Tracheostomy and Outcomes in Patients with COVID-19 and SARS
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This JAMA study suggests that tracheostomy is a relatively effective and safe treatment for patients with COVID-19 and also safe for the health care professionals (HCPs) performing the procedures who are wearing personal protective equipment.

The aim was to evaluate the association of tracheostomy with COVID-19 patient outcomes and the risk of SARS-CoV-2 transmission among health care professionals (HCPs).

English-language studies investigating patients with COVID-19 who were receiving invasive mechanical ventilation (IMV) and undergoing tracheostomy. Observational and randomized clinical trials were eligible. Of the 156 studies that underwent full-text review, only 69 were included in the qualitative synthesis, and 14 of these 69 studies were included in the meta-analysis. A total of 4669 patients were included in the 69 studies.

Researchers found that 28 studies investigated either surgical tracheostomy or percutaneous dilatational tracheostomy. Overall, 3 of 58 studies identified a small subset of HCPs who developed COVID-19 that was associated with a tracheostomy. Studies did not consistently report the number of HCPs involved in tracheostomy.

Among the patients, early tracheostomy was associated with faster ICU discharge, but no change in IMV weaning or decannulation. There was no association between mortality or perioperative complications and type of tracheostomy.

The findings of this systematic review and meta-analysis indicate that enhanced personal protective equipment is associated with low rates of SARS-CoV-2 transmission during tracheostomy. Early tracheostomy in patients with COVID-19 may reduce ICU stay, but this finding is limited by the observational nature of the included studies.