Increased utilisation of tracheostomy as the pandemic progressed.
We found that the proportion of critical care patients having a
tracheostomy significantly increased during the early part of the
pandemic. Anecdotally, during February-March 2020 there was some
hesitation in performing tracheostomies for COVID-19 patients owing to
the uncertainly regarding clinical prognosis and concerns for healthcare
worker safety when performing an aerosol generating procedure. There
were low rates of tracheostomies internationally during this period with
early reports from the USA stating that only 8% (17/203) of patients
had a tracheostomy in a multicentre cohort from March
2020.18
Tracheostomy use rapidly increased in April-June following the peak of
critical care admissions during the first wave in England. This increase
in tracheostomy utilisation reflects rapidly changing critical care
practice as understanding of the disease improved and patients survived
longer whilst intubated and ventilated. Furthermore, outcomes for
tracheostomy patients improved as procedure numbers increased over time.
It is possible that a combination of improved overall critical care
management with new information and better patient selection for
tracheostomy contributed to improved outcomes during early summer 2020.
The differences when plotting the data by discharge and admission month
appear to be driven by longer stay for patients undergoing tracheostomy
compared to non-tracheostomy patients, with the peak in tracheostomy
patient discharges in June 2020. Nevertheless, the same broad trend is
evident when plotting the data by either method.