A Scrutiny of Diverse Parameters and Post Tracheostomy Outcome with Quality of Life in Severe COVID-19 Infection
Ria Emmanuel *
Department of ENT, Manipal Hospital, Old Airport Road, Bangalore-560017, India.
M. V. Anoopa
Department of ENT, Manipal Hospital, Old Airport Road, Bangalore-560017, India.
A. M. Anitha Kumari
Department of ENT, Manipal Hospital, Old Airport Road, Bangalore-560017, India.
*Author to whom correspondence should be addressed.
Abstract
Objectives: The primary aim was to investigate the prognostic factors among critically ill COVID-19 patients, who required mechanical ventilation and tracheostomy. Secondary aim was to analyse their Health-related Quality of Life (HrQoL) at 90 days after ICU discharge.
Study Design & Setting: An observational cohort study conducted at a quaternary care setting in Bengaluru, India.
Patients’ demographics and clinical data including inflammatory markers, ventilatory parameters, details of intubation and tracheostomy were analysed.
Methods: Data were analysed and expressed as mean with percentage (%). Data from the 2 groups, survivors and non- survivors, were compared using Fisher's exact test for categorical variables and t test for continuous variables. The survivors and ‘age and sex’ - matched general population (not infected by COVID-19), from the same geographical area were subjected to questionnaires by the EuroQol group.
Results: Among 33 critically ill COVID-19 patients who underwent tracheostomy,15 patients (45.4%) survived. Comorbidities and COVID-19 related complications were noted high among the non-survivors. Ventilatory parameters FiO2, PEEP and PaO2/FiO2 were better in the survivors group which favored the recovery. Complication rate of tracheostomy was 18.1%.Ventilation liberation rate from our study was found to be 45.4% and decannulation rate 42.4%. Low values of D-Dimer and Ferritin strongly favored better recovery. Health-related Quality of Life of the survivor group and general population were comparable.
Conclusion: Ventilatory parameters, inflammatory markers and comorbidities do have a role in prognosticating outcome in patients who required tracheostomy. At 90 days follow up there was no significant impact of the disease in the quality of life of survivors.
Keywords: COVID-19, ARDS, ICU, ventilator, tracheostomy, health- related quality of life