Tracheostomy in patients with COVID-19: predictors and clinical features

Abstract

Background: Around 20% of patients hospitalized for COVID-19 need mechanical ventilation (MV). MV may be prolonged, thus warranting tracheostomy.

Methods: Observational cohort study enrolling patients admitted due to COVID-19. Demographic and clinical data at hospital and ICU admission were collected. The primary endpoint was to identify parameters associated with a need for tracheostomy; secondary endpoints were to analyze the clinical course of patients who needed tracheostomy.

Results: 118 patients were enrolled; 37 patients (31.5%) were transferred to ICU, of which 11 (29.72%) needed a tracheostomy due to prolonged MV. Sequential Organ Failure Assessment (SOFA) score at ICU admission (OR 0.65, 95% CI 0.47-0.92, p 0.015) was the only variable found to be associated with increased risk of the need for tracheostomy, with a cut-off point of 4.5 (sensitivity 0.72, specificity 0.73, positive predictive value 0.57 and negative predictive value 0.85). The main complications were nosocomial infection (100%), supraventricular cardiac arrhythmia (45.5%), agitation (54.5%), pulmonary thromboembolism (9.1%) and depression (9.1%). All patients presented with hypoalbuminemia and significant critical illness polyneuropathy.

Conclusion: SOFA at ICU admission is associated with an increased risk of tracheostomy in patients with COVID-19. Moreover, they present clinical features similar to those with chronic critical illness and suffer SARS-CoV-2-related complications.

Keywords: COVID-19; Prolonged mechanical ventilation; Respiratory failure; Tracheostomy.

Fig. 1

Study flowchart. ER Emergency Department, ICU intensive care unit, RCU respiratory care unit, RW respiratory ward

Fig. 2

a Probability of being tracheostomy-free after intubation. b Risk of tracheostomy after intubation

Fig. 3

Mortality in ICU patients admitted due to COVID-19

Fig. 4

Receiver operating characteristics curves. Sequential Organ Failure Assessment score (SOFA) at ICU admission (area under curve 0.779, 95% confidence interval 0.59–0.96, p = 0.009)