First management of percutaneous dilatational tracheostomy in severe acute respiratory syndrome coronavirus 2 akin to the vital head and neck region and thyroid gland bed: trust, but be careful whom (you trust)?

Albayrak, Tuna; Yanal, Hülya; Sengul, Demet; Sengul, Ilker; Albayrak, Mehmet; Eyüpoğlu, Selin; Muhtaroğlu, Ali; Cinar, Esma

doi:10.1590/1806-9282.20230832

Acessibilidade / Reportar erro

Brasil

Revista da Associação Médica Brasileira

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Assoc. Med. Bras. 69 (10) • 2023 • https://doi.org/10.1590/1806-9282.20230832 copy

First management of percutaneous dilatational tracheostomy in severe acute respiratory syndrome coronavirus 2 akin to the vital head and neck region and thyroid gland bed: trust, but be careful whom (you trust)?

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

The objective of this study was to compare the clinical outcomes of percutaneous dilatational tracheostomy in COVID-19 and non-COVID-19 patients.

METHODS:

A total of 48 patients who underwent percutaneous dilatational tracheostomy, with 24 COVID-19 patients (Group C) and 24 non-COVID-19 patients (Group N), were included in the study. Patients’ demographic features including age and gender, time to intubation, duration of intubation, Acute Physiology and Chronic Health Evaluation scores, comorbidities, duration of opening tracheostomy, complications, duration of mechanical ventilation, length of stay in the intensive care units, and mortality were recorded and compared between the groups.

RESULTS:

There was no statistically significant difference between the groups regarding age and gender (p=0.558 and p=0.110, respectively). Time to intubation was significantly more prolonged, and intubation follow-up duration was significantly shorter in Group C compared to Group N (p=0.034 and p=0.002, respectively). The Acute Physiology and Chronic Health Evaluation score was statistically significantly higher in Group N compared with Group C (p=0.012). The most common comorbidity was hypertension in 29 (60.4%) patients, followed by cerebrovascular disease in 19 (39.6%) patients. There was no statistically significant difference between the groups regarding mortality (p=0.212).

CONCLUSION:

This study suggests that percutaneous dilatational tracheostomy can be performed safely in COVID-19 and non-COVID-19 patients. However, COVID-19 patients may have a longer time to intubation and shorter intubation follow-up duration than non-COVID-19 patients. The study also found a higher incidence of complications in COVID-19 patients undergoing percutaneous dilatational tracheostomy. These results emphasize the importance of careful patient selection, meticulous technique, and close postoperative monitoring in patients undergoing percutaneous dilatational tracheostomy, particularly in those with COVID-19.

KEYWORDS:
Tracheostomy; Mechanical ventilation; Intensive care; COVID-19; Complications; Thyroidology

Characteristic features		wCVD₁₉	woCVD₁₉	p-value
Sex, n (%)
	Male	15 (62.5%)	13 (54.2%)	0.558
	Female	9 (37.5%)	11 (45.8%)	0.558
Age (years)		61 (47–77)	76 (56–85)	0.110
Time to intubation (days)		8 (5–13)	5 (2–10.5)	0.034
Intubation follow-up (days)		14.8±6.7	20.8±6.3	0.002
APACHE score		12 (6–19)	19 (15–23)	0.012

Comorbidity		wCVD₁₉	woCVD₁₉	p-value
Hypertension, n (%)	No	10 (41.7%)	9 (37.5%)	0.768
Hypertension, n (%)	Yes	14 (58.3%)	15 (62.5%)	0.768
CVD, n (%)	No	15 (62.5%)	14 (58.3%)	0.768
CVD, n (%)	Yes	9 (37.5%)	10 (41.7%)	0.768
COPD, n (%)	No	22 (91.7%)	17 (70.8%)	0.137
COPD, n (%)	Yes	2 (8.3%)	7 (29.2%)	0.137
DM, n (%)	No	19 (79.2%)	19 (79.2%)	1
DM, n (%)	Yes	5 (20.8%)	5 (20.8%)	1
CAD, n (%)	No	21 (87.5%)	21 (87.5%)	1
CAD, n (%)	Yes	3 (12.5%)	3 (12.5%)	1
Epilepsy, n (%)	No	20 (83.3%)	18 (75.0%)	0.724
Epilepsy, n (%)	Yes	4 (16.7%)	6 (25.0%)	0.724

Characteristics		Group C	Group N	p-value
Tracheostomy opening duration (min)		19.9±3.6	14.9±1.7	<0.001
Tracheostomy complication, n (%)
	No	6 (25.0%)ᵃ	18 (75.0%)^b	0.006
	Pneumothorax	3 (12.5%)ᵃ	2 (8.3%)ᵃ
	Bleeding	12 (50.0%)ᵃ	3 (12.5%)^b
	Subcutaneous emphysema	3 (12.5%)ᵃ	1 (4.2%)ᵃ
Mechanical ventilation duration (days)		41.3±20.7	68.2±31.6	0.001
Length of stay in the ICU (days)		50.6±24.7	79.5±34.9	0.002
Discharge, n (%)
	Other ICU	6 (25.0%)	9 (37.5%)	0.212
	Mortality	15 (62.5%)	9 (37.5%)
	Ward	3 (12.5%)	6 (25.0%)

Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
E-mail: ramb@amb.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author: demet.sengul.52@gmail.com