Association of Tracheostomy With Outcomes in Patients With COVID-19 and SARS-CoV-2 Transmission Among Health Care Professionals: A Systematic Review and Meta-analysis.

Importance approximately 5% to 15% of patients with covid-19 require invasive mechanical ventilation (imv) and, at times, tracheostomy.Details regarding the safety and use of tracheostomy in treating covid-19 continue to evolve.Objective to evaluate the association of tracheostomy with covid-19 patient outcomes and the risk of sars-co v-2 transmission among health care professionals (hcps).Data sources embase (ovid), medline (ovid), and web of science from january 1, 2020, to march 4, 2021.Study selection english-language studies investigating patients with covid-19 who were receiving imv and undergoing tracheostomy.Observational and randomized clinical trials were eligible (no randomized clinical trials were found in the search).All screening was performed by 2 reviewers (p.s.And m.l.).Overall, 156 studies underwent full-text review.Data extraction and synthesis we performed data extraction in accordance with meta-analysis of observational studies in epidemiology guidelines.We used a random-effects model, and robins-i was used for the risk-of-bias analysis.Main outcomes and measures sars-co v-2 transmission between hcps and levels of personal protective equipment, in addition to complications, time to decannulation, ventilation weaning, and intensive care unit (icu) discharge in patients with covid-19 who underwent tracheostomy.Results of the 156 studies that underwent full-text review, only 69 were included in the qualitative synthesis, and 14 of these 69 studies (20.3%) were included in the meta-analysis.A total of 4669 patients were included in the 69 studies, and the mean (range) patient age across studies was 60.7 (49.1-68.8) years (43 studies [62.3%] with 1856 patients).We found that in all studies, 1854 patients (73.8%) were men and 658 (26.2%) were women.We found that 28 studies (40.6%) investigated either surgical tracheostomy or percutaneous dilatational tracheostomy.Overall, 3 of 58 studies (5.17%) identified a small subset of hcps who developed covid-19 that was associated with tracheostomy.Studies did not consistently report the number of hcps involved in tracheostomy.Among the patients, early tracheostomy was associated with faster icu discharge (mean difference, 6.17 days; 95% ci, -11.30 to -1.30), but no change in imv weaning (mean difference, -2.99 days; 95% ci, -8.32 to 2.33) or decannulation (mean difference, -3.12 days; 95% ci, -7.35 to 1.12).There was no association between mortality or perioperative complications and type of tracheostomy.A risk-of-bias evaluation that used robins-i demonstrated notable bias in the confounder and patient selection domains because of a lack of randomization and cohort matching.There was notable heterogeneity in study reporting.Conclusions and relevance the findings of this systematic review and meta-analysis indicate that enhanced personal protective equipment is associated with low rates of sars-co v-2 transmission during tracheostomy.Early tracheostomy in patients with covid-19 may reduce icu stay, but this finding is limited by the observational nature of the included studies.

Journal: JAMA otolaryngology-- head & neck surgery (2021)
Publication types: Journal Article;Meta-Analysis;Systematic Review