Timing of elective tracheotomy and duration of mechanical ventilation among patients admitted to intensive care with severe COVID-19: A multicenter prospective cohort study

Identifier:  imarina:9229377

Handle: https://hdl.handle.net/20.500.11797/imarina9229377

Authors:  Prats-Uribe, Albert; Tobed, Marc; Miguel Villacampa, Jose; Aguero, Adriana; Garcia-Bastida, Clara; Ignacio Tato, Jose; Rodriganez, Laura; Duque Holguera, Victoria; Hernandez-Garcia, Estefania; Poletti, Daniel; Simonetti, Gabriela; Villarraga, Vanessa; Meler-Claramonte, Carla; Sanchez Barrueco, Alvaro; Chiesa-Estomba, Carlos; Casasayas, Maria; Parente-Arias, Pablo; Mata-Castro, Nieves; Rello, Jordi; Castro, Pedro; Prieto-Alhambra, Daniel; Vilaseca, Isabel; Xavier Aviles-Jurado, Francesc

Abstract:
Background Optimal timing for tracheotomy for critically ill COVID-19 patients requiring invasive mechanical ventilation (IMV) is not established. Methods Multicenter prospective cohort including all COVID-19 patients admitted to intensive care units (ICUs) in 36 hospitals who required tracheotomy during first pandemic wave. With a target emulation trial framework, we studied the causal effects of early (7-10 days) versus late (>10 days) tracheotomy (LT) on time from tracheotomy to weaning, postoperative mortality, and tracheotomy complications. Results Of 696 patients, 20.4% received early tracheotomy (ET). ET was associated with faster weaning (hazard ratio [HR] [95% confidence interval, CI]: 1.25 [1.00-1.56]) without differences in mortality (HR [95% CI]: 0.85 [0.60-1.21]) or complications (adjusted rate ratio [95% CI]: 0.56 [0.23-1.33]). Conclusions ET had a similar or lower post-tracheotomy weaning time than LT, potentially shortening IMV and ICU stays, without changing complication or mortality rates in COVID-19 patients.