Association between Tracheostomy Timing and Outcomes for Older Critically Ill COVID-19 Patients: Prospective Observational Study in European Intensive Care Units - Sorbonne Université Access content directly
Journal Articles British Journal of Anaesthesia Year : 2022

Association between Tracheostomy Timing and Outcomes for Older Critically Ill COVID-19 Patients: Prospective Observational Study in European Intensive Care Units

Abstract

Background: Tracheostomy is performed in patients expected to require prolonged mechanical ventilation, but to date optimal timing of tracheostomy has not been established. The evidence concerning tracheostomy in COVID-19 patients is particularly scarce. We aimed to describe the relationship between early tracheostomy (≤10 days since intubation) and outcomes for patients with COVID-19. Methods: This was a prospective cohort study performed in 152 centres across 16 European countries from February to December 2020. We included patients aged ≥70 yr with confirmed COVID-19 infection admitted to an intensive care unit, requiring invasive mechanical ventilation. Multivariable analyses were performed to evaluate the association between early tracheostomy and clinical outcomes including 3-month mortality, intensive care length of stay, and duration of mechanical ventilation. Results: The final analysis included 1740 patients with a mean age of 74 yr. Tracheostomy was performed in 461 (26.5%) patients. The tracheostomy rate varied across countries, from 8.3% to 52.9%. Early tracheostomy was performed in 135 (29.3%) patients. There was no difference in 3-month mortality between early and late tracheostomy in either our primary analysis (hazard ratio [HR]=0.96; 95% confidence interval [CI], 0.70-1.33) or a secondary landmark analysis (HR=0.78; 95% CI, 0.57-1.06). Conclusions: There is a wide variation across Europe in the timing of tracheostomy for critically ill patients with COVID-19. However, we found no evidence that early tracheostomy is associated with any effect on survival amongst older critically ill patients with COVID-19. Clinical trial registration: ClinicalTrials.gov NCT04321265.

Dates and versions

hal-03879093 , version 1 (30-11-2022)

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Kamil Polok, Jakub Fronczek, Peter Vernon Van Heerden, Hans Flaatten, Bertrand Guidet, et al.. Association between Tracheostomy Timing and Outcomes for Older Critically Ill COVID-19 Patients: Prospective Observational Study in European Intensive Care Units. British Journal of Anaesthesia, 2022, 128 (3), pp.482--490. ⟨10.1016/j.bja.2021.11.027⟩. ⟨hal-03879093⟩
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