Abstract
Objective
Methods
Results
Conclusion
Keywords
1. Introduction
- Lamb C.R.
- Desai N.R.
- Angel L.
- Chaddha U.
- Sachdeva A.
- Sethi S.
- et al.
2. Materials and methods
2.1 Study design and population
2.2 Data extraction
Osaka prefectural government osaka prefecture new coronavirus countermeasures headquarters meeting. 2020, [http://www.pref.osaka.lg.jp/kikaku_keikaku/sarscov2/]
2.3 Outcomes
2.4 Statistical analyses
3. Results
3.1 Study participants
Characteristics | All (n = 109) | PMV withouttracheostomy (n = 43) | Tracheostomy (n = 66) | p value |
---|---|---|---|---|
Age, years | 69 (63–76) | 72 (63.5–77) | 68 (63–73) | 0.155 |
Male sex | 83/109 (76.1%) | 32/43 (74.4%) | 51/66 (77.3%) | 0.911 |
Body mass index, kg/m2 | 24.8 (22.6–27.9) | 25.5 (23.0–29.0) | 24.1 (22.4–26.8) | 0.116 |
Comorbidity | ||||
Heart failure | 0/109 (0%) | 0/43 (0%) | 0/66 (0%) | N/A |
Respiratory failure | 2/109 (1.8%) | 1/43 (2.3%) | 1/66 (1.5%) | 1.000 |
Chronic liver disease | 0/109 (0%) | 0/43 (0%) | 0/66 (0%) | N/A |
Malignancy | 3/109 (2.8%) | 0/43 (0%) | 3/66 (4.5%) | 0.277 |
Immunodeficiency | 9/109 (8.3%) | 3/43 (7.0%) | 6/66 (9.1%) | 1.000 |
Maintenance dialysis | 6/109 (5.5%) | 4/43 (9.3%) | 2/66 (3.0%) | 0.210 |
Emergency admission | 106/109 (97.2%) | 41/43 (95.3%) | 65/66 (98.5%) | 0.561 |
Admission source | ||||
Emergency department | 26/109 (23.9%) | 11/43 (25.6%) | 15/66 (22.7%) | 0.746 |
Ward or other care units | 35/109 (32.1%) | 15/43 (34.9%) | 20/66 (30.3%) | |
Transferred from another hospital | 48/109 (44.0%) | 17/43 (39.5%) | 31/66 (47.0%) | |
Wave | ||||
First (–May 2020) | 53/109 (48.6%) | 20/43 (46.5%) | 33/66 (50.0%) | 0.914 |
Second (June–September 2020) | 18/109 (16.5%) | 7/43 (16.3%) | 11/66 (16.7%) | |
Third (October 2020 onwards) | 38/109 (34.9%) | 16/43 (37.2%) | 22/66 (33.3%) | |
APACHE II score | 19 (15–24) | 20 (16–25) | 18 (14–23) | 0.106 |
APACHE III score | 70 (56–89) | 73 (63–94) | 65 (54–85) | 0.063 |
SOFA score at ICU admission | 7 (5–10) | 8 (6.5–10) | 7 (5–9) | 0.096 |
Length of hospital stay before ICU admission, days | 0 (0–1) | 0 (0–1) | 0 (0–1.8) | 0.997 |
Data within 24 h after ICU admission | ||||
Highest heart rate, /min | 102 (91–121) | 102 (93–124) | 101 (91–115) | 0.239 |
Lowest heart rate, /min | 63 (54–70) | 63 (55–70) | 62 (52–72) | 0.838 |
Highest body temperature,°C | 37.6 (37.1–38.7) | 37.4 (37.1–38.7) | 37.8 (37.1–38.6) | 0.333 |
Lowest body temperature,°C | 36.2 (35.7–36.8) | 36 (35.4–36.6) | 36.4 (35.8–36.8) | 0.109 |
Highest respiratory rate, /min | 27 (24–32) | 27 (23–32) | 28 (24–32) | 0.723 |
Lowest respiratory rate, /min | 14 (10–16) | 14 (11–17) | 14 (10–16) | 0.938 |
Highest blood sugar level, mg/dL | 218 (162–275) | 252 (206–314) | 200 (143–239) | <0.001 |
Lowest blood sugar level, mg/dL | 124 (108–150) | 130 (114–163) | 124 (106–142) | 0.110 |
Highest creatinine level, mg/dL | 0.91 (0.69–1.27) | 1.02 (0.69–1.50) | 0.82 (0.68–1.12) | 0.179 |
Lactate, mmol/L | 1.5 (1.1–2.1) | 1.5 (1.2–2.0) | 1.5 (0.9–2.1) | 0.569 |
Urine output, mL/day | 1178 (828–1978) | 1138 (820–1673) | 1230 (855–2030) | 0.385 |
Incidence of AKI | 2/109 (1.8%) | 2/43 (4.7%) | 0/66 (0%) | 0.153 |
Lowest PaO2/FIO2 ratio | 130 (98–181) | 124 (86–178) | 136 (109–183) | 0.194 |
Highest PaCO2, mmHg | 49.3 (44.1–58.4) | 53.2 (45.3–58.6) | 48.5 (43.9–56.4) | 0.253 |
Lowest PaCO2, mmHg | 36.4 (32.2–40) | 35.7 (31.3–39.2) | 36.7 (32.2–40.1) | 0.390 |
Highest pH | 7.44 (7.40–7.47) | 7.42 (7.37–7.46) | 7.45 (7.41–7.48) | 0.049 |
Lowest pH | 7.32 (7.27–7.37) | 7.29 (7.24–7.34) | 7.34 (7.27–7.39) | 0.011 |
GCS | 15 (13–15) | 15 (14–15) | 15 (13–15) | 0.834 |
3.2 Processes of care during ICU stay and adjustment of patient demographics
Variables | All | PMV withouttracheostomy | Tracheostomy | p value |
---|---|---|---|---|
VV-ECMO | 29/109 (26.6%) | 10/43 (23.3%) | 19/66 (28.8%) | 0.658 |
VA-ECMO | 3/109 (2.8%) | 1/43 (2.3%) | 2/66 (3.0%) | 1.000 |
CRRT | 35/109 (32.1%) | 17/43 (39.5%) | 18/66 (27.3%) | 0.211 |
Length of ICU stay before MV commencement, days | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0.095 |
Duration of MV before tracheostomy, days | 15 (10.5–21.5) | - | 15 (10.5–21.5) | N/A |
Procedure of tracheostomy | ||||
Surgical tracheostomy | 35/109 (32.1%) | - | 35/66 (53.0%) | N/A |
Percutaneous tracheostomy | 26/109 (23.9%) | - | 26/66 (39.4%) | |
Unknown | 5/109 (4.6%) | - | 5/66 (7.6%) |
3.3 Clinical outcomes
Variables | All | PMV without tracheostomy | Tracheostomy | p value |
---|---|---|---|---|
MV duration in ICU, days | 24.6 (18.0–41.0) | 20.4 (16.8–30.9) | 27.0 (19.9–41.7) | 0.081 |
ICU mortality | 28/109 (25.7%) | 17/43 (39.5%) | 11/66 (16.7%) | 0.014 |
Length of ICU stay, days | 27.9 (20.4–44.2) | 26.9 (19.2–37.0) | 33.9 (21.7–48.6) | 0.094 |
Ventilator liberation during ICU stay | 59/109 (54.1%) | 23/43 (53.5%) | 36/66 (54.5%) | 1.000 |
28-day mortality | 15/92 (16.3%) | 10/36 (27.8%) | 5/56 (8.9%) | 0.022 |
Hospital outcome | ||||
Death | 38/109 (34.9%) | 21/43 (48.8%) | 17/66 (25.8%) | 0.046 |
Discharge | 21/109 (19.3%) | 7/43 (16.3%) | 14/66 (21.2%) | |
Transfer to another hospital | 50/109 (45.9%) | 15/43 (34.9%) | 35/66 (53.0%) | |
Hospital mortality | 38/109 (34.9%) | 21/43 (48.8%) | 17/66 (25.8%) | 0.023 |
Length of hospital stay, day | 41 (23–66) | 35 (23–49.5) | 49.5 (31.5–77.5) | 0.011 |
3.4 Impact of Tracheostomy
Outcomes | Original cohort | IPTW | ||||
---|---|---|---|---|---|---|
Crude HR (95% CI) | p value | Adjusted HR (95% CI) | p value | Crude HR (95% CI) | p value | |
ICU mortality | 0.277 (0.126–0.611) | 0.001 | 0.312 (0.134–0.725) | 0.007 | 0.269 (0.124–0.581) | <0.001 |
28-day mortality | 0.304 (0.104–0.889) | 0.030 | 0.322 (0.108–0.958) | 0.042 | 0.281 (0.094–0.839) | 0.023 |
Hospital mortality | 0.347 (0.179–0.670) | 0.002 | 0.413 (0.210–0.814) | 0.011 | 0.316 (0.163–0.612) | <0.001 |
4. Discussion
4.1 Key findings
4.2 Relationship with previous studies
- Martín Delgado M.C.
- Avilés-Jurado F.X.
- Álvarez Escudero J.
- Aldecoa Álvarez-Santuyano C.
- de Haro López C.
- Díaz de Cerio Canduela P.
- et al.
4.3 Implementation of tracheostomy in ICUs
- Hansson A.
- Sunnergren O.
- Hammarskjold A.
- Alkemark C.
- Taxbro K.
4.4 Implications of study findings
4.5 Strengths and limitations
5. Conclusions
Declaration of Competing Interest
Acknowledgements
Appendix. Supplementary materials
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