Association between Tracheostomy Timing and Clinical Outcomes in Critically Ill COVID19 Patients

TL;DR

This study examines how the timing of tracheostomies affects outcomes in critically ill COVID-19 patients, finding that early tracheostomy reduces total ventilation time but not survival.

Contribution

The study provides new evidence on the impact of early versus late tracheostomy timing in critically ill COVID-19 patients.

Findings

Early tracheostomy significantly reduces the total duration of mechanical ventilation.

Tracheostomy timing does not affect the duration of ventilation after the procedure.

Early tracheostomy does not improve overall patient survival rates.

Abstract

The COVID19 pandemic has posed one of the greatest challenges to healthcare systems worldwide. Tracheostomy is often required in critically ill patients with COVID19 who require prolonged mechanical ventilation and frequent airway clearance. Determining the optimal timing of tracheostomy in these patients, particularly after endotracheal intubation, remains clinically complex and controversial.

This retrospective study included COVID19–positive patients (confirmed by PCR) admitted to a referral hospital in Northwest Iran who underwent tracheostomy during their ICU stay. Patients were stratified into early and late tracheostomy groups based on the interval between intubation and tracheostomy (<14 days vs. ≥14 days). Demographic data, duration of mechanical ventilation before and after tracheostomy, and survival rates were analyzed.

A total of 62 patients were evaluated. Fourteen patients (22.6%) underwent early tracheostomy, while fortyeight patients (77.4%) underwent late tracheostomy. The mean duration of mechanical ventilation after tracheostomy was 28.57 days in the early group and 30 days in the late group. The overall duration of mechanical ventilation was significantly shorter in the early group compared with the late group (39.36 vs. 58.42 days). Survival rates were 57.1% in the early group and 39.6% in the late group.

Early tracheostomy-performed within the first 14 days following intubation-significantly decreases the total duration of mechanical ventilation in critically ill COVID19 patients. However, tracheostomy timing does not influence the duration of ventilation after tracheostomy or overall patient survival.

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