ABSTRACT
Introduction: In the context of the COVID-19 pandemic and a qualitatively questionable evidence base, a thorough understanding of the available evidence for the management of critically ill patients with COVID-19 is needed. Previous reports have described ICU stays and weaning as prolonged in patients who developed COVID-19 ARDS. Prolonged MV is the most common indication for tracheostomy in ICU patients. Pre-pandemic evidence on the benefits of early tracheostomy is conflicting but suggests shorter hospital stays and lower mortality rates compared to late tracheostomy. Method(s): We followed the standard Cochrane methodology to conduct the systematic review and meta-analyses. RCTs and observational studies evaluating concepts of early tracheostomy compared to late tracheostomy in critically-ill COVID-19 patients were included. Methodological quality was assessed using the Cochrane RoB 2 tool and ROBINS I tool. The quality of evidence in our prioritized categories was assessed using GRADE. Result(s): We included 1 RCT with 150 participants and 24 observational studies with 6372 critically-ill COVID-19 patients (Fig. 1). RoB assessment for the RCT was considered to be low. RoB for the observational studies was considered to be critical. Conclusion(s): * We found low-certainty evidence that early tracheostomy may result in little to no difference in overall mortality in criticallyill COVID-19 patients requiring mechanical ventilation (MV). In terms of clinical improvement, early tracheostomy results in little to no difference in duration to liberation from MV. We are not certain about the impact on clinical worsening and ICU length of stay (LOS). * Our sensitivity analysis suggests that early tracheostomy may reduce the duration of invasive MV and the ICU LOS. * The overall evidence in this review is graded as low and can only be interpreted as a indication that early compared to late tracheostomy may be recommended to shorten the duration of MV in critically-ill COVID-19 patients and to reduce all-cause mortality.