Tracheostomy for COVID-19: Multidisciplinary, multicenter data on timing, technique, and outcomes

Objective To assess the outcomes of tracheostomy in patients with COVID-19 respiratory failure. Summary Background Data Tracheostomy has an essential role in managing COVID-19 patients with respiratory failure who require prolonged mechanical ventilation. However, limited data are available on how tracheostomy affects COVID19 outcomes, and uncertainty surrounding risk of infectious transmission has led to divergent recommendations and practices. Methods It is a multicenter, retrospective study; data were collected on all tracheostomies performed in COVID-19 patients at seven hospitals in five tertiary academic medical systems through September 2020. Results Tracheotomy was performed in 118 patients with median time from intubation to tracheostomy of 22 days (Q1-Q3: 18-25). All tracheostomies were performed employing measures to minimize aerosol generation, 78.0% by percutaneous technique, and 95.8% at bedside in negative pressure rooms. Seventy-eight (66.1%) patients were weaned from the ventilator and 18 (15.3%) patients died from causes unrelated to tracheostomy. No major procedural complications occurred. Early tracheostomy (≤14 days) was associated with decreased ventilator days; median ventilator days [Q1-Q3] among patients weaned from the ventilator in the early, middle and late groups were 21 [21-31], 34 [26.5-42] and 37 [32-41] days, respectively with p=0.030. Compared to surgical tracheostomy, percutaneous technique was associated with faster weaning for patients weaned off the ventilator (median [Q1-Q3]: 34 [29-39] vs. 39 [34-51] days, p=0.038); decreased ventilator-associated pneumonia (58.7% vs. 80.8%, p=0.039); and among patients who were discharged, shorter intensive care unit duration (median [Q1-Q3]: 33 [27-42] vs. 47 [33-64] days, p=0.009); and shorter hospital length of stay (median [Q1-Q3]: 46 [33-59] vs. 59.5 [48-80] days, p=0.001). Conclusions Early, percutaneous tracheostomy was associated with improved outcomes compared to surgical tracheostomy in a multi-institutional series of ventilated patients with COVID-19.