Study aim: The outcome assessment of the early tracheotomy and orotracheal intubation in COVID-19 patients. Design: Two arm parallel group without blinding and randomization Settings and conduct: The study conducted on the total confirmed COVID-19 patients using the Polymerase Chain Reaction (PCR) technique and radiologic studies that admitted in the ICU centers of a tertiary hospital during one month. All patients required invasive ventilation. The patients categorized into two groups according to methods of airway management and divided randomly into the groups. Data analyzed using statistical package for social sciences (SPSS) version 18 (SPSS Inc. Chicago, IL, USA) for windows. Participants/Inclusion and exclusion criteria: All patients required invasive ventilation. Intervention groups: The early tracheotomy is conduction of tracheotomy surgery within at least 3 days from orotracheal intubation. The orotracheal intubation is the insertion of an endotracheal tube through the mouth and into the trachea. Main outcome variables: Mortality rate