Key points
- To our knowledge, our study is one of the largest published to date on
the profile of COVID-19 tracheostomy patients.
- There was increased utilisation of tracheostomy as the COVID-19
pandemic progressed.
- Tracheostomy was beneficial procedure for COVID-19 patients requiring
ventilatory weaning.
- Tracheostomy patients had lower odds of mortality and greater length
of stay compared to non-tracheostomy critical care patients.
- In patients that survived, earlier timing of tracheostomy was
significantly associated with shorter length of stay.
INTRODUCTION Critical care admission is common in people hospitalised with
COVID-19.1 In the United Kingdom, it has been reported
that 17% of COVID-19 hospital inpatients required critical care support
and 10% required mechanical ventilation.2 The
management of these patients has evolved as new evidence regarding
treatment approaches has been developed. However, an area of controversy
that has remained is the appropriate utilisation of tracheostomy and its
subsequent management.
Early in the pandemic, guidelines were published based on expert opinion
before much was understood about the disease. Most of these guidelines
focused on minimising risk of nosocomial transmission to clinicians and
delaying or avoiding tracheostomies in these patients as the benefits of
the procedure were unknown.3,4 As further experience
was gained, tracheostomy use became common for critical care COVID-19
patients5 although optimal timing of tracheostomy
remains a subject of debate.6,7
In England, reports of departments’ experiences have been
described8–10 and a UK multi-centre prospective
cohort study, COVIDTrach has been evaluating outcomes of COVID-19
tracheostomy patients.11 However, capturing
information directly from hospitals can be constrained by inconsistent
reporting patterns, especially if individual hospitals are overwhelmed
by surges of critical care patients.
The National Health Service (NHS) Hospital Episodes Statistics (HES)
database is an administrative dataset that contains a wide range of
details regarding all NHS-funded hospital admissions in England. Using
HES data, the aim of this study was to characterise tracheostomy use for
COVID-19 critical care patients in England, understand the patient
factors associated with having a tracheostomy and determine how this
related to outcomes.