A Systematic Review on Tracheostomy in COVID-19 Patients: Current Guidelines and Safety Measures

Timing of tracheostomy in mechanically ventilated COVID-19 patients

According to the World Health Organization as of September 16, 2021, there have been over 226 million documented cases of coronavirus disease 2019 (COVID-19), which has resulted in more than 4.6 million deaths and approximately 14% develop a more severe disease that requires respiratory assistance such as intubation. Early tracheostomy is recommended for patients that are expected to be on prolonged mechanical ventilation; however, supporting data has not yet been provided for early tracheostomies in COVID-19 patients. The aim of this study was to explore established guidelines for performing tracheostomies in patients diagnosed with COVID-19. Factors considered were patient outcomes such as mortality, ventilator-associated pneumonia, intensive care unit length of stay, complications associated with procedures, and risks to healthcare providers that performed tracheostomies. Various observational studies, meta-analyses, and systematic reviews were collected through a PubMed Database search. Additional sources were found through Google. The search was refined to publications in English and between the years of 2003 and 2021. The keywords used were “Coronavirus” and/or “guidelines'' and/or “tracheostomy” and/or “intensive care”. Twenty-three studies were retained. Due to the complex presentation of the respiratory virus COVID-19, previously established guidelines for tracheostomies had to be reevaluated to determine if these guidelines were still applicable to these critically ill ventilated patients. More specifically, medical guidelines state benefits to early tracheostomies in critically ill ventilated non-COVID-19 patients. However, after having conducted this review, the assumptions about the benefits of early tracheostomies in critically ill ventilated patients may not be appropriate for COVID-19 patients.

The Efficacy of Tracheotomy for Covid-19 Pneumonia: Impacts on Survival and Prognostic Factors

The role of tracheotomy during the pandemic remains to be determined for severe COVID-19 pneumonia. We evaluated the effect of tracheotomy on prognostic markers and assessed 4 weeks survival in terms of clinical and biochemical characteristics of patients and time and type (open or percutaneous) of the operation. We performed a retrospective study considering ICU patients with COVID-19 pneumonia and tracheotomy, between May 30 and December 31, 2020. Four weeks survival postoperatively and alteration of biochemical markers were analyzed. 24 patients with COVID-19 pneumonia and tracheotomy, included in this study. Median age was 68.3 years (range 38-90) with male:female ratio 16:8. All the patients were diagnosed with COVID-19 pneumonia considering clinical symptoms and COVID-19 specific CT findings. RT-PCR test results were positive in 58.3%. Prognostic markers were found to be increased postoperatively with both types of surgery (75%). 1 week and 4 weeks survival after the operation was 66.7% and 45.8%, respectively. 4 weeks survival was decreased significantly with NLR ≥ 10 compared to NLR < 10 (15.3-81.8%). Nevertheless, 4 weeks survival differences between males and females (12.5% and 62.5%) and between age ≤ 50 and > 50 (100% and 35%) were also found to be statistically significant. Patients with younger age, male gender, and NLR < 10, were found to have longer survival after tracheotomy. Positive PCR results and preoperative critically increased biochemical markers were related to decreased survival. The number of comorbidities, time and type of surgery, and postoperative increment of prognostic markers seemed not to affect survival.