Increased utilisation of tracheostomy as the pandemic progressed.
We found that the proportion of critical care patients having a tracheostomy significantly increased during the early part of the pandemic. Anecdotally, during February-March 2020 there was some hesitation in performing tracheostomies for COVID-19 patients owing to the uncertainly regarding clinical prognosis and concerns for healthcare worker safety when performing an aerosol generating procedure. There were low rates of tracheostomies internationally during this period with early reports from the USA stating that only 8% (17/203) of patients had a tracheostomy in a multicentre cohort from March 2020.18
Tracheostomy use rapidly increased in April-June following the peak of critical care admissions during the first wave in England. This increase in tracheostomy utilisation reflects rapidly changing critical care practice as understanding of the disease improved and patients survived longer whilst intubated and ventilated. Furthermore, outcomes for tracheostomy patients improved as procedure numbers increased over time. It is possible that a combination of improved overall critical care management with new information and better patient selection for tracheostomy contributed to improved outcomes during early summer 2020.
The differences when plotting the data by discharge and admission month appear to be driven by longer stay for patients undergoing tracheostomy compared to non-tracheostomy patients, with the peak in tracheostomy patient discharges in June 2020. Nevertheless, the same broad trend is evident when plotting the data by either method.