Outcomes of COVID-19 patients requiring tracheostomy in a tertiary public hospital setting in Johannesburg, South Africa

Abstract

Background: Respiratory decompensation is a hallmark of COVID-19. Patients may develop acute respiratory distress syndrome, resulting in the need for endotracheal intubation and mechanical ventilation, often for extended periods. Tracheostomy is an important clinical consideration for the optimal management of ICU patients requiring extended periods of invasive mechanical ventilation. Since the emergence of the COVID-19 pandemic, the number of tracheostomies for prolonged mechanically ventilated patients has risen. This research aimed to describe the outcomes of ventilated COVID-19 ICU patients who received tracheostomy. Method: This study was a retrospective chart review auditing files of 22 COVID-19 ICU Chris Hani Baragwanath Academic Hospital patients who received tracheostomies between 1st April 2020 and March 31, 2022. Results: The mean patient age was 50,6 years. Patients were mostly female and black. The number of tracheostomies performed averaged around one or two per month. The mean time from endotracheal intubation to tracheostomy was 15,6 days and from tracheostomy to discharge was 8,8 days. The survival rate after tracheostomy was 68,2%. All tracheostomies were performed as open surgical tracheostomies in the operating theatre. Conclusion and Contribution: This study has provided important insights into the outcomes of COVID-19 patients requiring tracheostomy in a tertiary public hospital in Johannesburg, South Africa. The findings highlight the critical role of tracheostomy in managing severe respiratory failure in COVID-19 patients and the variability in patient demographics and procedural outcomes. While the survival rate post-tracheostomy was encouraging, the study underscored the need for improved medical record- keeping, standardised protocols, and multidisciplinary care to optimise patient outcomes