Tracheostomy in COVID-19 Patients: Experience at a Tertiary Center in the First 11 Months of the Pandemic.

ABSTRACT

This study aimed to evaluate the experience of tracheostomy in COVID-19 patients in a Southern Europe tertiary hospital. Retrospective observational study in tracheostomized patients from April 1, 2020 to February 28, 2021. Data related to tracheostomy were evaluated in patients with and without COVID-19, including infections in healthcare professionals involved in patient care. Forty-two tracheostomies were performed in COVID-19 patients aged 68.4 ± 11.1 years, predominantly men (71%) and caucasians (81%). They had at least 1 comorbidity (93%), on average 3. The most frequent were heart disease (71%), age > 65 years (67%) diabetes (40%) and obesity (33%). The greater number of comorbidities was associated with the lesser probability of the patient's recovery (p = .001). Age (p = .047) and renal failure (p = .013) were associated with higher mortality. Patients were tracheostomized by prolonged endo-tracheal intubation (50%), pneumonia (33%) and extubation failure (10%). Ventilation time before the tracheostomy (22.9 ± 6.5 days) was higher than ventilation time after the tracheostomy (7.1 ± 15.1 days) (p < 0.001). No differences were found in ventilation time (p = 0.094) and tracheostomy time (p = 0.514) in the different indications. There were 3 minor complications (7.1%), 25 discharges (60%) and 11 deaths (26%). During the same period 49 tracheostomies were performed in patients without COVID-19, with a homogeneous gender and age distribution, 31% without comorbidities, with an average of 1 comorbidity per patient and higher mortality (43%). Tracheostomy in COVID-19 patients proved to be a safe procedure for both patients and healthcare professionals and improves the clinical outcome of patients with severe infection. The 21-day procedure timing seems adequate. Comorbidities played an essential role in patient´s recovery. Age and renal failure are associated with a worse vital prognosis.