Tracheostomy is a medical procedure performed on the front of a persons neck. It is usedto create a connection between the persons trachea and a mechanical ventilator instead ofusing a tube going through the mouth into the trachea, oral intubation. Living with atracheostomy tube is less stressful compared to oral intubation and facilitate beingawake and the start of training on spontaneous ventilation in mechanically ventilatedpatients. Studies of the timing of tracheostomy are either severely affected bymethodological bias of to small to determine an effect. Thus, it is not known what theoptimal timing of the tracheostomy is in mechanically ventilated COVID-19 patients.
Hypothesis It is hypothesised that timing of tracheostomy to day 9-11 is independently
linked to a higher number of days, alive without invasive mechanical ventilation and
several secondary outcomes when adequate methods to neutralize waiting time and immortal
time bias are used.
Data sources Existing data provided for another project will be used.
Statistical methods:
A cohort study with a target trial emulation (1) on a dataset with cloned individuals
assigned to different treatment strategies (i.e. tracheostomy at different timings).
Censoring at deviation from assigned strategy or death (2). Adjustment for confounding
will be used.
Procedure: Tracheostomy
Surgery for tracheostomy
Inclusion Criteria:
- Adult
- admitted to an intensive care unit in Sweden from 2020 to 2021
- Main discharge diagnosis COVID-19 (ICD-10, U07.1)
- Invasive mechanical ventilation
Exclusion Criteria:
- No Swedish personal identification number.
Uppsala University
Uppsala 2666199, Sweden
Björn Ahlström, PhD, Principal Investigator
Uppsala University