Timing of tracheostomy in mechanically ventilated COVID-19 patients

Abstract

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.

What factors predict craniomandibular disorders in severe COVID-19 survivors after prolonged intubation?

“…The results of a meta-narrative review, nonetheless, repudiated the benefit of early tracheostomy in COVID-19 MVPs (i.e. no significant effect on mortality, while high transmissibility risk due to high viral load), and ICU length of stay was shorter, if the MVPs remained intubated [18] . From these findings, it can thus be assumed that early tracheostomy suits COVID-19 MVPs aged ≥ 70 years only (i.e.…”

“…From these findings, it can thus be assumed that early tracheostomy suits COVID-19 MVPs aged ≥ 70 years only (i.e. mortality risks appear unchanged), while PIs in younger patients may be tolerated for 14-28 days [18] (in spite of higher likelihood of developing CMDs [2] , [3] , [4] , [5] , [6] ).…”