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Research ArticleOriginal Research

Tracheostomy in Mechanically Ventilated Patients With SARS-CoV-2-ARDS: Focus on Tracheomalacia

Marcello Guarnieri, Patrizia Andreoni, Hedwige Gay, Riccardo Giudici, Maurizio Bottiroli, Michele Mondino, Gianpaolo Casella, Osvaldo Chiara, Oscar Morelli, Serena Conforti, Thomas Langer and Roberto Fumagalli
Respiratory Care December 2021, 66 (12) 1797-1804; DOI: https://doi.org/10.4187/respcare.09063
Marcello Guarnieri
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, Milan, Italy.
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Patrizia Andreoni
Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, Milan, Italy.
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Hedwige Gay
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
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Riccardo Giudici
Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, Milan, Italy.
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Maurizio Bottiroli
Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, Milan, Italy.
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Michele Mondino
Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, Milan, Italy.
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Gianpaolo Casella
Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, Milan, Italy.
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Osvaldo Chiara
Department of Emergency and Trauma Surgery, Niguarda Hospital, University of Milan, Milan, Italy.
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Oscar Morelli
Department of Otolaryngology, Niguarda Hospital, Milan, Italy.
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Serena Conforti
Department of Thoracic Surgery, Niguarda Hospital, Milan, Italy.
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Thomas Langer
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, Milan, Italy.
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  • For correspondence: [email protected]
Roberto Fumagalli
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, Milan, Italy.
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Abstract

BACKGROUND: The SARS-CoV-2 pandemic increased the number of patients needing invasive mechanical ventilation, either through an endotracheal tube or through a tracheostomy. Tracheomalacia is a rare but potentially severe complication of mechanical ventilation, which can significantly complicate the weaning process. The aim of this study was to describe the strategies of airway management in mechanically ventilated patients with respiratory failure due to SARS-CoV-2, the incidence of severe tracheomalacia, and investigate the factors associated with its occurrence.

METHODS: This retrospective, single-center study was performed in an Italian teaching hospital. All adult subjects admitted to the ICU between February 24, 2020, and June 30, 2020, treated with invasive mechanical ventilation for respiratory failure caused by SARS-CoV-2 were included. Clinical data were collected on the day of ICU admission, whereas information regarding airway management was collected daily.

RESULTS: A total of 151 subjects were included in the study. On admission, ARDS severity was mild in 21%, moderate in 62%, and severe in 17% of the cases, with an overall mortality of 40%. A tracheostomy was performed in 73 (48%), open surgical technique in 54 (74%), and percutaneous Ciaglia technique in 19 (26%). Subjects who had a tracheostomy performed had, compared to the other subjects, a longer duration of mechanical ventilation and longer ICU and hospital stay. Tracheomalacia was diagnosed in 8 (5%). The factors associated with tracheomalacia were female sex, obesity, and tracheostomy.

CONCLUSIONS: In our population, approximately 50% of subjects with ARDS due to SARS-CoV-2 were tracheostomized. Tracheostomized subjects had a longer ICU and hospital stay. In our population, 5% were diagnosed with tracheomalacia. This percentage is 10 times higher than what is reported in available literature, and the underlying mechanisms are not fully understood.

  • severe acute respiratory syndrome
  • SARS-CoV-2
  • mechanical ventilation
  • airway management
  • tracheostomy
  • tracheomalacia

Footnotes

  • Correspondence: Thomas Langer MD, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Anesthesia and Intensive Care Medicine, Niguarda Ca’ Granda, Milan, Italy. E-mail: Thomas.Langer{at}unimib.it
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  • The study was performed at the Department of Anesthesia and Intensive Care Medicine, Niguarda Hospital, Milan, Italy.

  • The authors have no conflicts to disclose.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (12)
Respiratory Care
Vol. 66, Issue 12
1 Dec 2021
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Tracheostomy in Mechanically Ventilated Patients With SARS-CoV-2-ARDS: Focus on Tracheomalacia
Marcello Guarnieri, Patrizia Andreoni, Hedwige Gay, Riccardo Giudici, Maurizio Bottiroli, Michele Mondino, Gianpaolo Casella, Osvaldo Chiara, Oscar Morelli, Serena Conforti, Thomas Langer, Roberto Fumagalli
Respiratory Care Dec 2021, 66 (12) 1797-1804; DOI: 10.4187/respcare.09063

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Tracheostomy in Mechanically Ventilated Patients With SARS-CoV-2-ARDS: Focus on Tracheomalacia
Marcello Guarnieri, Patrizia Andreoni, Hedwige Gay, Riccardo Giudici, Maurizio Bottiroli, Michele Mondino, Gianpaolo Casella, Osvaldo Chiara, Oscar Morelli, Serena Conforti, Thomas Langer, Roberto Fumagalli
Respiratory Care Dec 2021, 66 (12) 1797-1804; DOI: 10.4187/respcare.09063
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Keywords

  • severe acute respiratory syndrome
  • SARS-CoV-2
  • mechanical ventilation
  • airway management
  • tracheostomy
  • tracheomalacia

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