Timing of elective tracheotomy and duration of mechanical ventilation among patients admitted to intensive care with severe COVID-19: A multicenter prospective cohort study.
Prats-Uribe A., Tobed M., Villacampa JM., Agüero A., García-Bastida C., Tato JI., Rodrigáñez L., Holguera VD., Hernández-García E., Poletti D., Simonetti G., Villarraga V., Meler-Claramonte C., Sánchez Barrueco Á., Chiesa-Estomba C., Casasayas M., Parente-Arias P., Mata-Castro N., Rello J., Castro P., Prieto-Alhambra D., Vilaseca I., Avilés-Jurado FX., TraqueoCOVID SEORL Group .
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.