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. 2021 Nov-Dec;42(6):103102.
doi: 10.1016/j.amjoto.2021.103102. Epub 2021 Jun 7.

Early vs. late tracheostomy in ventilated COVID-19 patients - A retrospective study

Nir Livneh  1 , Jobran Mansour  2 , Reut Kassif Lerner  3 , Gilad Feinmesser  4 , Eran Alon  4
Affiliations

Early vs. late tracheostomy in ventilated COVID-19 patients - A retrospective study

Nir Livneh et al. Am J Otolaryngol. 2021 Nov-Dec.

Abstract

Background: Tracheostomy is one of the most common surgical procedures performed on ventilated COVID-19 patients, yet the appropriate timing for operating is controversial.

Objectives: Assessing the effect of early tracheostomy on mortality and decannulation; elucidating changes in ventilation parameters, vasopressors and sedatives dosages immediately following the procedure.

Methods: A retrospective cohort of 38 ventilated COVID-19 patients, 19 of them (50%) underwent tracheostomy within 7 days of intubation (early tracheostomy group) and the rest underwent tracheostomy after 8 days or more (late tracheostomy group).

Results: Decannulation rates were significantly higher while mortality rates were non-significantly lower in the early tracheostomy group compared with the late tracheostomy group (58% vs 21% p < 0.05; 42% vs 74% p = 0.1, respectively). Tidal volume increased (446 ml vs 483 ml; p = 0.02) while PEEP (13 cmH20 vs 11.6 cmH2O, p = 0.04) decreased at the immediate time following the procedure. No staff member participating in the procedures was infected with SARS-CoV-2 virus.

Conclusion: Early tracheostomy might offer improved outcomes with higher decannulation rates and lower mortality rates in ventilated COVID-19 patients, yet larger scale studies are needed. Most likely, early exposure to COVID-19 patients with appropriate personal protective equipment during open tracheostomy does not put the surgical team at risk.

Keywords: COVID-19; Decannulation; PPE; Tracheostomy; Ventilation.

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Conflict of interest statement

All authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Comparison of mean ionotropic support and sedatives three days before and three days after the tracheostomy. Comparison of mean noradrenaline, propofol, fentanyl, and ketamine dosages given to the patients, all in mg/day. Mean fentanyl dosage was significantly higher at the three days after the procedure. P-value was calculated using related-samples Wilcoxon Signed Rank Test.
Fig. 2
Fig. 2
Comparison of ventilation parameters three days before and three days after the tracheostomy. Comparison of mean PEEP (CmH2O), FiO2 (percent), tidal volume (ml) and PaO2/FiO2 levels. Mean PEEP was significantly lower while mean tidal volume was significantly higher at the three days after the procedure. P-value was calculated using related-samples Wilcoxon Signed Rank Test. FiO2, fraction of inspired oxygen; PaO2, partial pressure of oxygen; PEEP, positive end-expiratory pressure.
See this image and copyright information in PMC

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