• Yun Tang, Yongran Wu, Fangfang Zhu, Xiaobo Yang, Chaolin Huang, Guo Hou, Wenhao Xu, Ming Hu, Lu Zhang, Aiguo Cheng, Zhengqin Xu, Boyi Liu, Song Hu, Guochao Zhu, Xuepeng Fan, Xijing Zhang, Yadong Yang, Huibin Feng, Lixia Yu, Bing Wang, Zhiqiang Li, Yong Peng, Zubo Shen, Shouzhi Fu, Yaqi Ouyang, Jiqian Xu, Xiaojing Zou, Minghao Fang, Zhui Yu, Bo Hu, and You Shang.
• Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
• Front Med (Lausanne). 2020 Jan 1; 7: 615845.

AbstractBackground: The outbreak of coronavirus disease 2019 (COVID-19) has led to a large and increasing number of patients requiring prolonged mechanical ventilation and tracheostomy. The indication and optimal timing of tracheostomy in COVID-19 patients are still unclear, and the outcomes about tracheostomy have not been extensively reported. We aimed to describe the clinical characteristics and outcomes of patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia who underwent elective tracheostomies. Methods: The multi-center, retrospective, observational study investigated all the COVID-19 patients who underwent elective tracheostomies in intensive care units (ICUs) of 23 hospitals in Hubei province, China, from January 8, 2020 to March 25, 2020. Demographic information, clinical characteristics, treatment, details of the tracheostomy procedure, successful weaning after tracheostomy, and living status were collected and analyzed. Data were compared between early tracheostomy patients (tracheostomy performed within 14 days of intubation) and late tracheostomy patients (tracheostomy performed after 14 days). Results: A total of 80 patients were included. The median duration from endotracheal intubation to tracheostomy was 17.5 [IQR 11.3-27.0] days. Most tracheotomies were performed by ICU physician [62 (77.5%)], and using percutaneous techniques [63 (78.8%)] at the ICU bedside [76 (95.0%)]. The most common complication was tracheostoma bleeding [14 (17.5%)], and major bleeding occurred in 4 (5.0%) patients. At 60 days after intubation, 31 (38.8%) patients experienced successful weaning from ventilator, 17 (21.2%) patients discharged from ICU, and 43 (53.8%) patients had died. Higher 60 day mortality [22 (73.3%) vs. 21 (42.0%)] were identified in patients who underwent early tracheostomy. Conclusions: In patients with SARS-CoV-2 pneumonia, tracheostomies were feasible to conduct by ICU physician at bedside with few major complications. Compared with tracheostomies conducted after 14 days of intubation, tracheostomies within 14 days were associated with an increased mortality rate.Copyright © 2020 Tang, Wu, Zhu, Yang, Huang, Hou, Xu, Hu, Zhang, Cheng, Xu, Liu, Hu, Zhu, Fan, Zhang, Yang, Feng, Yu, Wang, Li, Peng, Shen, Fu, Ouyang, Xu, Zou, Fang, Yu, Hu and Shang.

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