Timing of tracheostomy in mechanically ventilated COVID-19 patients

Table 1 A description of studies collected for the review

Ref.	Title	Country	Following Guidelines for COVID-19 in the United States?	Timing of Tracheostomy	Type of Tracheostomy	Where was the Tracheostomy Done	Patient Outcome
Parker et al[9]	AAO Position Statement: Tracheotomy Recommendations During the COVID-19 Pandemic	United States	Yes	Can be considered after 2-3 weeks from intubation with negative COVID test	Unknown	ICU or operating room	Inconclusive
Hur et al[10]	Factors Associated with Intubation and Prolonged Intubation in Hospitalized Patients with Covid-19	United States	Yes	Assessed after ICU admission and intubation	Open	Operating Room	Unknown
Meng et al[11]	Early vs Late Tracheostomy in Critically Ill Patients: A Systematic Review and Meta-analysis	China	No	Various Timings	Open and Percutaneous	ICU or CCU	Early trach does not significantly alter the mortality, incidence of VAP duration of MV or length of ICU stay
Shiba et al[12]	Tracheostomy Considerations During the COVID-19 Pandemic	Global	Yes	Avoided if the patient is still infectious	Open and Percutaneous	Operating Room and ICU bedside	If the patient cannot be intubated, a laryngeal mask airway may be preferred over an emergent trach
Smith et al[13]	Tracheostomy in the intensive care unit: Guidelines during COVID-19worldwide pandemic	Argentina	No	After 21 days, negative COVID-19 test	Percutaneous	ICU	No benefits to early trach, but benefits to trach may be the possibility of decreasing sedation and delirium, increasing patient comfort, and reducing the incidence of laryngotracheal stenosis, ICU stay, and pneumonia
Heyd et al[14]	Tracheostomy Protocols During COVID-19 Pandemic	Global	Yes	>21 days depending on vent settings; patient shouldn’t be infectious	Open	ICU or operating room	Inconclusive
Takhar, et al[15]	Recommendation of a Practical Guideline for Safe Tracheostomy During the COVID-19 Pandemic	Global	Yes	At least 14 days	Open and Percutaneous	Operating Room and ICU bedside	Tracheostomy should be avoided if the prognosis is not deemed favorable since the mortality is ~50%
Bier-Laning et al[16]	Tracheostomy During the COVID-19Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries	Global	Yes	2-3 weeks from intubation preferably with negative COVID-19 test and falling inflammatory markers	Open and Percutaneous	Negative pressure room in ICU or Operating Room	Should reduce risk of virus exposure to providers and increase patient stability
Mandal et al[17]	A Systematic Review on Tracheostomy in COVID-19 Patients: Current Guidelines and Safety Measures	Global	Yes	At least 14 days; Patient should no longer be infectious	Open and Percutaneous	Operating Room and ICU bedside	Inconclusive
Hiramatsu et al[18]	Anesthetic and Surgical Management of Tracheostomy in a Patient With COVID-19	Japan	Yes	Day 28 of hospitalization	Open	Negative-pressure room in ICU	Patient improved by day 35 and transferred to another hospital
Holmenet al[19]	Delayed Tracheostomy in a Patient With Prolonged Invasive Mechanical Ventilation due to COVID-19	United States	Yes	Day 41 of intubation	Unknown	Unknown	Patient status improved and was discharged to rehab facility on day 58 of hospitalization
Marzban-Rad et al[20]	Early percutaneous dilational tracheostomy in COVID-19 patients: A case report	Iran	No	<10 days	Percutaneous	ICU	Early tracheostomy can be safely performed and improve patients’ condition when necessary
Tang et al[21]	Tracheostomy in 80 COVID-9 Patients: A Multicenter, Retrospective, Observational Study	China	Yes	Before 14 days or after 14 days	Open and Percutaneous	ICU or Operating room	Trachs within 14 days were associated with an increased mortality rate
Volo et al[22]	Elective Tracheostomy During COVID-19 Outbreak: To Whom, When, How? Early Experience from Venice, Italy	Italy	No	Median timing was 13 days- 10 days was the cut off for early to late	Open and Percutaneous	ICU	Early tracheostomy was associated with a greater risk of mortality. This conclusion was combined with SOFA scores greater than 6 and D-dimer greater than 4
Schuler et al[23]	Surgical tracheostomy in a cohort of COVID-19 patients	Germany	No	Between 2-16 days	Open	ICU	No infection to staff, decreased sedatives, decrease the risk of myopathy, neuropathy, shortened ICU stay
Mata-Castro et al[24]	Tracheostomy in patients with SARS-CoV-2 reduces time on mechanical ventilation but not intensive care unit stay	Spain	No	15.2 days	Unknown	Operating theatre in ICU	Delay in trach increased days of mechanical ventilation
Chao et al[25]	Outcomes After Tracheostomy in COVID-19 Patients	United States	Yes	8-30 days, average 17.5 days	Open and percutaneous	Negative pressure room in ICU	Patients who underwent earlier trachs achieved ventilator liberation sooner than late trach, patients with ARDS on vents should be delayed
Botti et al[26]	The Role of Tracheotomy and Timing of Weaning and Decannulation in Patients Affected by Severe COVID-19	Italy	No	2-17 days, average 7 days	Open or percutaneous	Negative pressure room in ICU	Tracheostomies proved to be an easier approach for patients with blockages
Nishio et al[27]	Surgical strategy and optimal timing of tracheostomy in patients with COVID-19: Early experiences in Japan	Japan	Yes	14-27 days, average 20 days	Open	ICU	No differences in blood loss or infection from pre to post-procedure
Ferri et al[28]	Indications and Times for Tracheostomy in Patients With SARS CoV2-related	Italy	No	Intubated 14 days or more	Open	ICU	The mortality rate amongst trached patients was 25% compared to 26%
Mesolella et al[29]	Is Timing of Tracheotomy a Factor Influencing the Clinical Course in COVID-19 Patients?	Italy	Yes	After 18 days	Unknown	ICU	Decreased pneumonia, MV rates, ability to oral feed, avoid injury to the larynx
Kwak et al[30]	Tracheostomy in COVID-19 Patients: Why Delay or Avoid?	United States	No	12.8 Days	Unknown	Unknown	Decreased LOS, decreased MV, no infection to providers
McGrath et al[31]	Tracheostomy for COVID-19: business as usual?	Untied Kingdom	No	Case-specific	Open, percutaneous or hybrid	ICU or operating theatre	Safe for providers and patients, prevents prolonged ventilation, physiological status of patient is more important than the viral load

Observational studies, systematic reviews and meta-analyses were included in the selection process. This review was performed in accordance with PRISMA guidelines. COVID-19: Coronavirus disease 2019; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; ICU: Intensive care unit.