Weaning Outcomes and 28-day Mortality after Tracheostomy in COVID-19 Patients in Central India: A Retrospective Observational Cohort Study

Sunaina Tejpal Karna; Saurabh Trivedi; Pooja Singh; Alkesh Khurana; Revadi Gouroumourty; Brahmam Dodda; Saurabh Saigal; Jai Prakash Sharma; Amit Karna; Pranav Shrivastava; Aqeel Hussain; Vikas Gupta; Gankalyan Behera; Vaishali Waindeskar

doi:10.5005/jp-journals-10071-24080

Weaning Outcomes and 28-day Mortality after Tracheostomy in COVID-19 Patients in Central India: A Retrospective Observational Cohort Study

Indian J Crit Care Med. 2022 Jan;26(1):85-93. doi: 10.5005/jp-journals-10071-24080.

Affiliations

¹ Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
² Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
³ Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
⁴ Department of Anesthesiology and Critical Care, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India.
⁵ Department of Otorhinolaryngology, Head and Neck Surgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.

Abstract

Background: Tracheostomy is integral in long-term intensive care of coronavirus disease-2019 (COVID-19) patients. There is a paucity of studies on weaning outcomes and mortality after tracheostomy in COVID-19 in Indian scenario.

Materials and methods: We conducted a retrospective, single-center, observational study of severe COVID-19 patients who underwent elective tracheostomy (n = 65) during critical care in a tertiary care institute in Central India from May 1, 2020, to April 30, 2021. Data were collected from Medical records, ICU charts, and follow-up visits by patient. A primary objective was to study the clinical characteristics, tracheostomy complications, weaning outcomes, and mortality at 28 and 60 days of ICU admission. We categorized the cohort into two groups (deceased and survivor) and studied association of clinical parameters with 28-day mortality. Cox Proportional regression analysis was applied to calculate the hazard ratio among the predictors of mortality with p value <0.05 as significant.

Results: Elective tracheostomy was done in 69 of 436 (15.8%) patients on invasive mechanical ventilation, of which 65 were included. Tracheostomy was percutaneous in 45/65 (69%) and surgical in 20/65 (31%) with timing from intubation as early in 41/65 and late in 24/65 with most common indication as weaning failure followed by anticipated prolonged ventilation. Tracheostomy complications were present in 29/65 (45%) patients with no difference in complication rates between timing and type of tracheostomy. Downsizing, decannulation, and weaning were successful in 22%, 32 (49%), and 35/65 (54%) patients after tracheostomy. The 28-day mortality was 30/65 (46%). The fractional inspired oxygen concentration (FiO₂) requirement in survivors was lower (0.4-0.6, p = 0.015) with a higher PaO₂/FiO₂ ratio (118-200, p = 0.033). Early tracheostomy within 7 days of intubation was not associated with weaning or survival benefit.

Conclusions: We suggest that tracheostomy should be delayed to after 7 days of intubation, especially till FiO₂ reduces to 0.5 with improvement in PaO₂/FiO₂ for better outcomes and avoiding a wasted procedure (CTRI/2021/07/034768).

Study highlights: Tracheostomy is integral in care of COVID-19 patients needing prolonged ventilation. There is no difference in complications in early/late or percutaneous dilatational/surgical technique. We observed successful weaning post-tracheostomy in 54% patients. Mortality at 28 days was 46%. Early tracheostomy within 7 days of intubation did not improve weaning or survival.

How to cite this article: Karna ST, Trivedi S, Singh P, Khurana A, Gouroumourty R, Dodda B, et al. Weaning Outcomes and 28-day Mortality after Tracheostomy in COVID-19 Patients in Central India: A Retrospective Observational Cohort Study. Indian J Crit Care Med 2022;26(1):85-93.

Keywords: COVID-19 patients; Intensive care; Mortality; Tracheostomy; Weaning success.