Safety of percutaneous tracheostomy in critically ill COVID-19 patients: A retrospective observational study

Percutaneous tracheostomy is commonly performed in intensive care unit (ICU) for patients requiring prolonged mechanical ventilation. The coronavirus disease-19 (COVID-19) pandemic raised concerns about potential complications during tracheostomy, particularly in critically ill patients with severe hypoxemia, coagulopathy, and procedural risks in infected patients. This study aimed to compare early and late complications of tracheostomy in ICU patients with and without COVID-19, and to assess the relationship between these complications, patient comorbidities, and antiplatelet/anticoagulant medication use. We conducted a retrospective cohort analysis of 132 ICU patients who underwent percutaneous tracheostomy between January 2019 and May 2021. Based on COVID-19 infection status, patients were assigned to either the COVID-19 group (Group-C) or the non-COVID-19 group (Group-NC). Data on demographics, comorbidities, medications, procedure details, and early/late complications were collected. A multivariable logistic regression model was used to assess associations between COVID-19 status and early complications, adjusting for confounding factors. A total of 132 patients were analyzed, including 33 in Group-C and 99 in Group-NC. Cannula insertion time was shorter in Group-C (6.1 ± 2.3 vs 7.3 ± 4.1 minutes, P = .031). No major bleeding or esophageal injuries were reported. Minor bleeding occurred in 9.1% of Group-C and 17.2% of Group-NC (P > .05). Although hypoxia was observed only in Group-NC, this difference was not statistically significant. Late complications, including tracheal stenosis and tracheoesophageal fistulas, were rare and showed no significant group differences. Use of antiplatelet or anticoagulant therapy was significantly higher in Group-C (90.9% vs 27.3%, P < .001), but was not associated with increased bleeding complications. Percutaneous tracheostomy appears to be equally safe in COVID-19 and non-COVID-19 ICU patients, even in the setting of higher anticoagulant and antiplatelet therapy. These findings support the continued feasibility and safety of tracheostomy in both populations when performed under appropriate precautions.