Tracheostomies after SARS-CoV-2 intubation, performed by academic otorhinolaryngologists in the Paris area of France: Preliminary results - 09/03/21

Doi : 10.1016/j.anorl.2021.03.002

S. Bartier ^a,^{^{1
These authors contributed equally to the study.},}⁎ , C. La Croix ^b,^{^{1
These authors contributed equally to the study.}}, D. Evrard ^c,^{^{1
These authors contributed equally to the study.}}, R. Hervochon ^d,^{^{1
These authors contributed equally to the study.}}, O. Laccourreye ^e, C. Gasne ^f, A. Excoffier ^f, L. Tanaka ^g, B. Barry ^c, A. Coste ^a, F. Tankere ^d, R. Kania ^h,^{^{1
These authors contributed equally to the study.}}, J. Nevoux ^g,^{^{1
These authors contributed equally to the study.}}
^a Service ORL, Centre hospitalier intercommunal de Créteil, Université Paris Est, 40, avenue de Verdun, 94000 Créteil, France
^b Service ORL, AP–HP, Hôpital Cochin AP–HP, Université Paris centre, 27, rue du Faubourg-St.-Jacques, 75014 Paris, France
^c Service ORL, Hôpital Bichat, AP–HP, Université Paris centre, 46, rue Henri-Huchard, 75018 Paris, France
^d Service ORL, AP–HP, Hôpital La Pitié-Salpétrière, Université Paris Sorbonne, 47–83, boulevard de l’Hôpital, 75013 Paris, France
^e Service ORL, AP–HP, HEGP, Université Paris Centre, 20–40, rue Leblanc, 75015 Paris, France
^f Service ORL, AP–HP, Hôpital Tenon, AP–HP, Université Paris Sorbonne, 4, rue de la Chine, 75020 Paris, France
^g Service ORL, AP–HP, Hôpital Bicêtre, Université Paris Saclay, 78, rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
^h Service ORL, AP–HP, Hôpital Lariboisière, Université Paris Nord, 2, rue Ambroise-Paré, 75010 Paris, France

^⁎Corresponding author.

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Abstract

Objective

To analyse tracheostomies after intubation for SARS-Cov-2 infection performed by otorhinolaryngologists in 7 university hospitals in the Paris area of France during the month March 24 to April 23, 2020.

Material and methods

A multicentre retrospective observational study included 59 consecutive patients. The main goals were to evaluate the number, characteristics and practical conditions of tracheostomies, and the COVID-19 status of the otorhinolaryngologists. Secondary goals were to analyse tracheostomy time, decannulation rate, immediate postoperative complications and laryngotracheal axis status.

Results

Tracheostomy indications were for ventilatory weaning and extubation failure in 86% and 14% of cases, respectively. The technique was surgical, percutaneous or hybrid in 91.5%, 3.4% and 5.1% of cases, respectively. None of the operators developed symptoms consistent with COVID-19. Postoperative complications occurred in 15% of cases, with no significant difference between surgical and percutaneous/hybrid techniques (P=0.33), although no complications occurred after percutaneous or hybrid tracheostomies. No procedures or complications resulted in death. The decannulation rate was 74.5% with a mean tracheostomy time of 20±12 days. In 55% of the patients evaluated by flexible endoscopy after decannulation, a laryngeal abnormality was found. On univariate analysis, no clinical features had a significant influence on tracheostomy time, decannulation rate or occurrence of laryngeal lesions.

Conclusion

The main findings of the present retrospective study were: absence of contamination of the surgeons, heterogeneity of practices between centres, a high rate of complications and laryngeal lesions whatever the technique, and the specificities of the patients.

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Keywords : SARS-CoV-2, Tracheostomy, Otorhinolaryngology, France