Timing of elective tracheotomy and duration of mechanical ventilation among patients admitted to intensive care with severe COVID-19: A multicenter prospective cohort study.

Prats-Uribe, Albert; Tobed, Marc; Villacampa, José Miguel; Agüero, Adriana; García-Bastida, Clara; Tato, José Ignacio; Rodrigáñez, Laura; Holguera, Victoria Duque; Hernández-García, Estefanía; Poletti, Daniel; Simonetti, Gabriela; Villarraga, Vanessa; Meler-Claramonte, Carla; Sánchez Barrueco, Álvaro; Chiesa-Estomba, Carlos; Casasayas, Maria; Parente-Arias, Pablo; Mata-Castro, Nieves; Rello, Jordi; Castro, Pedro; Prieto-Alhambra, Daniel; Vilaseca, Isabel; Avilés-Jurado, Francesc Xavier

BACKGROUND Optimal timing for tracheotomy for critically ill COVID-19 patients requiring invasive mechanical ventilation (IMV) is not established. METHODS Multicenter prospective cohort including all COVID-19 patients admitted to intensive care units (ICUs) in 36 hospitals who required tracheotomy during first pandemic wave. With a target emulation trial framework, we studied the causal effects of early (7-10 days) versus late (>10 days) tracheotomy (LT) on time from tracheotomy to weaning, postoperative mortality, and tracheotomy complications. RESULTS Of 696 patients, 20.4% received early tracheotomy (ET). ET was associated with faster weaning (hazard ratio [HR] [95% confidence interval, CI]: 1.25 [1.00-1.56]) without differences in mortality (HR [95% CI]: 0.85 [0.60-1.21]) or complications (adjusted rate ratio [95% CI]: 0.56 [0.23-1.33]). CONCLUSIONS ET had a similar or lower post-tracheotomy weaning time than LT, potentially shortening IMV and ICU stays, without changing complication or mortality rates in COVID-19 patients.