Abstract: Background: Patients undergoing prolonged mechanical ventilation commonly
require tracheotomy. The main aim of this study was to evaluate the outcomes of tracheotomy
for patients with acute respiratory distress syndrome (ARDS) associated with
COVID-19 in low-resource settings. Methods: A retrospective, single-center, observational
cohort study was performed on patients with ARDS associated with COVID-19. Patients
who underwent intubation alone were compared with those who received both intubation
and subsequent tracheotomy. The analysis included patient demographics, comorbidities,
and outcomes. Results: Patients undergoing tracheotomy (n = 89) were compared with
intubated patients (n = 622). The median time from intubation to tracheotomy was 10 days
(IQR: 6–15 days). Overall, 608 patients (85.5%) died in the hospital. Thirty-seven patients
(35.9%) in the survival group had tracheostomy compared with fifty-two patients (8.5%)
in the non-survival group (p < 0.001). The Kaplan–Meier curve shows a higher probability
of survival in the tracheotomy group compared with the non-tracheotomy group
(log-rank test: p < 0.001). Tracheotomy was found to be independently associated with
lower in-hospital mortality (HR = 0.16 [95% CI: 0.11–0.23], p < 0.001) in the multivariable
Cox proportional hazards regression analysis after adjusting for potential confounding
factors. Furthermore, tracheotomy was associated with a higher cumulative incidence
of being alive and off the ventilator at day 28 (SHR = 2.87 [95% CI: 1.88–4.38], p < 0.001).
Conclusions: Tracheotomy was associated with reduced in-hospital mortality and longer
ventilator-free days.
