COVID-19 patients from hospitalization to tracheostomy, the experience of a ‎high volume center


Intubation Rate


How to Cite

Mokhber Dezfuli, M., Mosafaeii Rad, O. ., Ghorbani, F., Farzanegan, B. ., Mir-Moeini, E. ., & Shadmehr, M. B. (2022). COVID-19 patients from hospitalization to tracheostomy, the experience of a ‎high volume center. Iranian Red Crescent Medical Journal, 24(7). Retrieved from


Background: Decision-making and planning considering tracheostomy are not clear yet.
Objectives: We aimed to report tracheostomy rates in different settings of admitted patients and compare tracheostomy outcomes in COVID-19 and non-COVID patients regarding both technics including surgical and Percutaneous dilational tracheostomy.
Methods: From Feb. 2020 to May 2021 admitted patients at Masih Daneshvary hospital were assessed respecting intubation and tracheostomy rate. Different aspects of tracheostomy and outcome were compared in both methods of tracheostomy including surgical vs. percutaneous. Among Non-COVID patients, 15 ICU admitted patients with different etiologies of pneumonia who required mechanical ventilation and tracheostomy were randomly selected and were compared with COVID patients.
Results: A total of 7748 covid19 patients were admitted and an average rate of 12.7% of the patients were admitted to ICU with an intubation rate of 5.13%. Tracheostomy was performed for a total of 36 patients for prolonging intubation with a trend including of range of 0.1 to 1.45% in 16 months. Regarding method, 24% and 33.3% of patients in surgical method and PDT groups were survived respectively, (P = 0.44). In non COVID, surgical tracheostomy and PDT was performed in 26.5% and 40%, respectively (P = 0.5). Mortality rate  was 72.2% and  20%, respectively, (P = 0.003).
Conclusion: Given the fact that in some centers tracheostomy is delayed till the PCR test for covid19 turned to negative, so, we recommend making an effort to reduce this complication and giving the proper information to the patients at risk of stenosis.


References: ‎

‎1. ‎ Jamaati H, Dastan F, Tabarsi P, Marjani M, Saffaei A, Hashemian SM. A Fourteen-day ‎‎Experience with Coronavirus Disease 2019 (COVID-19) Induced Acute Respiratory Distress ‎‎Syndrome (ARDS): An Iranian Treatment Protocol. Iran J Pharm Res. 2020;0(March):31–6. ‎

‎2. ‎ Menegozzo CAM, Arap SS, Mariani AW, Minamoto H, Imamura R, Bento RF, et al. ‎‎Standardization of elective tracheostomies at the central institute of the hospital das clínicas ‎‎in são paulo during the covid-19 pandemic. Rev Col Bras Cir. 2020;47(1):1–7. ‎

‎3. ‎ Hasani H, Mardi S, Shakerian S, Taherzadeh-Ghahfarokhi N, Mardi P. The Novel ‎‎Coronavirus Disease (COVID-19): A PRISMA Systematic Review and Meta-analysis of ‎‎Clinical and Paraclinical characteristics. medRxiv [Internet]. 2020;2020.04.19.20071456. ‎‎Available from:

‎4. ‎ Martin-Villares C, Perez Molina-Ramirez C, Bartolome-Benito M, Bernal-Sprekelsen M. ‎‎Outcome of 1890 tracheostomies for critical COVID-19 patients: a national cohort study in ‎‎Spain. Eur Arch Oto-Rhino-Laryngology. 2020 Aug 4; ‎

‎5. ‎ Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol Generating Procedures and ‎‎Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic ‎‎Review. PLoS One [Internet]. 2012;7(4):35797. Available from:

‎6. ‎ Adly A, Youssef TA, El-Begermy MM, Younis HM. Timing of tracheostomy in patients with ‎‎prolonged endotracheal intubation: a systematic review. Eur Arch Oto-Rhino-Laryngology. ‎‎‎2018;275(3):679–90. ‎

‎7. ‎ Takhar A, Walker A, Tricklebank S, Wyncoll D, Hart N, Jacob T, et al. Recommendation of a ‎‎practical guideline for safe tracheostomy during the COVID-19 pandemic. Vol. 277, ‎‎European Archives of Oto-Rhino-Laryngology. Springer; 2020. p. 2173–84. ‎

‎8. ‎ Mooney B, Lawrence C, Johnson EG, Slaboden A, Ball K. How COVID-19 Patients Were ‎‎Moved to Speak: A Rehabilitation Interdisciplinary Case Series. HSS J [Internet]. 2020 Aug ‎‎‎26 [cited 2020 Sep 6];1–8. Available from:‎

‎9. ‎ Volo T, Stritoni P, Battel I, Zennaro B, Lazzari F, Bellin M, et al. Elective tracheostomy ‎‎during COVID-19 outbreak: to whom, when, how? Early experience from Venice, Italy. Eur ‎‎Arch Oto-Rhino-Laryngology. 2020; ‎

‎10. ‎ Chiang SS, Aboutanos MB, Jawa RS, Kaul SK, Houng AP-H, Dicker RA, et al. Controversies ‎‎in Tracheostomy for Patients With COVID-19: The When, Where, and How. Respir Care ‎‎‎[Internet]. 2020 Sep 1 [cited 2020 Sep 6]; Available from: ‎‎‎

‎11. ‎ Courtney A, Lignos L, Ward PA, Vizcaychipi MP. Surgical Tracheostomy Outcomes in ‎‎COVID-19–Positive Patients. 2021;5(1):1–6. ‎

‎12. ‎ Cheung NH, Napolitano LM. Tracheostomy: Epidemiology, Indications, Timing, Technique, ‎‎and OutcomesDiscussion. Respir Care. 2014;59(6):895–919. ‎

‎13. ‎ Shiba T, Ghazizadeh S, Chhetri D, St John M, Long J. Tracheostomy Considerations during ‎‎the COVID-19 Pandemic. OTO open [Internet]. Jan [cited 2020 Sep ‎‎‎6];4(2):2473974X20922528. Available from: ‎‎‎

‎14. ‎ Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Disease 2019 in China. 2020; ‎

‎15. ‎ Gattinoni L, Haren F Van, Larsson A, Mcauley DF, Ranieri M. Epidemiology, Patterns of ‎‎Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care ‎‎Units in 50 Countries. 2016; ‎

‎16. ‎ Yang X, Yu Y, Xu J et al. Clinical course and outcomes of critically ill patients with SARS-‎‎CoV-2 pneumonia in Wuhan, China: a single-cen- tered, retrospective, observational study. ‎‎Lancet Respir Med. 2020;8(5):465–81. ‎

‎17. ‎ Holmen IC, Kent A, Lakritz S, Brickson C, Mastalerz K. Delayed Tracheostomy in a Patient ‎‎With Prolonged Invasive Mechanical Ventilation due to COVID-19. Cureus. 2020 Jun 15; ‎

‎18. ‎ Rojas-marte G, Talib A, Khalid M, Chukwuka N, Fogel J. Outcomes in Patients With ‎‎COVID-19 Disease and High Oxygen Requirements. 2021;13(1):26–37. ‎

‎19. ‎ Vianello A, Turrin M, Guarnieri G, Molena B, Arcaro G, Turato C, et al. Prone Positioning Is ‎‎Safe and May Reduce the Rate of Intubation in Selected COVID-19 Patients Receiving High-‎‎Flow Nasal Oxygen Therapy. 2021; ‎

‎20. ‎ Id JCH, Abad MS, Yordi A, Higuera GD, Rodriguez LG, Torrejon CG, et al. Outcomes of an ‎‎intermediate respiratory care unit in the COVID-19 pandemic. 2020;4:1–12. Available from: ‎‎‎

‎21. ‎ Cardona S, Downing J, Alfalasi R, Bzhilyanskaya V, Milzman D, Rehan M, et al. American ‎‎Journal of Emergency Medicine Intubation rate of patients with hypoxia due to COVID-19 ‎‎treated with awake proning : A meta-analysis. Am J Emerg Med [Internet]. 2021;43:88–96. ‎‎Available from:‎

‎22. ‎ Marjani M, Tabarsi P, Moniri A, Hashemian SM, Nadji SA, Abtahian Z, et al. NRITLD ‎‎Protocol for the Management of Patients with COVID-19 Admitted to Hospitals. Tanaffos. ‎‎‎2020;19(2):91. ‎

‎23. ‎ Mecham JC, Thomas OJ, Pirgousis P, Janus JR. Utility of Tracheostomy in Patients with ‎‎COVID-19 and Other Special Considerations. Laryngoscope. 2020; ‎

‎24. ‎ David AP, Russell MD, El-Sayed IH, Russell MS. Tracheostomy guidelines developed at a ‎‎large academic medical center during the COVID-19 pandemic. In: Head and Neck. John ‎‎Wiley and Sons Inc.; 2020. p. 1291–6. ‎

‎25. ‎ Rovira A, Tricklebank S, Surda P, Whebell S, Zhang J, Takhar A, et al. Open versus ‎‎percutaneous tracheostomy in COVID ‑ 19 : a multicentre comparison and recommendation ‎‎for future resource utilisation. Eur Arch Oto-Rhino-Laryngology [Internet]. ‎‎‎2021;(0123456789). Available from:‎

‎26. ‎ Jiménez D, García-Sanchez A, Rali P, Muriel A, Bikdeli B, Ruiz-Artacho P, et al. Incidence ‎‎of venous thromboembolism and bleeding among hospitalized patients with COVID-19: a ‎‎systematic review and meta-analysis. Chest. 2020; ‎

‎27. ‎ Chow VLY, Chan JYW, Ho VWY, Pang SSY, Lee GCC, Wong MMK, et al. Tracheostomy ‎‎during COVID-19 pandemic—Novel approach. In: Head and Neck. John Wiley and Sons Inc.; ‎‎‎2020. p. 1367–73. ‎

‎28. ‎ Dharmarajan H, Snyderman CH. Tracheostomy time-out: New safety tool in the setting of ‎‎COVID-19. In: Head and Neck. John Wiley and Sons Inc.; 2020. p. 1397–402. ‎

‎29. ‎ ‎