Tracheostomy Timing and Outcome in Severe COVID-19: The WeanTrach Multicenter Study.

Abstract

BACKGROUND:

Tracheostomy can be performed safely in patients with coronavirus disease 2019 (COVID-19). However, little is known about the optimal timing, effects on outcome, and complications.

METHODS:

A multicenter, retrospective, observational study. This study included 153 tracheostomized COVID-19 patients from 11 intensive care units (ICUs). The primary endpoint was the median time to tracheostomy in critically ill COVID-19 patients. Secondary endpoints were survival rate, length of ICU stay, and post-tracheostomy complications, stratified by tracheostomy timing (early versus late) and technique (surgical versus percutaneous).

RESULTS:

The median time to tracheostomy was 15 (1-64) days. There was no significant difference in survival between critically ill COVID-19 patients who received tracheostomy before versus after day 15, nor between surgical and percutaneous techniques. ICU length of stay was shorter with early compared to late tracheostomy (p < 0.001) and percutaneous compared to surgical tracheostomy (p = 0.050). The rate of lower respiratory tract infections was higher with surgical versus percutaneous technique (p = 0.007).

CONCLUSIONS:

Among critically ill patients with COVID-19, neither early nor percutaneous tracheostomy improved outcomes, but did shorten ICU stay. Infectious complications were less frequent with percutaneous than surgical tracheostomy.

• Authors: Denise Battaglini, Francesco Missale, Irene Schiavetti, Marta Filauro, Francesca Iannuzzi, Alessandro Ascoli, Alberto Bertazzoli, Federico Pascucci, Salvatore Grasso, Francesco Murgolo, Simone Binda, Davide Maraggia, Giorgia Montrucchio, Gabriele Sales, Giuseppe Pascarella, Felice Eugenio Agrò, Gaia Faccio, Sandra Ferraris, Savino Spadaro, Giulia Falò, Nadia Mereto, Alessandro Uva, Jessica Giuseppina Maugeri, Bellissima Agrippino, Maria Vargas, Giuseppe Servillo, Chiara Robba, Lorenzo Ball, Francesco Mora, Alessio Signori, Antoni Torres, Daniele Roberto Giacobbe, Antonio Vena, Matteo Bassetti, Giorgio Peretti, Patricia R M Rocco, Paolo Pelosi
• Journal: Journal of clinical medicine (J Clin Med) Vol. 10 Issue 12 (Jun 16 2021) ISSN: 2077-0383 [Print] Switzerland
• PMID: 34208672 (Publication Type: Journal Article)