Obesity and COVID-19: An analysis of the relationship between obesity and outcomes of tracheostomy secondary to COVID-19 Public

Abstract

Introduction: Tracheostomy has been an essential tool in management of severe COVID-19. Even before the COVID-19 pandemic, optimal timing and surgical approach has been debated; intense research on best practices for tracheostomy of the critically ill COVID-19 patient has persisted over the past two years. Because obesity alters anatomy and immune function, managing COVID-19 patients with body mass index >30 has been a special focus of investigation.  

Methods: Hazard ratios (HR)  for mortality, prolonged ventilator dependence and prolonged hospitalization were compared for patients with BMI above and below or equal to 30.  HR for the same were calculated for open versus closed surgical approach, interacting with BMI.

Results: BMI > 30 alone did not independently predict  mortality, ventilator independence, or hospital discharge over a 90 day follow-up period. I did find, however, that open tracheostomy technique and having a P/F ratio before tracheostomy of under 100 were associated with an increased hazard of hospital discharge when interacting with the BMI category. 

Conclusion: More research is needed to determine the ideal treatment course of critically ill patients with high BMIs.

Table of Contents

Table of Contents

Chapter One Literature Review………………………………………………………………….1

1.1 Introduction……………………………………………………………………………1

1.2 Obesity in COVID-19…………………………………………………………………2

1.3 Obesity Paradox……………………………………………………………………….2

1.4 Ventilating Obese Patients…………………………………………………………….6

1.5 Tracheostomy………………………………………………………………………….7

1.6 Conclusion…………………………………………………………………………...10

Chapter Two Obesity and COVID-19: An analysis of the relationship between obesity and outcomes of tracheostomy secondary to COVID-19 ……………………………………………12

    2.1 Abstract……………………………………………………………………………....12

    2.2 Introduction…………………………………………………………………………..13

2.3 Methods………………………………………………………………………...…….13

2.4 Results………………………………………………………………………………..16

2.5 Discussion……………………………………………………………………………20

2.6 Conclusion…………………………………………………………………………...23

Future Directions of Research………………………………………………………….……...24

References..…...………………………………………………………………………………..25

Appendix…………………………………………………………………...……………………29

    A.1 Supplemental Tables……………………………………………………...…………29

    A.2 Supplemental Figures……………………………………………………………..…32

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.S.P.H.
Submission	Master's Thesis
Language	English
Research Field	Biology, General Biology, Virology
Mot-clé	Tracheostomy COVID-19 SARS-CoV-2 Obesity Coronavirus
Committee Chair / Thesis Advisor	Dr. Constance H. Shreckengost, Emory University Dr. Anne Spaulding, Emory University

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