Association between tracheostomy timing and outcomes for older critically ill COVID-19 patients: prospective observational study in European intensive care units Academic Article uri icon

  •  
  • Overview
  •  
  • Research
  •  
  • Identity
  •  
  • Additional Document Info
  •  
  • View All
  •  

abstract

  • Background

    Tracheostomy is performed in patients expected to require prolonged mechanical ventilation, but to date optimal timing of tracheostomy has not been established. The evidence concerning tracheostomy in COVID-19 patients is particularly scarce. We aimed to describe the relationship between early tracheostomy (≤10 days since intubation) and outcomes for patients with COVID-19.

    Methods

    This was a prospective cohort study performed in 152 centres across 16 European countries from February to December 2020. We included patients aged ≥70 yr with confirmed COVID-19 infection admitted to an intensive care unit, requiring invasive mechanical ventilation. Multivariable analyses were performed to evaluate the association between early tracheostomy and clinical outcomes including 3-month mortality, intensive care length of stay, and duration of mechanical ventilation.

    Results

    The final analysis included 1740 patients with a mean age of 74 yr. Tracheostomy was performed in 461 (26.5%) patients. The tracheostomy rate varied across countries, from 8.3% to 52.9%. Early tracheostomy was performed in 135 (29.3%) patients. There was no difference in 3-month mortality between early and late tracheostomy in either our primary analysis (hazard ratio [HR]=0.96; 95% confidence interval [CI], 0.70-1.33) or a secondary landmark analysis (HR=0.78; 95% CI, 0.57-1.06).

    Conclusions

    There is a wide variation across Europe in the timing of tracheostomy for critically ill patients with COVID-19. However, we found no evidence that early tracheostomy is associated with any effect on survival amongst older critically ill patients with COVID-19.

    Clinical trial registration

    ClinicalTrials.gov NCT04321265.

authors

  • Polok, Kamil
  • Fronczek, Jakub
  • van Heerden, Peter Vernon
  • Flaatten, Hans
  • Guidet, Bertrand
  • De Lange, Dylan W
  • Fjølner, Jesper
  • Leaver, Susannah
  • Beil, Michael
  • Sviri, Sigal
  • Bruno, Raphael Romano
  • Wernly, Bernhard
  • Artigas, Antonio
  • Pinto, Bernardo Bollen
  • Schefold, Joerg C
  • Studzińska, Dorota
  • Joannidis, Michael
  • Oeyen, Sandra
  • Marsh, Brian
  • Andersen, Finn H
  • Moreno, Rui
  • Cecconi, Maurizio
  • Jung, Christian
  • Szczeklik, Wojciech

publication date

  • March 2022