Publication date: Feb 03, 2025
Background: 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. Methods: 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. Results: Patients undergoing tracheotomy (n = 89) were compared with intubated patients (n = 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 (p < 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: p < 0. 001). Tracheotomy was found to be independently associated with lower in-hospital mortality (HR = 0. 16 [95% CI: 0. 11-0. 23], p < 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], p < 0. 001). Conclusions: Tracheotomy was associated with reduced in-hospital mortality and longer ventilator-free days.
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| Concepts | Keywords |
|---|---|
| Free | ARDS |
| Mortality | COVID-19 |
| Tracheostomy | mechanical ventilation |
| Ventilator | percutaneous tracheotomy |
| ventilator-free day |
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | Critically Ill |
| disease | MESH | COVID-19 |
| disease | MESH | acute respiratory distress syndrome |
| drug | DRUGBANK | Coenzyme M |
| disease | MESH | lung injury |
| disease | MESH | hypoxia |
| disease | MESH | pulmonary edema |
| drug | DRUGBANK | Trestolone |
| disease | MESH | viral infections |
| disease | MESH | influenza |
| disease | MESH | weaning |
| disease | MESH | complications |
| disease | MESH | infections |
| disease | IDO | site |
| disease | IDO | entity |
| disease | IDO | infection |
| disease | MESH | death |
| disease | IDO | facility |
| disease | MESH | malignancy |
| drug | DRUGBANK | Fibrinogen Human |
| drug | DRUGBANK | Tocilizumab |
| disease | MESH | pneumothorax |
| disease | MESH | heart failure |
| disease | MESH | lung disease |
| disease | MESH | liver disease |
| disease | MESH | Chronic kidney disease |
| disease | MESH | Obesity |
| drug | DRUGBANK | Methylprednisolone |
| drug | DRUGBANK | Dexamethasone |
| disease | MESH | Acute kidney injury |