Denise Battaglini1,2, Francesco Missale3, Irene Schiavetti4, Marta Filauro3, Francesca Iannuzzi1,5, Alessandro Ascoli3, Alberto Bertazzoli6, Federico Pascucci6, Salvatore Grasso7, Francesco Murgolo7, Simone Binda8, Davide Maraggia8, Giorgia Montrucchio9, Gabriele Sales9, Giuseppe Pascarella10, Felice Eugenio Agrò10, Gaia Faccio11, Sandra Ferraris11, Savino Spadaro12, Giulia Falò12, Nadia Mereto13, Alessandro Uva13, Jessica Giuseppina Maugeri14, Bellissima Agrippino14, Maria Vargas15, Giuseppe Servillo15, Chiara Robba1,5, Lorenzo Ball1,5, Francesco Mora3, Alessio Signori4, Antoni Torres16, Daniele Roberto Giacobbe17,18, Antonio Vena18, Matteo Bassetti17,18, Giorgio Peretti3, Patricia R M Rocco19,20, Paolo Pelosi1,5. 1. Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy. 2. Department of Medicine, University of Barcelona, 08007 Barcelona, Spain. 3. Department of Otorhinolaryngology-Head and Neck Surgery, University of Genoa, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, 16132 Genoa, Italy. 4. Department of Health Sciences, Section of Biostatistics, University of Genoa, 16132 Genoa, Italy. 5. Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, 16132 Genoa, Italy. 6. First Division of Anesthesiology and Intensive Care Unit, ASST Spedali Civili di Brescia, 25123 Brescia, Italy. 7. Dipartimento dell'Emergenza e Trapianti d'Organo (DETO), Sezione di Anestesiologia e Rianimazione, Università degli Studi di Bari "Aldo Moro", Ospedale Policlinico, 70124 Bari, Italy. 8. Anaesthesia and Intensive Care Department, University Hospital, Ospedale di Circolo, 21100 Varese, Italy. 9. Anestesia e Rianimazione 1U, Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, 10121 Turin, Italy. 10. Department of Anaesthesia, Intensive Care and Pain Management, Universita Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy. 11. U.O. di Anestesia e Rianimazione, Ospedale di Treviglio-Caravaggio, 24047 Treviglio, Italy. 12. Department of Morphology, Surgery and Experimental Medicine, Faculty of Medicine, University of Ferrara, 44121 Ferrara, Italy. 13. Anestesia e Rianimazione, Ospedale Villa Scassi, 16132 Genoa, Italy. 14. Anesthesia and Intensive Care, "Garibaldi Centro" Hospital, ARNAS Garibaldi, 95100 Catania, Italy. 15. Dipartimento di Neuroscienze, Scienze Riproduttive e Odontostomatologiche, Università degli Studi di Napoli Federico II, 80126 Napoli, Italy. 16. Department of Pulmonology, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, SGR 911-Ciber de Enfermedades Respiratorias (CIBERES), 08007 Barcelona, Spain. 17. Dipartimento di Scienze della Salute (DISSAL), Università degli Studi di Genova, 16132 Genova, Italy. 18. Clinica Malattie Infettive, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) per l'Oncologia e le Neuroscienze, 16132 Genova, Italy. 19. Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro 21941, Brazil. 20. COVID-19 Virus Network (RedeVírus MCTI), Ministry of Science, Technology, and Innovation, Brasília 70007, Brazil.
Abstract
BACKGROUND: Tracheostomy can be performed safely in patients with coronavirus disease 2019 (COVID-19). However, little is known about the optimal timing, effects on outcome, and complications. METHODS: A multicenter, retrospective, observational study. This study included 153 tracheostomized COVID-19 patients from 11 intensive care units (ICUs). The primary endpoint was the median time to tracheostomy in critically ill COVID-19 patients. Secondary endpoints were survival rate, length of ICU stay, and post-tracheostomy complications, stratified by tracheostomy timing (early versus late) and technique (surgical versus percutaneous). RESULTS: The median time to tracheostomy was 15 (1-64) days. There was no significant difference in survival between critically ill COVID-19 patients who received tracheostomy before versus after day 15, nor between surgical and percutaneous techniques. ICU length of stay was shorter with early compared to late tracheostomy (p < 0.001) and percutaneous compared to surgical tracheostomy (p = 0.050). The rate of lower respiratory tract infections was higher with surgical versus percutaneous technique (p = 0.007). CONCLUSIONS: Among critically ill patients with COVID-19, neither early nor percutaneous tracheostomy improved outcomes, but did shorten ICU stay. Infectious complications were less frequent with percutaneous than surgical tracheostomy.
BACKGROUND: Tracheostomy can be performed safely in patients with coronavirus disease 2019 (COVID-19). However, little is known about the optimal timing, effects on outcome, and complications. METHODS: A multicenter, retrospective, observational study. This study included 153 tracheostomized COVID-19patients from 11 intensive care units (ICUs). The primary endpoint was the median time to tracheostomy in critically illCOVID-19patients. Secondary endpoints were survival rate, length of ICU stay, and post-tracheostomy complications, stratified by tracheostomy timing (early versus late) and technique (surgical versus percutaneous). RESULTS: The median time to tracheostomy was 15 (1-64) days. There was no significant difference in survival between critically illCOVID-19patients who received tracheostomy before versus after day 15, nor between surgical and percutaneous techniques. ICU length of stay was shorter with early compared to late tracheostomy (p < 0.001) and percutaneous compared to surgical tracheostomy (p = 0.050). The rate of lower respiratory tract infections was higher with surgical versus percutaneous technique (p = 0.007). CONCLUSIONS: Among critically illpatients with COVID-19, neither early nor percutaneous tracheostomy improved outcomes, but did shorten ICU stay. Infectious complications were less frequent with percutaneous than surgical tracheostomy.