Tracheostomy covid paper
title: Safety and 30 Day Outcomes of Tracheostomy for COVID-19 - observational cohort study notebook: 🌕-Work tags:
2020_12_20
They had better survival in tracheostomy group than non-tracheostomy group. However, one variable should include the fact that they would only trach those who they thought would be likely to survive.
The reasons people were worried about trach included the likelihood of infection of healthcare workers. So guidelines talked about waiting enough time before trach.
Their markers for trach being suitable were:
- Isolated resp failure (except for acute renal failure)
- Prolonged intubation and mechanical ventilation
- Multiple failed sedation holds, failed extubation, anticipated prolonged wean
- Improving oxygen requirements: FiO2 <0.4, PEEP <10
- Appropriate coag
- Unlikely to need further proning
So: most of these markers were: getting better, but it'll take a while
I think their sensitivity analysis MIGHT be useful? About subgroups for timings.
So they did majority traches with percutaneous in ICU, and the minority were surgical in operating theatre.
I don't think you can use your apache score to tell you much about this. What they're saying is, these two groups appeared to be similarly sick on admission, then a little while later one group was well enough to receive tracheostomy. That group who looked better survived more.
Yes, it is the case that more survived there, but you don't know if they would have done better if avoided trach, or trach later, or trach earlier. There is no useful comparison group to give you a decent answer about what is the right thing to do.
85/100 patients surviving with tracheostomy.
"This appeared to be independent of baseline prognosis" - NO IT WASN'T - baseline at admission maybe, but not at decision to trach/not trach
"At the peak of cases, more than 10 tracheostomies were being performed per day" - Holy shit