Comparing the Effect of Early Tracheostomy Against Late Tracheostomy Upon Clinical Outcomes of Critically Ill COVID-19 Patients: Thesis
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Saudi Digital Library
Abstract
Background: Tracheostomy placement is a frequent airway management strategy intended to
reduce the need for prolonged intubation and to improve respiratory stability in patients requiring
ventilatory support. The SARS-CoV-2 outbreak has led to a growing number of ICU patients with
respiratory hypoxemia, placing a tremendous demand on ICU personnel and equipment,
particularly mechanical ventilators. Despite the positive role of tracheostomy in prolonged
ventilated patients, the impact of the timing of tracheostomy was debated prior to the advent of
COVID-19 (Coronavirus Disease 2019) and continues today.
Aim: The purpose of this review is to determine if the timing of tracheostomy placement has an
effect on the clinical outcomes of critically ill COVID-19 patients in terms of mortality, length of
stay in the intensive care unit, and duration of invasive mechanical ventilation. Additionally, to
evaluate the safety of the procedure and the risk of developing SARS-CoV-2 among healthcare
workers (HCWs) performing the tracheostomy.
Design: A systematic literature review
Methods: For this systematic literature review, a comprehensive search of four electronic
databases including Medline via Ovid (1949-current), CINAHL, Scopus and Cochrane Library
was conducted to identify the most relevant primary research publications. This review included
only studies that clearly defined an early vs a late tracheostomy group, excluding those that
compared tracheostomised to non-tracheostomised patients. The modified Newcastle-Ottawa
Quality Assessment Scale (NOS) was used to evaluate the quality of selected articles.
Results: From 87 relevant publications, nine observational cohort studies were identified with a
combined sample size of 798 participants (range from 28 to 153 patients). The mean age of the
participants ranged from 52.9 to 68.9 years, most of whom were males (66%–87%). There was no
statistically significant difference in mortality rates between tracheostomies performed during the
first 14 days following intubation and those performed after 14 days of intubation. However, early
tracheostomies may significantly reduce the duration of IMV (MD = -9 days), and the length of
ICU stay (MD = -10 days) than the late tracheostomies, with a minimal risk of viral transmission
among HCWs conducting the procedure.
NURS5080 Capstone (Thesis)
5
Conclusion: Performing tracheostomies on critically ill COVID-19 patients is generally safe when
appropriate precautions (PPE) are taken. Early tracheostomy (ET) is likely to reduce the length of
the intensive care unit stay as well as the duration of invasive mechanical ventilation (IMV), but
has no significant effect on mortality rates.