Incidence of post-intubation complications in early vs late-tracheostomy in hospitalized covid-19 patients

SESSION TITLE: Critical Care Posters 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Laryngotracheal complications have been reported in prolonged laryngotracheal intubation, and the outcomes include failed extubation, stridor, or dysphonia after extubation. Initiation of an early tracheostomy can avoid such risks to some extent, although the evidence of such benefit in the COVID-19 population is inadequately described in the existing literature. METHODS: We performed a retrospective multi-center study on COVID-19 patients admitted to the Mayo Clinic Enterprise health system between March 2020 and June 2022 and underwent tracheostomy during the hospital stay. Data were extracted from the Society of Critical Care Medicine VIRUS COVID-19 registry and retrospective chart review. We used a cutoff of 7 days from the day of intubation to identify early tracheostomy. Information regarding post-intubation complications was collected from hospital discharge notes and ENT notes (consult notes and follow-up visit notes) and included but was not limited to subglottic stenosis, vocal cord edema, upper airway injury, and vocal paresis with dysphonia. The chi-square and independent sample t-test were used to compare the categorical and continuous variables. RESULTS: Our study cohort consisted of 226 patients, of which the majority were male (66.37%), Caucasian (67.25%), and non-Hispanic (79.64%). The cohort's median age was 57 years, and the median BMI was 31.4 kg/m2. Among 226 patients, 61 underwent early tracheostomy, and 165 underwent late tracheostomy. The median length of invasive mechanical ventilation via endotracheal tube before tracheostomy was 3 (1,6) days in the early-tracheostomy group and 15 (12,20) days in the late-tracheostomy group. The median number of intubation events before tracheostomy was similar across the two groups (1 day in both groups). The overall incidence of post-intubation complication in our cohort was 3.09% (7 out of 226 patients), with an incidence of 3.63% (6/165) in the late tracheostomy group and 1.63% (1/61) in the early tracheostomy group. However, the difference was not statistically significant between the two groups (p=0.44). The most common type of complication was subglottic stenosis (4/7; 57.12%). Other complications were vocal cord edema, upper airway (oropharyngeal) injury, and vocal paresis with dysphonia. CONCLUSIONS: Our study found no statistically significant difference in post-intubation complications between hospitalized COVID-19 patients who underwent early or late tracheostomy. However, due to the low incidence, further large-scale studies are warranted to confirm these findings. CLINICAL IMPLICATIONS: Identifying post-intubation laryngotracheal complications is of great importance during the patient’s hospital stay and after discharge. Reduction of such risk through an early tracheostomy, if supported by evidence, will positively influence patient outcomes and healthcare burden. DISCLOSURES: No relevant relationships by Prasanth Balasubramanian No relevant relationships by Arvind Balavenkataraman No relevant relationships by Vikas Bansal No relevant relationships by Anirban Bhattacharyya No relevant relationships by Sanjay Chaudhary No relevant relationships by Ricardo Diaz Milian No relevant relationships by Pramod Guru No relevant relationships by Abby Hanson No relevant relationships by Shahin Isha No relevant relationships by Anek Jena No relevant relationships by Anna Jenkins No relevant relationships by Rahul Kashyap No relevant relationships by Subekshya Khadka No relevant relationships by Syed Khan No relevant relationships by Sean Kiley No relevant relationships by Pablo Moreno Franco No relevant relationships by Neal Patel No relevant relationships by Quintin Quinones No relevant relationships by Devang Sanghavi No relevant relationships by PARTHKUMAR SATASHIA No relevant relationships by Anna Shapiro No relevant relationships by Rabi Shrestha No relevant relationships by Kawaljeet Singh No relevant relationships by Aysun Tekin