Tracheostomy in the coronavirus disease 2019 patient: evaluating feasibility, challenges and early outcomes of the 14-day guidance

Abstract

Objectives: To report feasibility, early outcomes and challenges of implementing a 14-day threshold for undertaking surgical tracheostomy in the critically ill coronavirus disease 2019 patient.

Methods: Twenty-eight coronavirus disease 2019 patients underwent tracheostomy. Demographics, risk factors, ventilatory assistance, organ support and logistics were assessed.

Results: The mean time from intubation to tracheostomy formation was 17.0 days (standard deviation = 4.4, range 8-26 days). Mean time to decannulation was 15.8 days (standard deviation = 9.4) and mean time to intensive care unit stepdown to a ward was 19.2 days (standard deviation = 6.8). The time from intubation to tracheostomy was strongly positively correlated with: duration of mechanical ventilation (r(23) = 0.66; p < 0.001), time from intubation to decannulation (r(23) = 0.66; p < 0.001) and time from intubation to intensive care unit discharge (r(23) = 0.71; p < 0.001).

Conclusion: Performing a tracheostomy in coronavirus disease 2019 positive patients at 8-14 days following intubation is compatible with favourable outcomes. Multidisciplinary team input is crucial to patient selection.

Keywords: Coronavirus Disease 2019; Critical Care; Multidisciplinary Team; Personal Protective Equipment; SARS-CoV-2; Tracheostomy.

Fig. 1.

Mean ventilatory requirements (positive end-expiratory pressure, fraction of inspired oxygen, pressure of oxygen/fraction of inspired oxygen ratio) on: days 1 and 7 of mechanical ventilation, on day of tracheostomy, and on days 5 and 7 post-tracheostomy. FiO₂ = fraction of inspired oxygen; P/F ratio = partial pressure of oxygen/fraction of inspired oxygen; PEEP = positive end-expiratory pressure

Fig. 2.

Outcomes of patients during the first 16 days post-tracheostomy and details of their current state. Pt no. = patient number; ICU = intensive care unit

Fig. 3.

Inter-relationship between duration of mechanical ventilation and time from intubation to tracheostomy (y = 2.0492x – 3.5956; R² = 0.4403).

Fig. 4.

Inter-relationship between time from intubation to decannulation and time from intubation to tracheostomy (y = 2.0151x - 0.5642; R² = 0.4467).

Fig. 5.

Inter-relationship between time from intubation to intensive care unit (ICU) discharge and time from intubation to tracheostomy (y = 2.4031x - 3.4747; R² = 0.5098).