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. 2021 Mar;278(3):781-789.
doi: 10.1007/s00405-020-06190-6. Epub 2020 Jul 12.

Elective tracheostomy during COVID-19 outbreak: to whom, when, how? Early experience from Venice, Italy

T Volo  1 , P Stritoni  2 , I Battel  3 , B Zennaro  2 , F Lazzari  4 , M Bellin  4 , L Michieletto  5 , G Spinato  6 , C Busatto  7 , D Politi  2 , R Spinato  2
Affiliations

Elective tracheostomy during COVID-19 outbreak: to whom, when, how? Early experience from Venice, Italy

T Volo et al. Eur Arch Otorhinolaryngol. 2021 Mar.

Abstract

Purpose: The need for prolonged invasive mechanical ventilation in COVID-19 patients is placing the otorhinolaryngologist in front of an increasing request for tracheostomy. Nowadays, there is uncertainty regarding the timing of tracheostomy, the prognosis of these patients and the safety of healthcare workers. The aim of this study is to evaluate the efficacy and safety of tracheostomy placement in patients with COVID-19.

Methods: A retrospective cohort study on 23 COVID 19 patients, to analyse the timing of tracheostomy, the risk factors associated with in-hospital death and the infection of the involved health care workers. Early tracheostomy was defined as ≤ 10 days and late ones > 10 days.

Results: The mortality rate of COVID-19 patients admitted to ICU that underwent tracheostomy was 18%. The overall mortality of patients admitted to ICU was 53%. The univariate analysis revealed that early tracheostomy, SOFA score > 6, and D-dimer level > 4 were significantly associated with a greater risk of death. At the multivariate analysis SOFA score > 6 and D-dimer level > 4 resulted as significant factors for a higher risk of death. No health care workers associated with tracheostomy are confirmed to be infected by SARS-CoV2.

Conclusion: We suggest to wait at least 14 days to perform tracheostomy. In patients with SOFA score > 6 and D dimer > 4, tracheostomy should not be performed or should be postponed. Optimized procedures and enhanced personal protective equipment can make the tracheostomy safe and beneficial in COVID-19 patients.

Keywords: COVID-19; D-dimer level; SOFA score; Tracheostomy.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Sequential organ failure assessment (SOFA) score
Fig. 2
Fig. 2
Procedure of open surgical tracheotomy. ETT endotracheal tube, HME heat and moisture exchangers
See this image and copyright information in PMC

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