Comparing the Effect of Early Tracheostomy Against Late Tracheostomy Upon Clinical Outcomes of Critically Ill COVID-19 Patients: Thesis

Abstract

Background: Tracheostomy placement is a frequent airway management strategy intended to reduce the need for prolonged intubation and to improve respiratory stability in patients requiring ventilatory support. The SARS-CoV-2 outbreak has led to a growing number of ICU patients with respiratory hypoxemia, placing a tremendous demand on ICU personnel and equipment, particularly mechanical ventilators. Despite the positive role of tracheostomy in prolonged ventilated patients, the impact of the timing of tracheostomy was debated prior to the advent of COVID-19 (Coronavirus Disease 2019) and continues today. Aim: The purpose of this review is to determine if the timing of tracheostomy placement has an effect on the clinical outcomes of critically ill COVID-19 patients in terms of mortality, length of stay in the intensive care unit, and duration of invasive mechanical ventilation. Additionally, to evaluate the safety of the procedure and the risk of developing SARS-CoV-2 among healthcare workers (HCWs) performing the tracheostomy. Design: A systematic literature review Methods: For this systematic literature review, a comprehensive search of four electronic databases including Medline via Ovid (1949-current), CINAHL, Scopus and Cochrane Library was conducted to identify the most relevant primary research publications. This review included only studies that clearly defined an early vs a late tracheostomy group, excluding those that compared tracheostomised to non-tracheostomised patients. The modified Newcastle-Ottawa Quality Assessment Scale (NOS) was used to evaluate the quality of selected articles. Results: From 87 relevant publications, nine observational cohort studies were identified with a combined sample size of 798 participants (range from 28 to 153 patients). The mean age of the participants ranged from 52.9 to 68.9 years, most of whom were males (66%–87%). There was no statistically significant difference in mortality rates between tracheostomies performed during the first 14 days following intubation and those performed after 14 days of intubation. However, early tracheostomies may significantly reduce the duration of IMV (MD = -9 days), and the length of ICU stay (MD = -10 days) than the late tracheostomies, with a minimal risk of viral transmission among HCWs conducting the procedure. NURS5080 Capstone (Thesis) 5 Conclusion: Performing tracheostomies on critically ill COVID-19 patients is generally safe when appropriate precautions (PPE) are taken. Early tracheostomy (ET) is likely to reduce the length of the intensive care unit stay as well as the duration of invasive mechanical ventilation (IMV), but has no significant effect on mortality rates.