Timing and predictors of tracheostomy decannulation in COVID-19 and non-COVID-19 ARDS: A real-world study

Cinzia Lastoria; Annalisa Carlucci; Francesca Cemmi; Manuela Bergonzi; Abramo Bazza; Roberta Marra; Federica Fioretti; Matteo Vigna; Francesco Tursi; Chiara Mele; Claudia Crimi

doi:10.5826/mrm.2026.1048

Timing and predictors of tracheostomy decannulation in COVID-19 and non-COVID-19 ARDS: A real-world study

Authors

Cinzia Lastoria Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit
Annalisa Carlucci Department of Clinical and Experimental Medicine, Università del Salento, Lecce. Respiratory Medicine Unit, Vito Fazzi Hospital, Lecce https://orcid.org/0000-0001-7474-1467
Francesca Cemmi Pulmonary Unit, P. Pederzoli Hospital - Peschiera del Garda
Manuela Bergonzi Intermediate Care Unit, Emergency Department, Guglielmo da Saliceto Hospital - Piacenza
Abramo Bazza Medical Department, Cremona Hospital - Cremona
Roberta Marra Respiratory Medicine Unit, Vito Fazzi Hospital, Lecce
Federica Fioretti Pulmonary Unit, C.&G. Mazzoni Hospital - Ascoli Piceno
Matteo Vigna Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation Unit
Francesco Tursi UOC Riabilitazione Cardiorespiratoria, Ospedale di Codogno
Chiara Mele Department of Translational Medicine, University of Piemonte Orientale, Novara
Claudia Crimi Department of Clinical and Experimental Medicine, University of Catania. Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco" University Hospital, Catania

DOI: https://doi.org/10.5826/mrm.2026.1048

Keywords:

ARDS, Tracheostomy, Tracheostomy healing time

Abstract

Background: Tracheostomy is a commonly performed procedure in patients requiring prolonged mechanical ventilation (MV) in Intensive Care Units (ICUs), including COVID-19-related ARDS. However, limited data exist on the timing and predictors of decannulation.
Aim: To compare time to decannulation between COVID-19 and non-COVID-19 ARDS patients and to identify predictive factors.
Methods: A retrospective study including 96 COVID-19 ARDS and 32 non-COVID-19 ARDS tracheostomized patients admitted to step-down units after ICU stay from March 2020 to May 2021. Clinical, demographic data and comorbidities were analysed as well as predictors for decannulation delay.
Results: Timing of decannulation was similar between the two groups. Multivariate analysis identified limb weakness assessed by the Medical Research Council (MRC) scale, duration of steroids therapy, clinical complications, PaO₂/FiO₂ ratio and smoking history as independent predictors of decannulation timing.
Conclusions: COVID-19 did not affect timing of decannulation compared to non-COVID-19 ARDS. ICU-acquired weakness, assessed through the MRC scale, was the strongest predictor of delayed decannulation.

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