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Timing of elective tracheotomy and duration of mechanical ventilation among patients admitted to intensive care with severe COVID ‐19: A multicenter prospective cohort study

2021; Wiley; Volume: 43; Issue: 12 Linguagem: Inglês

10.1002/hed.26863

1097-0347

Albert Prats‐Uribe, Marc Tobed, José Miguel Villacampa, Adriana Agüero, Clara García‐Bastida, José Ignacio Tato, Laura Rodrigáñez, Victoria Duque-Holguera, Estefanía Hernández‐García, Daniel Poletti, Gabriela Simonetti, Vanessa Villarraga, Carla Meler‐Claramonte, Álvaro Sánchez Barrueco, Carlos M. Chiesa‐Estomba, María Casasayas, Pablo Parente Arias, Nieves Mata‐Castro, Jordi Rello, Pedro Castro, Daniel Prieto‐Alhambra, Isabel Vilaseca, Francesc Xavier Avilés‐Jurado,

Congenital Diaphragmatic Hernia Studies

Abstract Background Optimal timing for tracheotomy for critically ill COVID‐19 patients requiring invasive mechanical ventilation (IMV) is not established. Methods Multicenter prospective cohort including all COVID‐19 patients admitted to intensive care units (ICUs) in 36 hospitals who required tracheotomy during first pandemic wave. With a target emulation trial framework, we studied the causal effects of early (7–10 days) versus late (>10 days) tracheotomy (LT) on time from tracheotomy to weaning, postoperative mortality, and tracheotomy complications. Results Of 696 patients, 20.4% received early tracheotomy (ET). ET was associated with faster weaning (hazard ratio [HR] [95% confidence interval, CI]: 1.25 [1.00–1.56]) without differences in mortality (HR [95% CI]: 0.85 [0.60–1.21]) or complications (adjusted rate ratio [95% CI]: 0.56 [0.23–1.33]). Conclusions ET had a similar or lower post‐tracheotomy weaning time than LT, potentially shortening IMV and ICU stays, without changing complication or mortality rates in COVID‐19 patients.