Data collection and statistics
Data were recorded on a Google Sheets spreadsheet (Google LLC, Mountain
View, CA, US), anonymised and extracted. Descriptive statistics were
performed by transferring data into an Excel 2010 spreadsheet (Microsoft
Corp, Redmont, WA, US). Due to the small sample, data were considered as
nonparametric.
RESULTS
The English translation of the full questionnaire with responses is
available online as supporting information to this paper. Each director
from the 42 Otolaryngology departments in Lombardy answered the
questionnaire. Among them, two belonged to cancer centres and one to a
paediatric hospital. All the hospitals, minus the two cancer centres,
admitted COVID-19 patients into their wards and ICUs. The 40 hospitals
accounted for almost 9000 hospital and approximately 1000 ICU
COVID-19-dedicated beds. The two cancer centres were devoted to managing
all complex cancer cases from the region, and patients were transferred
whenever possible.
At the time of interview (six weeks after Italy’s outbreak), over 500
tracheostomies were reported for intubated critical COVID-19 patients in
Lombardy. In 38 of 40 involved hospitals, at least one procedure was
performed. However, the number of performed procedures was inconsistent
among centres, regardless of the number of long-term invasively
ventilated patients. Notably, nearly half reported fewer than ten
procedures.
In all cases, the anaesthesiologist determined a tracheostomy need, but
we noticed tremendous time and preferred technique discrepancies among
centres. We found the median time between symptom onset and ICU
admission was 10 ± 3, 5 days (range 1–18 days), and since then, the
median time between intubation and tracheostomy was 12 ± 4 days (range
3–18 days). Pronation cycles were tried in each centre before
prescribing tracheostomies but significantly differed among hospitals. A
median of 3,5 ± 1,5 pronation cycles was performed before tracheostomy
(range 1–18 cycles).
Concerning the preferred technique, 27 of 38 centres that reported at
least one tracheostomy performed exclusively or mostly PTs. Among the
remaining hospitals, in five cases PTs and STs were equally performed,
whereas in six cases STs were preferred to PTs. No association was found
between the number of performed procedures and preferred techniques.
Reasons for the chosen techniques are reported in Table 1. Operator
preference was the primary determiner for choosing PTs. Additional
reasons frequently cited were the superior postoperative management of
the cannula and lower risk of complications. Open STs were mainly
utilised for unfavourable anatomic conditions but also from a lack of
experienced PT staff or PT kits.
DISCUSSION