Patients with coronavirus disease 2019 (COVID-19) undergoing tracheostomy within 10 days of endotracheal intubation had shorter hospital lengths of stay and were more likely to discontinue mechanical ventilation, according to study results published in JAMA Otolaryngology–Head & Neck Surgery.
Researchers retrospectively reviewed outcome measures from patients with confirmed COVID-19 requiring mechanical ventilation at a single tertiary-care medical center in New York City. Study outcomes included time from endotracheal intubation to tracheostomy, total time on mechanical ventilation, and total length of stay. Outcomes were compared between patient groups undergoing tracheostomy within 10 days of endotracheal intubation (early), and those with later tracheostomy.
Of the 148 patients with COVID-19 requiring mechanical ventilation, 120 were men and 28 were women, and the mean age was 58.1 years. The mean time from symptom onset to intubation, symptom onset to tracheostomy, and endotracheal intubation to tracheostomy was 10.57, 22.76, and 12.23 days, respectively. In the primary study outcome, patients undergoing early tracheostomy had a median length of stay of 40 days vs 49 days among those undergoing late tracheostomy. Additionally, the late tracheostomy group was 16% less likely to discontinue mechanical ventilation.
“As the onslaught from the first surge of the pandemic settles, this analysis of data from our experience in the early months of the pandemic provides an opportunity to reconsider guidelines for tracheostomy for patients with COVID-19,” the study authors wrote. “These data demonstrate that with thoughtful selection of patients, there is no countervailing evidence to recommend categorically delaying tracheostomy in this patient population.”
Kwak PE, Connors JR, Benedict PA, et al. Early outcomes from early tracheostomy for patients with COVID-19. JAMA Otolaryngol Head Neck Surg. Published online December 17, 2020. doi:10.1001/jamaoto.2020.4837