New perspectives on timing towards tracheostomy among critically ill covid-19 patients : role of pressure support ventilation.
J. Saullo*a (Dr), I. Carboni Bissoa (Dr), C. Lockharta (Dr), I. Fernandez Ceballosa (Dr), J. Cantosa (Dr), I. Huespea (Dr), M. Las Herasa (Dr)
a Hospital Italiano de Buenos Aires, Capital Federal, ARGENTINA
Background: The optimal time to perform a tracheostomy ( TQT) in patients with COVID-19 has been the object of study but still remains in debate. The current study examined the hypothesis that patients with tracheostomy due to COVID-19 who made a Pressure support ventilation (PSV) before the TQT regardless of the day of the procedure present more mechanical ventilation free days (VFD´s) in relationship with patients who didn't. Materials and methods: A single-center analytical retrospective cohort study of critically ill adult patients with COVID-19 undergoing elective tracheostomy. Participants were recruited between March 15th of 2020 and June 6th of 2021. The main outcome was ventilator free days . Results: during the study period, 338 patients were admitted to the ICU for COVID-19, 244 required invasive mechanical ventilation, 107 underwent percutaneous tracheostomy. Patients who performed PSV prior to TQT had 20 VFD´s and a median of 36 days of mechanical ventilation (IQR 30-46.8) and patients who performed PSV after TQT had 18 VFD´s and 37 (IQR 30-46) days of mechanical ventilation. In the Fine and Gray analysis, the sHR of patients who underwent PSV after TQT was 1.05 (95% CI 0.66-1.69) and adjusted for confounders was 1.01 (95% CI 0.43-2.36). Conclusion : the PSV realization before the tracheostomy regardless of the day of the procedure, has no statistical significance in terms of mechanical ventilation free days in relationship with patients who didn't.
Disclosure of funding source(s): none