Dear Editor,
we read with great interest the article by Mata-Castro et al. about the outcomes of critically ill patients with COVID-19 underwent tracheostomy [1]. The authors concluded that the delay in tracheostomy may prolonged the need of mechanical ventilation but did not affect mortality [1]. We applaud the work of the authors however we have some concerns.
First the author reported that tracheostomy was performed in intensive care unit (ICU) by an experienced team [1]. Tracheostomy is an aerosol generating procedure and staff safety during it should be guaranteed [2]. Different reports suggested modifying tracheostomy technique with the aim to add further protection for the staff [3], according to this we ask more details about the protocol used to perform tracheostomy and, particularly, how the airway was managed.
Second, mortality in critically ill tracheostomized patients is a complex matter because patient characteristics, comorbidities, reasons of ICU admission may affect it [4]. In patients with respiratory failure, ICU mortality was 50% [4]. Severe respiratory failure is the most worrisome problem and common complication of COVID-19 [5]. The authors reported an ICU mortality of 31% even in line with the current literature but much higher that the pooled mortality of 13% recently reported by a systematic review involving tracheostomized COVID-19 patients [1,6]. In this systematic review only 3 studies had a mortality more than 20% [6], we ask the authors to further discuss their data on mortality in this view.
We agree with the authors that they reported data and outcome of a unique population of patients, in this view we ask for more information that may help physicians in this pandemic.
Funding
None.
Availability of data and material (data transparency)
NA.
Code availability
NA.
Authors' contributions
MV, AM and GS collected the data, evaluated the literature, analyzed the data, wrote the manuscript and approved the final version.
Declaration of competing interest
None.
References
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