Gamboa Miño SN y col. Traqueostomía percutánea en la era COVID-19: ¿cambió algo?. Rev Argent Cir. 2024;116(3):209-214
213
should be considered in cases of prolonged MV. In
their review they found a study that showed that 33%
of paꢀents undergoing percutaneous tracheostomy
were weaned from IMV aꢄer a mean follow-up of 10
■
TABLE 1
Variables controlled in paꢀents with percutaneous tracheostomy in
the pre-pandemic and pandemic periods.
Variables
Male sex, n (%)
Age, years (± SD)
Pre-pandemic
7 (20)
Pandemic
11 (18.33)
59 ± 11,63
p
5
days . In a review by Takhar et al., between 9.8% and
1 (*)
15.2% of paꢀents required IMV. They recommended
6
prolonged IMV as a criterion for tracheostomy . Before
59,5 ± 14,31
0,931 (**)
the pandemic, Griffiths et al. performed a systemaꢀc
review where they showed that early tracheostomy (<
Comorbidiꢀes
Diabetes
3
3
0
7
4
2
0.594 (*)
0.306 (*)
0.600 (*)
0.582(*)
COPD
7
days) reduced mechanical venꢀlaꢀon duraꢀon and
Rheumaꢀc disease
Cardiovascular disease
1
7
11
length of stay in the ICU . A similar finding was reported
by the systemaꢀc review performed by Ahmed et al.
in 2017 .
(
*) Fisher’s exact test (**) Student’s t test. X: mean. SD: Standard deviaꢀon.
8
Swain et al. esꢀmated that the number of
tracheostomies would increase due to the higher
number of SARS-CoV-2 infecꢀons and prolonged
venꢀlaꢀon.However,theyfeltthatprolongedintubaꢀon
alone should not be an indicaꢀon for tracheostomy,
as they found in their review published in 2020 that
66.7% of paꢀents who underwent tracheostomy did
■
TABLE 2
Variables compared in paꢀents with percutaneous tracheostomy in
the pre-pandemic and pandemic periods.
Variables
Pre-pandemic
Pandemic
8
p
Scheduled decannulaꢀon
2
0.252(*)
Days spent on MV unꢀl
scheduled decannulaꢀon
73 ± 41.71
45.5 ± 17.32 0.125(*)
9
not show the expected benefits . On the other hand,
(
X and SD)
Breꢃ et al. developed the recommendaꢀons of the
New York Head and Neck Society to reduce the number
of tracheostomies performed in the pandemic era due
to the increased likelihood of infecꢀon of health care
Days spent on MV unꢀl death 37.14 ± 16.90 39.42 ± 18.46 0.787(**)
Mortality (deceased paꢀents)
Reintubaꢀon/recannulaꢀon
7
14
1
0.263(*)
0.647(*)
1
1
0
workers . A tracheostomy is a crucial procedure in this
case, as it helps in the process of weaning from IMV.
This avoids tracheal stenosis, reduces the need for
sedaꢀon unꢀl weaning, minimizes airway resistance and
work of breathing, and opꢀmizes secreꢀon clearance.
Percutaneous tracheostomy was selected due to its
Complicaꢀons:
1
1
-
3
-
False passage
.635(*)
0
Intraoperaꢀve bleeding
2
Tracheoesophageal fistula
1
(
*) Fisher’s exact test (**) Student’s t test. X: mean. SD: Standard deviaꢀon.
Discussion
In a study published by Vallejo-Díez et al. at the advantages compared to the open approach, including
Hospital Universitario Río Hortega, in Valladolid, Spain, a shorter operaꢀve ꢀme, reduced peritracheostoma
between March 2020 and March 2021 10% of paꢀents leakage, no need for aerosol-generaꢀng instruments
with COVID-19 in Spain required admission to the ICU such as the cautery knife, the ease of replacing the
while 5% required invasive mechanical venꢀlaꢀon tracheostomy tube from the first week, and a lower
(
IMV). An increase in the number tracheostomies infecꢀon rate, among others5,12. It is esꢀmated that
performed was observed with the aim of facilitaꢀng the number of percutaneous tracheostomies increased
weaning from IMV and withdrawal of sedaꢀon . during the pandemic
Similar results were reported by McGrath et al. in their
The limitaꢀons of our study include is its
3
11,12
.
guidelines published in 2020. Approximately 8-13% of retrospecꢀve nature and the small sample size.
paꢀents admiꢃed to the ICU requiring IMV required In conclusion, in the present study there were no
a tracheostomy. They established that the main staꢀsꢀcally significant differences between paꢀents
indicaꢀon for tracheostomy was prolonged MV, with who underwent percutaneous tracheostomy during the
the aim of reducing its complicaꢀons and achieving pandemic and pre-pandemic periods. However overall
4
early weaning from IMV . At the same ꢀme, in an expert mortality in the group of paꢀents with viral infecꢀon
consensus Lamb et al. established that tracheostomy was twice as high as in the group without infecꢀon.
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