Open Tracheostomy for Critically Ill Patients with COVID-19

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Surgical Procedures

Background:

• COVID-19 pandemic necessitates prolonged mechanical ventilation for many critically ill patients.
• Tracheostomy is a potential intervention to reduce intensive care unit (ICU) length of stay and facilitate ventilator weaning.
• Understanding the long-term outcomes of COVID-19 patients with invasive mechanical ventilation, with or without tracheostomy, is crucial.

Purpose of the Study:

• To evaluate the long-term evolution and outcomes of critically ill COVID-19 patients.
• To assess the impact of tracheostomy on patients requiring prolonged invasive mechanical ventilation and orotracheal intubation (OTI).

Main Methods:

• A prospective study included 93 COVID-19 patients admitted to the ICU requiring OTI between March 10 and April 30, 2020.
• Data collected included epidemiological factors, tracheostomy status, time to tracheotomy, time to weaning, and patient outcomes at a minimum one-month follow-up.
• Otolaryngology teams underwent COVID-19 testing before and after procedures to ensure safety.

Main Results:

• Twenty-seven patients (29%) underwent tracheostomy.
• Among tracheostomized patients, 29.6% died and 48.15% were extubated within a mean of 28.53 days.
• Mortality in non-tracheostomized patients was 42.4%.

Conclusions:

• Tracheostomy is a safe procedure for COVID-19 patients requiring prolonged OTI.
• Tracheostomy appears to be associated with lower mortality rates compared to non-tracheostomized patients.
• Tracheostomy facilitates the weaning process for patients on prolonged mechanical ventilation.