Tracheotomy in COVID-19 patients:Optimizing patient selection and identifying prognostic indicators

Stubington, T.J. and Mallick, A.S. and Garas, G. and Stubington, E. and Reddy, C. and Mansuri, M.S. (2020) Tracheotomy in COVID-19 patients:Optimizing patient selection and identifying prognostic indicators. Head Neck, 42 (7). pp. 1386-1391. ISSN 1043-3074

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Abstract

Background: Tracheotomy, through its ability to wean patients off ventilation, can shorten ICU length of stay and in doing so increase ICU bed capacity, crucial for saving lives during the COVID-19 pandemic. To date, there is a paucity of patient selection criteria and prognosticators to facilitate decision making and enhance precious ICU capacity. Methods: Prospective study of COVID-19 patients undergoing tracheotomy (n = 12) over a 4-week period (March-April 2020). Association between preoperative and postoperative ventilation requirements and outcomes (ICU stay, time to decannulation, and death) were examined. Results: Patients who sustained FiO2 ≤ 50% and PEEP ≤ 8 cm H2O in the 24 hours pretracheotomy exhibited a favorable outcome. Those whose requirements remained below these thresholds post-tracheotomy could be safely stepped down after 48 hours. Conclusion: Sustained FiO2 ≤ 50% and PEEP ≤ 8 cm H2O in the 48 hours post-tracheotomy are strong predictive factors for a good outcome, raising the potential for these patients to be stepped down early, thus increasing ICU capacity.