• Carlos-Miguel Romero, Abraham Ij Gajardo, Amalia Cruz, Eduardo Tobar, Jaime Godoy, Nicolás Medel, Ricardo Zamorano, Daniel Rappoport, Verónica Rojas, María-Cristina Herrera, Rodrigo Cornejo, Cecilia Luengo, and Nivia Estuardo.
• Critical Care Unit, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago, Chile.
• Rev Med Chil. 2023 Feb 1; 151 (2): 151159151-159.

BackgroundThe usefulness of tracheostomy has been questioned in patients with COVID-19 and prolonged invasive mechanical ventilation (IMV).AimTo compare the 90-day mortality rate of patients who underwent a tracheostomy due prolonged IMV with those that did not receive this procedure.Material And MethodsWe studied a historical cohort of 92 patients with COVID-19 and prolonged IMV (> 10 days). The primary outcome was the 90-day mortality rate. Secondary outcomes included days on IMV, hospital/intensive care unit (ICU) length of stay, frequency of nosocomial infections, and thrombotic complications demonstrated by images. A logistic regression was performed to adjust the effect of tracheostomy by SOFA score and days on IMV.ResultsForty six patients aged 54 to 66 years (72% males) underwent tracheostomy. They had a median of two comorbidities, and received the procedure after a median of 20.5 days on IMV (interquartile range: 17-26). 90-day mortality was lower in patients who were tracheostomized than in the control group (6.5% vs. 32.6%, p-value < 0.01). However, after controlling for confounding factors, no differences were found in mortality between both groups (relative risk = 0.303, p-value = 0.233). Healthcare-associated infections and hospital/ICU length of stay were higher in patients with tracheostomy than in controls. Thrombotic complications occurred in 42.4% of the patients, without differences between both groups. No cases of COVID-19 were registered in the healthcare personnel who performed tracheostomies.ConclusionsIn patients with COVID-19 undergoing prolonged IMV, performing a tracheostomy is not associated with excess mortality, and it is a safe procedure for healthcare personnel.

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