Tracheotomy in COVID-19 patients: Optimizing patient selection and identifying prognostic indicators

Background Tracheotomy, through its ability to wean patients off ventilation, can shorten ICU length of stay and in doing so increase ICU bed capacity, crucial for saving lives during the COVID-19 pandemic. To date, there is a paucity of patient selection criteria and prognosticators to facilitate decision making and enhance precious ICU capacity. Methods Prospective study of COVID-19 patients undergoing tracheotomy (n = 12) over a 4-week period (March-April 2020). Association between preoperative and postoperative ventilation requirements and outcomes (ICU stay, time to decannulation, and death) were examined. Results Patients who sustained FiO(2) <= 50% and PEEP <= 8 cm H2O in the 24 hours pretracheotomy exhibited a favorable outcome. Those whose requirements remained below these thresholds post-tracheotomy could be safely stepped down after 48 hours. Conclusion Sustained FiO(2) <= 50% and PEEP <= 8 cm H2O in the 48 hours post-tracheotomy are strong predictive factors for a good outcome, raising the potential for these patients to be stepped down early, thus increasing ICU capacity.