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World J Crit Care Med. Nov 9, 2021; 10(6): 345-354
Published online Nov 9, 2021. doi: 10.5492/wjccm.v10.i6.345
Timing of tracheostomy in mechanically ventilated COVID-19 patients
Nwonukwuru Amadi, Radhika Trivedi, Nasim Ahmed
Nwonukwuru Amadi, Radhika Trivedi, Division of Trauma, Jersey Shore University Medical Center, Neptune, NJ 07754, United States
Nasim Ahmed, Division of Trauma and Surgical Critical Care, Jersey Shore University Medical Center, Nepune, NJ 07754, United States
Author contributions: Amadi N conducted the initial screening of sources and wrote the manuscript; Trivedi R acquired additional sources, wrote and edited the manuscript; Ahmed N developed the research question, acquired additional sources, wrote and edited the manuscript.
Conflict-of-interest statement: All authors involved in this study have no financial or non-financial conflicts of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nasim Ahmed, MBBS, FACS, Professor, Chief, Director, Division of Trauma and Surgical Critical Care, Jersey Shore University Medical Center, 1945 State Route 33, Nepune, NJ 07754, United States. nasim.ahmed@hmhn.org
Received: June 28, 2021
Peer-review started: June 28, 2021
First decision: July 29, 2021
Revised: August 9, 2021
Accepted: October 27, 2021
Article in press: October 27, 2021
Published online: November 9, 2021
Processing time: 129 Days and 17.9 Hours
Abstract

According to the World Health Organization as of September 16, 2021, there have been over 226 million documented cases of coronavirus disease 2019 (COVID-19), which has resulted in more than 4.6 million deaths and approximately 14% develop a more severe disease that requires respiratory assistance such as intubation. Early tracheostomy is recommended for patients that are expected to be on prolonged mechanical ventilation; however, supporting data has not yet been provided for early tracheostomies in COVID-19 patients. The aim of this study was to explore established guidelines for performing tracheostomies in patients diagnosed with COVID-19. Factors considered were patient outcomes such as mortality, ventilator-associated pneumonia, intensive care unit length of stay, complications associated with procedures, and risks to healthcare providers that performed tracheostomies. Various observational studies, meta-analyses, and systematic reviews were collected through a PubMed Database search. Additional sources were found through Google. The search was refined to publications in English and between the years of 2003 and 2021. The keywords used were “Coronavirus” and/or “guidelines'' and/or “tracheostomy” and/or “intensive care”. Twenty-three studies were retained. Due to the complex presentation of the respiratory virus COVID-19, previously established guidelines for tracheostomies had to be reevaluated to determine if these guidelines were still applicable to these critically ill ventilated patients. More specifically, medical guidelines state benefits to early tracheostomies in critically ill ventilated non-COVID-19 patients. However, after having conducted this review, the assumptions about the benefits of early tracheostomies in critically ill ventilated patients may not be appropriate for COVID-19 patients.

Keywords: Tracheostomy; Timing; COVID-19; SARS-CoV-2; Coronavirus

Core Tip: With the sudden onset coronavirus disease 2019 (COVID-19), guidelines for patient care were rapidly evolving to protect both providers and patients. However, it has yet to be determined if performing tracheostomies earlier or later was more beneficial for outcomes in patients infected with COVID-19. This review assesses studies that discuss the timing of tracheostomies in COVID-19 patients to establish appropriate guidelines for best patient outcomes.