53 - Séance de prix
British Journal of Surgery Session BJS Lecture & BJS-Paper Session inkl. Award ceremony
3 juin 2021, 15:25 - 17:30, Stream 1 - 4
Advantages of tracheostomy by ventilated patients during Covid-19 pandemic - a single center experience
G. Bernasconi, M. Bernasconi, F. Lanzi, M. Llamas, M. Arigoni, Presenter: G. Bernasconi (Locarno)
To face COVID-19 pandemic the government of our canton decided to divide hospitals in Covid and non-Covid facilities. Our hospital was designated as one of two regional COVID centres. Our ICU was upgraded from 7 to a maximum of 45 ventilated beds. Despite these measures, availability of ICU beds was critical. To face this problem we decided to proceed with early tracheostomy of intubated patients to be able to transfer them to an intermediate care unit created for this purpouse. The aim of our study is to describe the outcomes of a cohort of patients who underwent tracheostomy during the Covid-19-outbreak in a single centre experience compared to the cohort of ICU-patients who were only intubated.
Data of all intubated COVID-19 patients, treated from the 17.03.20 to the 20.01.21 in our hospital were collected from our patient registry. All tracheostomies were carried out under surgical supervision. The decision to perform tracheostomy was taken by a senior intensive care physician. Percutaneous dilatational tracheostomy (PDT) or open surgical tracheostomy (OST) was performed. Patient data and outcome were analysed and compared between the groups of tracheostomy (A) and non-tracheostomy (B) patients.
In the study period, 167 COVID-19 patients needed intubation in our ICU (mean age 68 y; 72.4% men). 94 of these underwent tracheostomy (mean age 68 y, 68.4% men; 91 PDT, 3 OST). In 3 patients OST was necessary due to the anatomical conformation of their neck. Mean intubation time before tracheostomy (ITBT) was 13.2 days (range 5-32 days). Cumulative mortality of all patients admitted to the ICU was 38.3% (64/167). Mortality rate was 24.5% (23/94) in group A and 56.2% (41/73) in group B (p=0,001).
Our case series is one of the largest case series of patients undergoing tracheostomy during the recent Covid-19-pandemic. Our results show a lower mortality rate for tracheostomy patients compared to non-tracheostomy patients. Tracheostomy as a post-intubation airway management with the objective to optimize patient trasnfers from ICU to intermediate care to overcome bed shortage in ICU during the pandemic peak was therefore not only safe, but seems to affect patients survival as well.