive care unit due to the need for invasive mechanical ventilation for viral respiratory symptoms. Those with incomplete medical records and hospitalized for other respiratory causes were excluded. Results. A total of 122 patients were included in the study with a median age of 63 years (IQR 22; 20-89), with 66.4% (n = 81) being male. No significant correlation was found between the number of days from the onset of the clinical condition to the performance of tracheostomy (p = 0.12), nor between the time elapsed from endotracheal intubation to the performance of tracheostomy, with respect to survival (p = 0.53). However, there was a relationship between the number of days of invasive mechanical ventilation and the final outcome (p = 0.02). Discussion. Although it has been reported that tracheostomy is one of the riskiest procedures in the management of patients with severe respiratory symptoms, during the COVID-19 pandemic the literature describes that this intervention increases survival, decreases the time required for mechanical ventilation and reduces the length of stay in the intensive care unit. The number of complications is very low in comparison to the benefit it confers, and it was observed that the local behavior is very similar to that reported in the literature. Conclusions. Time from symptom onset or endotracheal intubation to the performance of tracheostomy does not correlate with survival in patients with respiratory symptomatology suggestive of COVID-19 who are mechanically ventilated and tracheostomized.
References
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