Early Tracheotomy Correlated to Shorter ICU Stays in Severe COVID-19 Cases

by Linda Kossoff •

What can be learned from analyzing tracheotomy timing, mechanical ventilation, and ICU stay in patients with COVID-19 infection, and from investigating tracheotomy complications and mortality in these patients?

BOTTOM LINE

Early tracheotomy is related to reduced need for mechanical ventilation and shorter ICU stay in severe COVID-19 cases, and complications during and after tracheotomy in this cohort include perioperative hypoxia risk and postoperative bleeding.

BACKGROUND: The COVID-19 pandemic has produced more patients with severe acute respiratory distress syndrome (ARDS) in ICUs. Although tracheotomy, which can help wean these patients from mechanical ventilation, is aerosol generating, recent evidence suggests low transmission risk to surgical teams. Data regarding complications and tracheotomy timing in COVID-19 patients are scarce.

STUDY DESIGN: Retrospective study.

SETTING: Department of Otorhinolaryngology, Institute of Clinical Science, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.

SYNOPSIS: Researchers assessed medical records for 115 patients (21 female, 94 male, mean age 58.2, mean body mass index 30.5) with confirmed COVID-19 infection who were admitted to the department of infectious diseases of a single institution between March 7 and June 5, 2020, and who required ICU stay, mechanical ventilation, and endotracheal intubation. Primary endpoints were mechanical ventilation duration and length of ICU stay; secondary endpoints were tracheotomy complications and overall mortality rate. Of all patients, 55 underwent tracheotomy. Results showed a shorter time between intubation and tracheotomy correlating with a shorter mechanical ventilation, and a shorter time between intubation and tracheotomy correlating with a shorter ICU stay. The most common perioperative tracheotomy complications were desaturation and hypoxemia (17%). Postoperative bleeding (31%) was mostly superficial from the tracheotomy stoma. Overall mortality was 20%. Results suggest that in COVID-19 ARDS cases, earlier tracheotomy correlates to reduced need for mechanical ventilation and shorter ICU stays. Limitations included the study’s retrospective design with subsequent collection of nonstandardized data.

CITATION: Pauli N, Eeg-Olofsson M, Bergquist H. Tracheotomy in COVID-19 patients: A retrospective study on complications and timing [Published online ahead of print April 7, 2021]. Laryngoscope Investig Otolaryngol.