• Gonzalo Hernandez, Francisco Javier Ramos, José Manuel Añon, Ramón Ortiz, Laura Colinas, Joan Ramón Masclans, Candelaria De Haro, Alfonso Ortega, Oscar Peñuelas, María Del Mar Cruz-Delgado, Alfonso Canabal, Oriol Plans, Concepción Vaquero, Gemma Rialp, Federico Gordo, Amanda Lesmes, María Martinez, Juan Carlos Figueira, Alejandro Gomez-Carranza, Rocio Corrales, Andrea Castellvi, Beatriz Castiñeiras, Fernando Frutos-Vivar, Jorge Prada, Raul De Pablo, Antonio Naharro, Juan Carlos Montejo, Claudia Diaz, Alfonso Santos-Peral, Rebeca Padilla, Judith Marin-Corral, Carmen Rodriguez-Solis, Juan Antonio Sanchez-Giralt, Jorge Jimenez, Rafael Cuena, Santiago Perez-Hoyos, and Oriol Roca.
• Intensive Care Unit, University Hospital Virgen de la Salud, Toledo, Spain. Electronic address: ghernandezm@telefonica.net.
• Chest. 2022 Jan 1; 161 (1): 121129121-129.

BackgroundDuring the first wave of the COVID-19 pandemic, shortages of ventilators and ICU beds overwhelmed health care systems. Whether early tracheostomy reduces the duration of mechanical ventilation and ICU stay is controversial.Research QuestionCan failure-free day outcomes focused on ICU resources help to decide the optimal timing of tracheostomy in overburdened health care systems during viral epidemics?Study Design And MethodsThis retrospective cohort study included consecutive patients with COVID-19 pneumonia who had undergone tracheostomy in 15 Spanish ICUs during the surge, when ICU occupancy modified clinician criteria to perform tracheostomy in Patients with COVID-19. We compared ventilator-free days at 28 and 60 days and ICU- and hospital bed-free days at 28 and 60 days in propensity score-matched cohorts who underwent tracheostomy at different timings (≤ 7 days, 8-10 days, and 11-14 days after intubation).ResultsOf 1,939 patients admitted with COVID-19 pneumonia, 682 (35.2%) underwent tracheostomy, 382 (56%) within 14 days. Earlier tracheostomy was associated with more ventilator-free days at 28 days (≤ 7 days vs > 7 days [116 patients included in the analysis]: median, 9 days [interquartile range (IQR), 0-15 days] vs 3 days [IQR, 0-7 days]; difference between groups, 4.5 days; 95% CI, 2.3-6.7 days; 8-10 days vs > 10 days [222 patients analyzed]: 6 days [IQR, 0-10 days] vs 0 days [IQR, 0-6 days]; difference, 3.1 days; 95% CI, 1.7-4.5 days; 11-14 days vs > 14 days [318 patients analyzed]: 4 days [IQR, 0-9 days] vs 0 days [IQR, 0-2 days]; difference, 3 days; 95% CI, 2.1-3.9 days). Except hospital bed-free days at 28 days, all other end points were better with early tracheostomy.InterpretationOptimal timing of tracheostomy may improve patient outcomes and may alleviate ICU capacity strain during the COVID-19 pandemic without increasing mortality. Tracheostomy within the first work on a ventilator in particular may improve ICU availability.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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