Early Tracheostomy May Be Beneficial in Ventilated COVID-19 Patients

By David Douglas

December 11, 2020

NEW YORK (Reuters Health) - Early percutaneous tracheostomy in mechanically ventilated COVID-19 patients is associated with improved outcomes compared to management with translaryngeal intubation alone, according to Italian researchers.

Current recommendations are that tracheostomy should be delayed in patients showing signs of clinical improvement and that extended translaryngeal intubation should be considered as the standard of care for the entire duration of ventilation, Dr. Antonio Rosano and colleagues at Poliambulanza Foundation Hospital, in Brescia, note in Critical Care Medicine.

However, Dr. Rosano told Reuters Health by email, "the choice of the early approach to tracheostomy effectively avoided the problem of failed extubation with adverse effects, such as the need for reintubation and the risk of contagion."

The researchers analyzed data on 164 patients who were not initially tracheostomized. They were evaluated for percutaneous tracheostomy after the first three days of mechanical ventilation if weaning from mechanical ventilation could not be reasonably completed within the next seven days.

One hundred twenty-one were tracheostomized at a median of six days after translaryngeal intubation and the remaining 43 were managed with translaryngeal intubation alone. The mortality rate was 63% in those without tracheostomy and 46% in those with tracheostomy (P=0.009).

Forty-seven of the tracheostomized patients (71%) had their tracheostomy tube removed before discharge.

On multivariable analysis, early percutaneous tracheostomy was associated with lower hospital mortality. In the tracheostomized patients, age and being male were the only characteristics that were independently associated with a higher mortality risk.

The reduced mortality seen with tracheostomy "does not imply a cause-effect relationship and does not demonstrate that early percutaneous tracheostomy reduced mortality by itself," the researchers say.

Nevertheless Dr. Rosano concluded, "early tracheostomy shortens the duration of sedation and ICU stay, increases the number of ventilator-free days, can facilitate the weaning process, and can reduce unplanned or failed extubations."

SOURCE: https://bit.ly/3orlWDU Critical Care Medicine, online November 17, 2020.