Early tracheostomy is associated with improved mobility and shorter duration of sedative-analgesic use in critically ill covid-19 patients

SESSION TITLE: Outcomes and Survival From the ICU SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm PURPOSE: Current evidence has suggested that early mobilization helps improve physical, cognitive, and functional outcomes. While it is challenging to ensure mobility in intubated and mechanically ventilated patients on sedation, the use of tracheostomy often facilitates mobilization at an earlier stage. We aim to explore the effects of early tracheostomy on sedative-analgesic use and mobility scores in mechanically ventilated COVID-19 patients. 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. Data were extracted from the Society of Critical Care Medicine VIRUS COVID-19 registry, automated data pull by Mayo Data Explorer and retrospective chart review. We used a cutoff of 7 days from the day of intubation to identify early tracheostomy. We selected the BMS value closest to the tracheostomy date as pre-tracheostomy BMS, the latest BMS value within 14 days as immediate post-tracheostomy BMS, and the highest BMS before discharge as maximum post-tracheostomy BMS. Statistical analysis was performed on BlueSky 10.2.1. The chi-square test and Wilcoxon tests (independent sample and paired sample) were used to compare the categorical and continuous variables, respectively. 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. Out of 226 patients, 61 patients underwent early tracheostomy (≤7 days of intubation), and 165 underwent late tracheostomy (>7 days). Our analysis showed that the maximum post-tracheostomy BMS before discharge was higher among the early tracheostomy group (median 38.32 vs. 28.13, p=0.005), with no difference in pre-tracheostomy BMS and immediate post-tracheostomy BMS (within 14 days) between the groups. The median day when pre-tracheostomy BMS (3 vs 4 days prior, p=1.00) and maximum post-tracheostomy BMS (23 vs. 20 days, p=0.41) were collected were similar across the two groups. It was also noted that the early tracheostomy group had a shorter median duration of treatment with propofol (10 vs. 15 days, p=0.01) and fentanyl (9 vs. 15 days, p<0.001) over the entire hospitalization. The total duration of treatment with ketamine, midazolam, and hydromorphone did not vary between the two groups. CONCLUSIONS: Our findings suggest that early tracheostomy in mechanically ventilated COVID-19 patients is associated with lower sedative analgesic use and better mobilization during hospitalization. CLINICAL IMPLICATIONS: While COVID-19 has posed certain challenges from resource perspective, our findings indicate that adopting an early tracheostomy strategy can confer positive changes in patient mobility and disposition. A reduced sedative medication dosing can also help in cognitive and mental improvement, thus promoting positive hospitalization outcomes. 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