Background

We performed a systematic review of mechanically ventilated patients with COVID-19, which analysed the effect of tracheostomy timing and technique (surgical vs percutaneous) on mortality. Secondary outcomes included intensive care unit (ICU) and hospital length of stay (LOS), decannulation from tracheostomy, duration of mechanical ventilation, and complications.

Methods

Four databases were screened between January 1, 2020 and January 10, 2022 (PubMed, Embase, Scopus, and Cochrane). Papers were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Population or Problem, Intervention or exposure, Comparison, and Outcome (PICO) guidelines. Meta-analysis and meta-regression for main outcomes were performed.

Results

The search yielded 9024 potentially relevant studies, of which 47 (n=5268 patients) were included. High levels of between-study heterogeneity were observed across study outcomes. The pooled mean tracheostomy timing was 16.5 days (95% confidence interval [CI]: 14.7–18.4; I²=99.6%). Pooled mortality was 22.1% (95% CI: 18.7–25.5; I²=89.0%). Meta-regression did not show significant associations between mortality and tracheostomy timing, mechanical ventilation duration, time to decannulation, and tracheostomy technique. Pooled mean estimates for ICU and hospital LOS were 29.6 (95% CI: 24.0–35.2; I²=98.6%) and 38.8 (95% CI: 32.1–45.6; I²=95.7%) days, both associated with mechanical ventilation duration (coefficient 0.8 [95% CI: 0.2–1.4], P=0.02 and 0.9 [95% CI: 0.4–1.4], P=0.01, respectively) but not tracheostomy timing. Data were insufficient to assess tracheostomy technique on LOS. Duration of mechanical ventilation was 23.4 days (95% CI: 19.2–27.7; I²=99.3%), not associated with tracheostomy timing. Data were insufficient to assess the effect of tracheostomy technique on mechanical ventilation duration. Time to decannulation was 23.8 days (95% CI: 19.7–27.8; I²=98.7%), not influenced by tracheostomy timing or technique. The most common complications were stoma infection, ulcers or necrosis, and bleeding.

Conclusions

In patients with COVID-19 requiring tracheostomy, the timing and technique of tracheostomy did not clearly impact on patient outcomes.

Systematic Review Protocol

PROSPERO CRD42021272220.

中文翻译：

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COVID-19 危重患者的气管切开术结果：系统评价、荟萃分析和荟萃回归

背景

我们对 COVID-19 机械通气患者进行了系统回顾，分析了气管切开术时机和技术（手术与经皮）对死亡率的影响。次要结果包括重症监护室 (ICU) 和住院时间 (LOS)、气管切开术拔管、机械通气持续时间和并发症。

方法

2020 年 1 月 1 日至 2022 年 1 月 10 日期间筛选了四个数据库（PubMed、Embase、Scopus 和 Cochrane）。论文是根据系统评价和荟萃分析 (PRISMA) 的首选报告项目以及人口或问题、干预或暴露、比较和结果 (PICO) 指南选择的。对主要结果进行了元分析和元回归。

结果

搜索产生了 9024 项可能相关的研究，其中 47 项（n = 5268 名患者）被纳入。在研究结果中观察到高水平的研究间异质性。汇总的平均气管切开时间为 16.5 天（95% 置信区间 [CI]：14.7–18.4；I ² =99.6%）。汇总死亡率为 22.1%（95% CI：18.7–25.5；I ² =89.0%）。Meta 回归未显示死亡率与气管切开时间、机械通气持续时间、拔管时间和气管切开技术之间存在显着关联。ICU 和医院 LOS 的合并平均估计值为 29.6（95% CI：24.0–35.2；I ² =98.6%）和 38.8（95% CI：32.1–45.6；I ²=95.7%) 天，均与机械通气持续时间相关（系数分别为 0.8 [95% CI：0.2–1.4]，P = 0.02 和 0.9 [95% CI：0.4–1.4]，P =0.01），但与气管切开时间无关. 数据不足以评估 LOS 的气管切开技术。机械通气持续时间为 23.4 天（95% CI：19.2–27.7；I ² =99.3%），与气管切开术时间无关。数据不足以评估气管切开技术对机械通气持续时间的影响。拔管时间为 23.8 天（95% CI：19.7–27.8；I ² =98.7%），不受气管切开时间或技术的影响。最常见的并发症是造口感染、溃疡或坏死以及出血。

结论

在需要气管切开术的 COVID-19 患者中，气管切开术的时机和技术并未明显影响患者的预后。

系统审查协议

普洛斯彼罗 CRD42021272220。