Where have all the traches gone? Variations in tracheostomy requirements for COVID-19 positive patients on mechanical ventilation during the pandemic waves

ABSTRACT

Introduction/Aims: In the United Kingdom, maxillofacial and allied specialty units were required to perform tracheostomies for COVID-19 positive patients from the start of the pandemic in 2020. This necessitated changes to technique and workforce planning. We review our data relating to surgical and surgeon-assisted percutaneous tracheostomies performed in our unit since 2020. Material(s) and Method(s) A review of the electronic case notes for all surgical or surgeon-assisted percutaneous tracheostomies was performed. For COVID-19 positive patients who required a tracheostomy for weaning from mechanical ventilation, analysis of the timing of the procedure from admission to hospital and intubation was compared along with co-morbidities, body mass index and COVID-19 complications. The indications for surgical tracheostomy was appraised. Results/Statistics Between January 2020 to mid January 2022, 126 surgical tracheostomy cases were performed with 67 (53%) on COVID-19 positive patients for weaning off mechanical ventilation. Two distinct activity peaks were appreciated, which corresponded to spikes in the UK hospital admission rates for COVID-19 and for the number of patients in mechanical ventilation beds (Source UK Government). COVID-19 positive patients spent an average of 21.9 days in hospital and 19.7 days intubated prior to surgical tracheostomy. In addition to respiratory failure, 77.6% of patients had acute kidney injury and 22.3% a pulmonary embolism. High BMI and other anatomical constraints were the main indication for a surgical approach. Conclusions/Clinical Relevance The anticipated increase in tracheostomy referrals with rising cases of the Omicron variant in the United Kingdom did not transpire in our hospital, as was seen with the first and second COVID-19 waves. Copyright © 2022