Synopsis of key and new findings
The entire healthcare system helped manage the region’s COVID-19
pandemic. Many patients required ICU stays, often with prolonged
mechanical ventilation, resulting in nearly all centres to perform at
least one tracheostomy. Notably, Lombardy’s ICUs reached maximum
occupancy, which required converting operating theatres into ICUs for
invasive ventilation.1 This unprecedented situation
forced the entire region to face the wide-scale clinical emergency
without patient-treatment guidelines. We observed that non-existent
criteria for performing tracheostomies on intubated COVID-19 patients
result in significant discrepancies between their timing and techniques.
This survey revealed two distinct timing approaches: most centres
reverted to tracheostomy for prolonged intubations, lasting more than
10–12 days, whereas some others performed tracheostomies after 5–6
days to accelerate weaning from mechanical ventilation. The latter group
is among those performing a higher number of procedures.
Median reported ICU stay is nine days,3 therefore,
waiting for respiratory disorder recovery seems reasonable. However,
tracheostomy within seven days reduces the duration of mechanical
ventilation and ICU stays as well as hospital-acquired pneumonia and
mortality.4 Early tracheostomy also reduces the need
for sedation and may accelerate rehabilitation.5Further studies are needed to provide data for determining appropriate
approach.
Percutaneous tracheostomy is the preferred technique, most often
performed by anaesthesiologists, whereas otolaryngologists are required
for STs in case of predicted anatomical difficulties. However, a closer
collaboration between these specialists is advisable since each of the
two techniques has its advantages. Percutaneous tracheotomies reduce the
risk for major bleeding and stoma infection. This proves vital due to
the high prevalence of multi-resistant bacteria in ICUs and the use of
anticoagulants for COVID-19 patient because of suspected microvascular
pulmonary thrombosis.6 Concurrently, recently proposed
COVID-19-specific ST techniques reduce hypoxia time and minimise aerosol
generation and operator infection.7-10 Furthermore, in
an emergency setting, shortages of resources, PT-experienced staff and
PT kits must be considered.