Characteristics and factors associated with mortality in tracheostomized patients with COVID-19: a retrospective cohort study in a hospital in Tacna, Peru

Authors

DOI:

https://doi.org/10.17843/rpmesp.2023.404.12629

Keywords:

Tracheostomy, Tracheotomy, Survival, SARS-CoV-2, COVID-19, Mortality, Peru, Risk Factors

Abstract

Objective. We aimed to describe the main demographic, clinical, laboratory and therapeutic characteristics and to identify whether they are associated with mortality in tracheostomized patients. Material and methods. Retrospective cohort study in adult patients diagnosed with COVID-19, admitted to ICU (Intensive Care Unit) and requiring tracheostomy. Demographic, clinical, laboratory and treatment data were obtained from the medical records of patients admitted to Hospital III Daniel Alcides Carrión in Tacna. The Cox proportional hazards model was used for survival analysis and hazard ratios (HR) with their 95% confidence intervals (95%CI) were calculated. Results. We evaluated 73 patients, 72.6% were men, the most common comorbidities were obesity (68.5%), type 2 diabetes mellitus (35.6%), and arterial hypertension (34.2%). Thirty-seven percent of the participants died during their stay at the ICU. The median time from intubation to tracheostomy and the duration of tracheostomy was 17 (RIC: 15-21) and 21 (RIC: 3-39) days, respectively. Multivariate analysis showed that the factors associated with mortality were procalcitonin > 0.50 ng/dL at the time of tracheostomy (HRa: 2.40 95%CI: 1.03-5.59) and a PaO2/FiO2 ratio less than or equal to 150 mmHg (HRa: 4.44 95%CI: 1.56-12.60). Conclusions. The factors associated with mortality at the time of tracheostomy were procalcitonin > 0.50 ng/dL and a PaO2/FiO2 ratio less than or equal to 150 mmHg.

Downloads

Download data is not yet available.

References

Aleem A, Akbar Samad AB, Slenker AK. Emerging Variants of SARSCoV-2 And Novel Therapeutics Against Coronavirus (COVID-19). En: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [citado 9 de octubre de 2022]. Disponible en: http://www.ncbi.nlm.nih.gov/books/NBK570580/.

Ministerio de Salud. Sala Situacional Covid 19 en el Perú 2023 [Internet]. Lima : Dirección General de Epidemiología. MINSA; 2023 [citado 22 de mayo de 2023]. Disponible en: https://covid19.minsa.gob.pe/sala_situacional.asp.

World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard With Vaccination Data | WHO Coronavirus (COVID-19) Dashboard With Vaccination Data [Internet]. [citado 22 de mayo de 2023]. Disponible en: https://covid19.who.int/table.

Mecham JC, Thomas OJ, Pirgousis P, Janus JR. Utility of Tracheostomy in Patients With COVID-19 and Other Special Considerations. Laryngoscope. 2020;130(11):2546-9.doi: 10.1002/lary.28734

Evrard D, Jurcisin I, Assadi M, Patrier J, Tafani V, Ullmann N, et al. Tracheostomy in COVID-19 acute respiratory distress syndrome patients and follow-up: A parisian bicentric retrospective cohort. PLoS ONE. 2021;16(12):e0261024. doi: 10.1371/journal.pone.0261024.

Asensio Martín MJ, Hernández Bernal M, Yus Teruel S, Minvielle A. Infecciones en el paciente crítico. Medicine (Baltimore). 2018;12(52):3085-96. doi: 10.1016/j.med.2018.03.014.

Vayas Valdivieso WA, Viteri Rodríguez JA, Viteri Villa MF, Wong Vázquez L. Principales secuelas neurológicas del COVID-19: una revisión exploratoria. Bol Malariol Salud Ambient. 2022;62(4):678-85. doi: 10.52808/bmsa.7e6.624.008

Ye Q, Wang B, Mao J. The pathogenesis and treatment of the `Cytokine Storm’ in COVID-19. J Infect. 2020; 80(6):607-613. doi: 10.1016/j.jinf.2020.03.037.

Corona A, Santis V de, Vitale D, Nencini C, Potalivo A, Prete A, et al. Tracheostomy in critically ill patients with SARS 2 COVID-19 infection: a prospective observational multi-center study of short- and long-term outcomes. Can J Respir Ther. 2022 30;58:155-161. doi:10.29390/cjrt-2022-018.

ALHumaid S, Elkrim MA, AlOqaili YA, AlSowailmi GA, AlObaid FA, AlSalem AA, et al. Outcomes of tracheostomy in COVID-19 patients in National Guard Health Affairs, Riyadh, Saudi Arabia. Saudi Med J. 2021;42(11):1217-22. doi:10.15537/smj.2021.42.11.20210505.11.

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. doi:10.5005/jp-journals-10071-24080.

Flinspach AN, Booke H, Zacharowski K, Balaban Ü, Herrmann E, Adam EH. Association of mortality and early tracheostomy in patients with COVID-19: a retrospective analysis. Sci Rep. 2022;12(1):15406. doi: 10.1038/s41598-022-19567-w.

Diaz JV, Riviello ED, Papali A, Adhikari NKJ, Ferreira JC. Global Critical Care: Moving Forward in Resource-Limited Settings. Ann Glob Health. 2019;85(1):3. doi:10.5334/aogh.2413.

Hueda-Zavaleta M, Copaja-Corzo C, Bardales-Silva F, Flores-Palacios R, Barreto-Rocchetti L, Benites-Zapata VA, et al. Factores asociados a la muerte por COVID-19 en pacientes admitidos en un hospital público en Tacna, Perú.Rev Perú Med Exp Salud Pública. 2021;38(2):214-23. doi:10.17843/rpmesp.2021.382.7158.

Geiseler J, Westhoff M. [Weaning from invasive mechanical ventilation]. Med Klin Intensivmed Notfmed. 2021;116(8):715-26. doi: 10.1007/s00063-021-00858-5.

World Health Organization. Clinical management of COVID-19: Living guideline, 13 January 2023 [Internet]. 2023 [cited 2023 Feb 8]. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoVclinical-2023.1.

Seguro Social del Perú, EsSalud [Internet]. Lima. Essalud. 2019. [citado 31 de mayo de 2023]. Disponible en: http://www.essalud.gob.pe/essaludimplementa-historia-clinica-digital-para-atencion-de-asegurados/.

Vuu SKM, Soltani T, Liu H, DeMuro J, Albors LM, Crimi E, et al. Optimal timing and outcomes among COVID-19 patients undergoing tracheostomy.Surgery. 2023;173(4):927-935. doi:10.1016/j.surg.2022.11.017.

Musso G, Managó M, Gomez C, Appendino G, Friscione L, González C, et al. Supervivencia y decanulación a los 90 días luego de traqueostomía por dilatación percutánea en unidad de cuidados intensivos COVID-19. Medicina (B Aires) [Internet]. 2022 [citado el 14 de enero del 2023];82(6):836–44.Disponible en: https://www.medicinabuenosaires.com/revistas/vol82-22/n6/836.pdf.

Battaglini D, Premraj L, White N, Sutt AL, Robba C, Cho SM, et al. Tracheostomy outcomes in critically ill patients with COVID-19: a systematic review, meta-analysis, and meta-regression. Br J Anaesth. 2022;129(5):679-692. doi: 10.1016/j.bja.2022.07.032.

Breik O, Nankivell P, Sharma N, Bangash MN, Dawson C, Idle M, et al. Safety and 30-day outcomes of tracheostomy for COVID-19: a prospective observational cohort study. Br J Anaesth. 2020;125(6):872-879. doi: 10.1016/j.bja.2020.08.023.

Chorath K, Hoang A, Rajasekaran K, Moreira A. Association of Early vs Late Tracheostomy Placement With Pneumonia and Ventilator Days in Critically Ill Patients: A Meta-analysis. JAMA Otolaryngol--Head Neck Surg. 2021;147(5):450-9.doi: 10.1001/jamaoto.2021.0025.

Hueda-Zavaleta M, Copaja-Corzo C, Miranda-Chávez B, Flores-Palacios R, Huanacuni-Ramos J, Mendoza-Laredo J, et al. Determination of PaO2/FiO2 after 24 h of invasive mechanical ventilation and 1PaO2/FiO2 at 24 h as predictors of survival in patients diagnosed with ARDS due to COVID-19. PeerJ. 2022;10:e14290. doi:10.7717/peerj.14290.

Andriolo BN, Andriolo RB, Saconato H, Atallah ÁN, Valente O. Early versus late tracheostomy for critically ill patients. Base de datos Cochrane de Revisiones Sistemáticas 2015, Número 1. Art. Nº: CD007271. doi: 10.1002/14651858.CD007271.

Harrell Shreckengost CS, Foianini JE, Moron Encinas KM, Tola Guarachi H, Abril K, Amin D, et al. Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study. Crit Care Explor. 2022;4(11):e0796. doi:10.1097/CCE.0000000000000796.

Tang Y, Wu Y, Zhu F, Yang X, Huang C, Hou G, et al. Tracheostomy in 80 COVID-19 Patients: A Multicenter, Retrospective, Observational Study. Front Med (Lausanne). 2020;7:615845. doi: 10.3389/fmed.2020.615845.

Singh Y, Soni KD, Singh A, Choudhary N, Perveen F, Aggarwal R, et al. Clinical characteristics of COVID-19 patients who underwent tracheostomy and its effect on outcome: A retrospective observational study. World J Virol. 2022 Nov 25;11(6):477-484. doi: 10.5501/wjv.v11.i6.477.

Bisso IC, Ruiz V, Huespe IA, Rosciani F, Cantos J, Lockhart C, et al. Bronchoscopy-guided percutaneous tracheostomy during the COVID-19 pandemic. Surgery. 2023;173(4):944-949. doi: 10.1016/j.surg.2022.12.010.

Mora Carpio AL, Mora JI. Ventilator Management. En: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [citado 6 de junio de 2023]. Disponible en: http://www.ncbi.nlm.nih.gov/books/NBK448186/.

Fan E, Brodie D, Slutsky AS. Acute Respiratory Distress Syndrome: Advances in Diagnosis and Treatment. JAMA. 2018;319(7):698-710. doi: 10.1001/jama.2017.21907.

Hu R, Han C, Pei S, Yin M, Chen X. Procalcitonin levels in COVID-19 patients.Int J Antimicrob Agents. 2020;56(2):106051. doi: 10.1016/j.ijantimicag.2020.106051.

Heidari-Beni F, Vahedian-Azimi A, Shojaei S, Rahimi-Bashar F, Shahriary A, Johnston TP, et al. The Level of Procalcitonin in Severe COVID-19 Patients: A Systematic Review and Meta-Analysis. Adv Exp Med Biol. 2021;1321:277-86. doi: 10.1007/978-3-030-59261-5_25.

Copaja-Corzo C, Hueda-Zavaleta M, Benites-Zapata VA, Rodriguez-Morales AJ. Antibiotic use and fatal outcomes among critically ill patients with covid-19 in Tacna, Peru. Antibiotics (Basel). 2021;10(8):959. doi: 10.3390/antibiotics10080959.

Zinellu A, De Vito A, Scano V, Paliogiannis P, Fiore V, Madeddu G, et al. The PaO2/FiO2 ratio on admission is independently associated with prolonged hospitalization in COVID-19 patients. J Infect Dev Ctries. 31 de marzo de 2021;15(3):353-9. doi: https://doi.org/10.3855/jidc.13288.

Pink I, Raupach D, Fuge J, Vonberg RP, Hoeper MM, Welte T, et al. C-reactive protein and procalcitonin for antimicrobial stewardship in COVID-19. Infection. 2021 Oct;49(5):935-943. doi:10.1007/s15010-021-01615-8.

Published

2023-12-18

Issue

Section

Original Article

How to Cite

1.
Flores Palacios RJ, Hueda Zavaleta M, Gutiérrez Avila AG, Gómez de La Torre JC, Benites Zapata VA. Characteristics and factors associated with mortality in tracheostomized patients with COVID-19: a retrospective cohort study in a hospital in Tacna, Peru. Rev Peru Med Exp Salud Publica [Internet]. 2023 Dec. 18 [cited 2024 Jun. 12];40(4):441. Available from: https://rpmesp.ins.gob.pe/index.php/rpmesp/article/view/12629

Most read articles by the same author(s)

1 2 3 4 5 6 7 8 9 10 > >>