A Cohort Study of Mechanically Ventilated COVID-19 Patients Undergoing Tracheostomy

COVID-19 can lead to a severe respiratory illness with 5-12% requiring mechanical
ventilation.Standard UK intensive care practice is to consider a tracheostomy after 7-10 days
of mechanical ventilation in order to facilitate weaning, reduce duration of mechanical
ventilation, shorten intensive care stay and reduce complications relating to prolonged
presence of an endotracheal tube. Given the severity of respiratory illness and a mortality
in mechanically ventilated COVID 19 patients which exceeds 50%, the benefit of tracheostomy
in this group is uncertain.

There are also unique considerations regarding health care professional (HCP) safety when
performing tracheostomy in COVID-19 patients due to the potential of aerosol generation and
transmission of the infection. ENT UK and other organisations have issued guidance regarding
surgical tracheostomy in terms of timing, environment, technique and level of personal
protective equipment (PPE). The ability of hospital departments to follow this guidance and
the effectiveness of these measures is unknown.

This UK national cohort study aims to assess the effects of tracheostomy in mechanically
ventilated COVID-19 patients in terms of the duration of mechanical ventilation, length of
ICU and hospital stay and mortality. These data will be related to COVID-19 patients who are
mechanically ventilated but do not undergo tracheostomy, as captured by the UK Intensive Care
National Audit and Research Centre (ICNARC).

In parallel we will collect data on the tracheostomy procedure itself and compare these to
national guidance on tracheostomy in patients diagnosed with COVID-19, and on COVID-19
infections in the surgical and medical teams involved in the tracheostomy procedure.

This proposal builds upon the ongoing COVIDTrach project that has captured data on 550
COVID-19 tracheostomies from 78 NHS hospitals throughout the UK so far. COVIDTrach has
successfully brought together surgical, intensive care and anaesthetic specialists to capture
early timepoints following tracheostomy. Moving forward, we will work with speech and
language therapists and physiotherapists to capture later stages in the patient pathway. This
will provide a unique and comprehensive assessment of the role of tracheostomy in COVID-19
patients. It will lay the foundation for further much needed multidisciplinary research into
the role of tracheostomy in respiratory disease beyond the COVID-19 pandemic.