Early Versus Late Tracheostomy in Mechanically Ventilated COVID-19 Patients: A Comparative Study

The decision to perform tracheostomy during the COVID-19 pandemic has been based mainly on practical and empirical standards. Also, the amount of scientific evidence to determine the exact timing of tracheostomy in patients with severe COVID-19 on mechanical ventilation is not significant. We conducted a retrospective cohort study on mechanically ventilated COVID-19 patients from April 25, 2021 to January 25, 2022 in intensive care units of Imam Khomeini Hospital Complex, Tehran, Iran. The 30-day survival of patients was calculated and compared between patients under tracheostomy and those without tracheostomy. A number of 135 COVID-19 cases (75 patients in the intubated group and 60 patients in the tracheostomy group) were included in this study. The mean age of the population was 53.6±12.4. The overall mortality rate was 101 (74.8%). The 30-day mortality rate was significantly higher in the intubated group (90.6%) than in the tracheostomy group (55%) (P< 0.001). The mortality rate was 60% in the early (≤ 7 days) tracheostomy group and 50% in the late (>7 days) group. This difference was not statistically significant (P> 0.05). Tracheostomy is a preferred method in airway management of severe COVID-19 patients under mechanical ventilation; however, early tracheostomy during the first week of intubation may not be superior to late tracheostomy in decreasing the mortality rate.