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Observational Study
. 2024 Jan 24;69(2):202-209.
doi: 10.4187/respcare.11113.

Epidemiology of Tracheostomized Adult Patients Admitted to Specialized Weaning Centers After Acute COVID-19

Dario Villalba  1 , Emiliano Navarro  2 , Amelia Matesa  3 , Andrés Brusco  4 , Virginia Morales  4 , Gastón Germán Morel Vulliez  2 , Emilio Sebastián Rositi  2 , Luciana Prieto  5 , Mauro Javier Bosso  5 , Silvana De Paoli  6 , Alejo Cotero  6 , Juan Nadur  6 , Marcela Santini  7 , Marcelo Alonso  7 , Florencia Larocca  5 , Carlos Duarte  8 , Verónica García  8 , Romina Campodónico  8 , Gabriel Musso  9 , Mariel Leingruber  9 , Aldana Soledad Morales  10 , Analía Segura  11 , María Eugenia Vallory  11 , Selva Del Carmen Pieruzzi  12 , Pablo Sebastián Pascal  12 , Eduardo Luis De Vito  2
Affiliations
Observational Study

Epidemiology of Tracheostomized Adult Patients Admitted to Specialized Weaning Centers After Acute COVID-19

Dario Villalba et al. Respir Care. .

Abstract

Background: Epidemiological data on patients with COVID-19 referred to specialized weaning centers (SWCs) are sparse, particularly in low- and middle-income countries. Our aim was to describe clinical features, epidemiology, and outcomes of subjects admitted to SWCs in Argentina.

Methods: We conducted a prospective, multi-center, observational study between July 2020-December 2021 in 12 SWCs. We collected demographic characteristics, laboratory results, pulmonary function, and dependence on mechanical ventilation at admission, decannulation, weaning from mechanical ventilation, and status at discharge. A multiple logistic model was built to predict home discharge.

Results: We enrolled 568 tracheostomized adult subjects after the acute COVID-19 phase who were transferred to SWCs. Age was 62 [52-71], males 70%, Charlson comorbidity index was 2 [0-3], and length of stay in ICU was 42 [32-56] d. Of the 315 ventilator-dependent subjects, 72.4% were weaned, 427 (75.2%) were decannulated, and 366 subjects (64.5%) were discharged home. The mortality rate was 6.0%. In multivariate analysis, age (odds ratio 0.30 [95% CI 0.16-0.56], P < .001), Charlson comorbidity index (odds ratio 0.43 [95% CI 0.22-0.84], P < .01), mechanical ventilation duration in ICU (odds ratio 0.80 [95% CI 0.72-0.89], P < .001), renal failure (odds ratio 0.40 [95% CI 0.22-0.73], P = .003), and expiratory muscle weakness (odds ratio 0.35 [95% CI 0.19-0.62], P < .001) were independently associated with home discharge.

Conclusions: Most subjects with COVID-19 transferred to SWCs were weaned, achieved decannulation, and were discharged to home. Age, high-comorbidity burden, prolonged mechanical ventilation in ICU, renal failure at admission, and expiratory muscle weakness were inversely associated with home discharge.

Keywords: COVID-19; SARS-CoV-2; critical illness; prolonged mechanical ventilation; specialized weaning centers; tracheostomy.

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Conflict of interest statement

The authors have disclosed no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Outcomes across subjects related to weaning and decannulation status. SWC = specialized weaning center.
Fig. 2.
Fig. 2.
Kaplan-Meier plot of home discharge in decannulated and non-decannulated subjects up to 6 months follow-up in specialized weaning centers. SWC = specialized weaning center.
See this image and copyright information in PMC

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