A Scrutiny of Diverse Parameters and Post Tracheostomy Outcome with Quality of Life in Severe COVID-19 Infection

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.