early versus late tracheostomy in mechanically ventilated covid-19 patients: a comparative study

The decision to perform tracheostomy during the covid-19 pandemic has been based mainly on practical and empirical standards. also, the amount of scientific evidence to determine the exact timing of tracheostomy in patients with severe covid-19 on mechanical ventilation is not significant. we conducted a retrospective cohort study on mechanically ventilated covid-19 patients from april 25, 2021 to january 25, 2022 in intensive care units of imam khomeini hospital complex, tehran, iran. the 30-day survival of patients was calculated and compared between patients under tracheostomy and those without tracheostomy. a number of 135 covid-19 cases (75 patients in the intubated group and 60 patients in the tracheostomy group) were included in this study. the mean age of the population was 53.6±12.4. the overall mortality rate was 101 (74.8%). the 30-day mortality rate was significantly higher in the intubated group (90.6%) than in the tracheostomy group (55%) (p< 0.001). the mortality rate was 60% in the early (≤ 7 days) tracheostomy group and 50% in the late (>7 days) group. this difference was not statistically significant (p> 0.05). tracheostomy is a preferred method in airway management of severe covid-19 patients under mechanical ventilation; however, early tracheostomy during the first week of intubation may not be superior to late tracheostomy in decreasing the mortality rate.