Tracheostomy and short-term mortality in ICU patients with COVID-19-preliminary result

Introduction: The disease Covid-19 is of pandemic proportions, with an incredibly vast number of patients and significant mortality. The use of tracheostomy during the Covid-19 pandemic remains a controversial issue. The dilemmas relate to the expected benefit, timing, and technique of performing the tracheostomy. The difference in short-term outcomes between Covid-19 patients with or without tracheostomy remains unexplored. Aim: To examine and compare the short-term outcome of Covid-19 patients on invasive mechanical ventilation (MV) with and without tracheostomy. Methods: We retrospectively compared the mortality of Covid-19 patients on invasive mechanical ventilation with and without tracheostomy. From the beginning of the pandemic to the present day in our hospital, were 739 patients on invasive mechanical ventilation. We perform 86 tracheostomies, but at this moment, only 48 patients were compared to 228 patients without tracheostomy and statistically analyzed. We defined the short-term outcome as one-month all-cause mortality. Results: Tracheostomy group had significantly fewer patients without chronic diseases compared to the MV-only group. The primary outcome, short-term mortality, was significantly lower in the tracheostomy group (56,3% vs. 92,5%, p < 0.001). Logistic regression models with the lethal outcome as dependent variable and tracheotomy as independent showed that the odds ratio for mortality is ten times lower in the tracheostomy group (OR-0,106 p<0.001). In the end, due to high differences in both groups, the analysis of subjects is repeated with a propensity score matching procedure. Mortality is lower in the tracheostomy group, but without significance, due to smaller sample size when matched using propensity score (p-0,399). Conclusion: We found a difference in short-term outcome in Covid-19 patients with and without tracheostomy, but without statistical significance. A larger sample or meta-analysis of similar studies is needed to show the effect of tracheostomy on mortality in these patients.