Timing of elective tracheotomy and duration of mechanical ventilation among patients admitted to intensive care with severe COVID‐19: A multicenter prospective cohort study

Background Optimal timing for tracheotomy for critically ill COVID‐19 patients requiring invasive mechanical ventilation (IMV) is not established. Methods Multicenter prospective cohort including all COVID‐19 patients admitted to intensive care units (ICUs) in 36 hospitals who required tracheotomy during first pandemic wave. With a target emulation trial framework, we studied the causal effects of early (7–10 days) versus late (>10 days) tracheotomy (LT) on time from tracheotomy to weaning, postoperative mortality, and tracheotomy complications. Results Of 696 patients, 20.4% received early tracheotomy (ET). ET was associated with faster weaning (hazard ratio [HR] [95% confidence interval, CI]: 1.25 [1.00–1.56]) without differences in mortality (HR [95% CI]: 0.85 [0.60–1.21]) or complications (adjusted rate ratio [95% CI]: 0.56 [0.23–1.33]). Conclusions ET had a similar or lower post‐tracheotomy weaning time than LT, potentially shortening IMV and ICU stays, without changing complication or mortality rates in COVID‐19 patients.