Tracheotomy in COVID‐19 patients: Optimizing patient selection and identifying prognostic indicators

Stubington, Thomas J.; Mallick, Ali S.; Garas, Georgios; Stubington, Emma; Reddy, Chetan; Mansuri, Mohammed S.

BACKGROUND: Tracheotomy, through its ability to wean patients off ventilation, can shorten ICU length of stay and in doing so increase ICU bed capacity, crucial for saving lives during the COVID‐19 pandemic. To date, there is a paucity of patient selection criteria and prognosticators to facilitate decision making and enhance precious ICU capacity. METHODS: Prospective study of COVID‐19 patients undergoing tracheotomy (n = 12) over a 4‐week period (March‐April 2020). Association between preoperative and postoperative ventilation requirements and outcomes (ICU stay, time to decannulation, and death) were examined. RESULTS: Patients who sustained FiO(2) ≤ 50% and PEEP ≤ 8 cm H(2)O in the 24 hours pretracheotomy exhibited a favorable outcome. Those whose requirements remained below these thresholds post‐tracheotomy could be safely stepped down after 48 hours. CONCLUSION: Sustained FiO(2) ≤ 50% and PEEP ≤ 8 cm H(2)O in the 48 hours post‐tracheotomy are strong predictive factors for a good outcome, raising the potential for these patients to be stepped down early, thus increasing ICU capacity.