COVIDTrach; a prospective cohort study of mechanically ventilated COVID-19 patients undergoing tracheostomy in the UK

AbstractPurposeCOVIDTrach is a UK multi-centre prospective cohort study project evaluating the outcomes of tracheostomy in patients with COVID-19 receiving mechanical ventilation. It also examines the incidence of SARS-CoV-2 infection among healthcare workers involved in the procedure.MethodAn invitation to participate was sent to all UK NHS departments involved in tracheostomy in COVID-19 patients. Data was entered prospectively and clinical outcomes updated via an online database (REDCap). Clinical variables were compared with outcomes using multivariable regression analysis, with logistic regression used to develop a prediction model for mortality. Participants recorded whether any operators tested positive for SARS-CoV-2 within two weeks of the procedure.ResultsThe cohort comprised 1605 tracheostomy cases from 126 UK hospitals. The median time from intubation to tracheostomy was 15 days (IQR 11, 21). 285 (18%) patients died following the procedure. 1229 (93%) of the survivors had been successfully weaned from mechanical ventilation at censoring and 1049 (81%) had been discharged from hospital. Age, inspired oxygen concentration, PEEP setting, pyrexia, number of days of ventilation before tracheostomy, C-reactive protein and the use of anticoagulation and inotropic support independently predicted mortality. Six reports were received of operators testing positive for SARS-CoV-2 within two weeks of the procedure.ConclusionsTracheostomy appears to be safe in mechanically ventilated patients with COVID-19 and to operators performing the procedure and we identified clinical indicators that are predictive of mortality.FundingThe COVIDTrach project is supported by the Wellcome Trust UCL COVID-19 Rapid Response Award and the National Institute for Health Research.Trial registrationThe study is registered with ClinicalTrials.Gov (NCT04572438).

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COVIDTrach: a prospective cohort study of mechanically ventilated patients with COVID-19 undergoing tracheostomy in the UK

BMJ Surgery, Interventions, & Health Technologies ◽

10.1136/bmjsit-2020-000077 ◽

2021 ◽

Vol 3 (1) ◽

pp. e000077

Author(s):

Keyword(s):

Mechanical Ventilation ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Clinical History ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Pressure Setting ◽

Uk National Health Service ◽

Ventilated Patients

ObjectivesCOVIDTrach is a UK multicentre prospective cohort study project that aims to evaluate the outcomes of tracheostomy in patients with COVID-19 receiving mechanical ventilation and record the incidence of SARS-CoV-2 infection among healthcare workers involved in the procedure.DesignData on patient demographic, clinical history and outcomes were entered prospectively and updated over time via an online database (REDCap). Clinical variables were compared with outcomes, with logistic regression used to develop a model for mortality. Participants recorded whether any operators tested positive for SARS-CoV-2 within 2 weeks of the procedure.SettingUK National Health Service departments involved in treating patients with COVID-19 receiving mechanical ventilation.ParticipantsThe cohort comprised 1605 tracheostomy cases from 126 UK hospitals collected between 6 April and 26 August 2020.Main outcome measuresMortality following tracheostomy, successful wean from mechanical ventilation and length of time from tracheostomy to wean, discharge from hospital, complications from tracheostomy, reported SARS-CoV-2 infection among operators.ResultsThe median time from intubation to tracheostomy was 15 days (IQR 11, 21). 285 (18%) patients died following the procedure. 1229 (93%) of the survivors had been successfully weaned from mechanical ventilation at censoring and 1049 (81%) had been discharged from hospital. Age, inspired oxygen concentration, positive end-expiratory pressure setting, fever, number of days of ventilation before tracheostomy, C reactive protein and the use of anticoagulation and inotropic support independently predicted mortality. Six reports were received of operators testing positive for SARS-CoV-2 within 2 weeks of the procedure.ConclusionsTracheostomy appears to be safe in mechanically ventilated patients with COVID-19 and to operators performing the procedure and we identified clinical parameters that are predictive of mortality.Trial registration numberThe study is registered with ClinicalTrials.Gov (NCT04572438).

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Authors' response to: Multiple repeat caesarean section in the UK: incidence and consequences to mother and child. A national, prospective cohort study

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/1471-0528.12233 ◽

2013 ◽

Vol 120 (9) ◽

pp. 1155-1155 ◽

Cited By ~ 3

Author(s):

JR Cook ◽

M Knight ◽

MK Dhanjal

Keyword(s):

Cohort Study ◽

Caesarean Section ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Mother And Child ◽

The Uk ◽

Multiple Repeat

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Hormonal and reproductive factors and risk of upper gastrointestinal cancers in men: A prospective cohort study within the UK Biobank

International Journal of Cancer ◽

10.1002/ijc.31375 ◽

2018 ◽

Vol 143 (4) ◽

pp. 831-841

Author(s):

Úna C. Mc Menamin ◽

Andrew T. Kunzmann ◽

Michael B. Cook ◽

Brian T. Johnston ◽

Liam J. Murray ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Reproductive Factors ◽

Uk Biobank ◽

Gastrointestinal Cancers ◽

The Uk ◽

Upper Gastrointestinal

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Safety in intrahospital transportation: evaluation of respiratory and hemodynamic parameters. A prospective cohort study

Sao Paulo Medical Journal ◽

10.1590/s1516-31802008000600005 ◽

2008 ◽

Vol 126 (6) ◽

pp. 319-322 ◽

Cited By ~ 12

Author(s):

Bruno Franco Mazza ◽

José Luiz Gomes do Amaral ◽

Heloisa Rosseti ◽

Rosana Borges Carvalho ◽

Ana Paula Resque Senna ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Arterial Blood ◽

Before And After ◽

High Risk Situation ◽

Change In Mean ◽

Ventilated Patients

CONTEXT AND OBJECTIVE: Intrahospital transportation of mechanically ventilated patients is a high-risk situation. We aimed to determine whether transfers could be safely performed by using a transportation routine. DESIGN AND SETTING: Prospective cohort study with "before and after" evaluation. METHODS: Mechanically ventilated patients who needed transportation were included. Hemodynamic and respiratory parameters were measured before and after transportation. Statistical analysis consisted of variance analysis and paired Student's t test. Results were considered significant if P < 0.05. RESULTS: We studied 37 transfers of 26 patients (12 female) of mean age 46.6 ± 15.7. Patients with pulmonary diseases, positive end expiratory pressure > 5, FiO2 > 0.4 and vasoactive drug use comprised 42.4%, 24.3%, 21.6% and 33.0% of cases, respectively. Mean duration of transportation was 43.4 ± 18.9 minutes. Complications occurred in 32.4%. There was a significant increase in CO2 (before transportation, 29.6 ± 7.3 and after transportation, 34.9 ± 7.0; P = 0.000); a trend towards improved PO2/FiO2 ratio (before transportation, 318.0 ± 137.0 and after transportation, 356.8 ± 119.9; P = 0.053); increased heart rate (before transportation, 80.9 ± 18.7 and after transportation, 85.5 ± 17.6; P = 0.08); and no significant change in mean arterial blood pressure (P = 0.93). CONCLUSION: These results suggest that intrahospital transportation can be safely performed. Our low incidence of complications was possibly related to both the presence of a multidisciplinary transportation team and proper equipment.

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