Key points
INTRODUCTION Critical care admission is common in people hospitalised with COVID-19.1 In the United Kingdom, it has been reported that 17% of COVID-19 hospital inpatients required critical care support and 10% required mechanical ventilation.2 The management of these patients has evolved as new evidence regarding treatment approaches has been developed. However, an area of controversy that has remained is the appropriate utilisation of tracheostomy and its subsequent management.
Early in the pandemic, guidelines were published based on expert opinion before much was understood about the disease. Most of these guidelines focused on minimising risk of nosocomial transmission to clinicians and delaying or avoiding tracheostomies in these patients as the benefits of the procedure were unknown.3,4 As further experience was gained, tracheostomy use became common for critical care COVID-19 patients5 although optimal timing of tracheostomy remains a subject of debate.6,7
In England, reports of departments’ experiences have been described8–10 and a UK multi-centre prospective cohort study, COVIDTrach has been evaluating outcomes of COVID-19 tracheostomy patients.11 However, capturing information directly from hospitals can be constrained by inconsistent reporting patterns, especially if individual hospitals are overwhelmed by surges of critical care patients.
The National Health Service (NHS) Hospital Episodes Statistics (HES) database is an administrative dataset that contains a wide range of details regarding all NHS-funded hospital admissions in England. Using HES data, the aim of this study was to characterise tracheostomy use for COVID-19 critical care patients in England, understand the patient factors associated with having a tracheostomy and determine how this related to outcomes.