Tracheostomy safe and effective in patients with COVID-19: JAMA Study

Approximately 5% to 15% of patients with COVID-19 require invasive mechanical ventilation (IMV) and, at times, tracheostomy. Details regarding the safety and use of tracheostomy in treating COVID-19 continue to evolve.

Authors, Phillip Staibano and colleagues from the Department of Surgery, Otolaryngology–Head and Neck Division, McMaster University, Hamilton, Ontario, Canada conducted the present research with the objective to evaluate the association of tracheostomy with COVID-19 patient outcomes and the risk of SARS-CoV-2 transmission among health care professionals (HCPs).

English-language studies investigating patients with COVID-19 who were receiving IMV and undergoing tracheostomy were included in the study. Observational and randomized clinical trials were eligible (no randomized clinical trials were found in the search). All screening was performed by 2 reviewers.

The researchers included a total of 4669 patients in the 69 studies, and the mean (range) patient age across studies was 60.7 (49.1-68.8) years (43 studies [62.3%] with 1856 patients). In all studies, 1854 patients (73.8%) were men and 658 (26.2%) were women.

SARS-CoV-2 transmission between HCPs and levels of personal protective equipment, in addition to complications, time to decannulation, ventilation weaning, and intensive care unit (ICU) discharge in patients with COVID-19 who underwent tracheostomy were set as the main outcomes to be determined.

Based on the methodology, the following results were drafted-

1. 40.6% of the studies investigated either surgical tracheostomy or percutaneous dilatational tracheostomy.
2. Overall, 3 of 58 studies constituting 5.17% identified a small subset of HCPs who developed COVID-19 that was associated with tracheostomy.
3. Studies did not consistently report the number of HCPs involved in tracheostomy.
4. Among the patients, early tracheostomy was associated with faster ICU discharge (mean difference, 6.17 days; 95% CI, −11.30 to −1.30), but no change in IMV weaning (mean difference, −2.99 days; 95% CI, −8.32 to 2.33) or decannulation (mean difference, −3.12 days; 95% CI, −7.35 to 1.12).
5. There was no association between mortality or perioperative complications and type of tracheostomy.
6. A risk-of-bias evaluation that used ROBINS-I demonstrated notable bias in the confounder and patient selection domains because of a lack of randomization and cohort matching.
7. There was notable heterogeneity in study reporting.

Therefore, the authors concluded that "enhanced personal protective equipment is associated with low rates of SARS-CoV-2 transmission during tracheostomy. Early tracheostomy in patients with COVID-19 may reduce ICU stay, but this finding is limited by the observational nature of the included studies."