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Review
. 2020 Aug;277(8):2173-2184.
doi: 10.1007/s00405-020-05993-x. Epub 2020 Apr 21.

Recommendation of a practical guideline for safe tracheostomy during the COVID-19 pandemic

Arunjit Takhar  1 , Abigail Walker  2 , Stephen Tricklebank  3 , Duncan Wyncoll  3 , Nicholas Hart  4 , Tony Jacob  2 , Asit Arora  5 , Christopher Skilbeck  5 , Ricard Simo  5 , Pavol Surda  5
Affiliations
Review

Recommendation of a practical guideline for safe tracheostomy during the COVID-19 pandemic

Arunjit Takhar et al. Eur Arch Otorhinolaryngol. 2020 Aug.

Abstract

Purpose: The COVID-19 pandemic is placing unprecedented demand upon critical care services for invasive mechanical ventilation. There is current uncertainty regarding the role of tracheostomy for weaning ventilated patients with COVID-19 pneumonia. This is due to a number of factors including prognosis, optimal healthcare resource utilisation, and safety of healthcare workers when performing such a high-risk aerosol-generating procedure.

Methods: Literature review and proposed practical guideline based on the experience of a tertiary healthcare institution with 195 critical care admissions for COVID-19 up until 4th April 2020.

Results: A synthesis of the current international literature and reported experience is presented with respect to prognosis, viral load and staff safety, thus leading to a pragmatic recommendation that tracheostomy is not performed until at least 14 days after endotracheal intubation in COVID-19 patients. Practical steps to minimise aerosol generation in percutaneous tracheostomy are outlined and we describe the process and framework for setting up a dedicated tracheostomy team.

Conclusion: In selected COVID-19 patients, there is a role for tracheostomy to aid in weaning and optimise healthcare resource utilisation. Both percutaneous and open techniques can be performed safely with careful modifications to technique and appropriate enhanced personal protective equipment. ORL-HNS surgeons can play a valuable role in forming tracheostomy teams to support critical care teams during this global pandemic.

Keywords: COVID-19; Mechanical ventilation; Novel coronavirus; SARS-CoV-2; Tracheostomy.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
ENT-UK Guidance for COVID-19 tracheostomy. Reproduced with the permission of the authors
Fig. 1
Fig. 1
ENT-UK Guidance for COVID-19 tracheostomy. Reproduced with the permission of the authors
Fig. 1
Fig. 1
ENT-UK Guidance for COVID-19 tracheostomy. Reproduced with the permission of the authors
Fig. 1
Fig. 1
ENT-UK Guidance for COVID-19 tracheostomy. Reproduced with the permission of the authors
Fig. 2
Fig. 2
Percutaneous tracheostomy action card
See this image and copyright information in PMC

References

    1. John Hopkins University (2020) Coronavirus Resource Centre. https://coronavirus.jhu.edu/map.html. Accessed 10 April 2020
    1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for disease control and Prevention. JAMA. 2020 doi: 10.1001/jama.2020.2648. - DOI - PubMed
    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan. China Lancet. 2020;395(10223):497–506. doi: 10.1016/S0140-6736(20)30183-5. - DOI - PMC - PubMed
    1. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan. JAMA. 2020;323(11):1061–1069. doi: 10.1001/jama.2020.1585. - DOI - PMC - PubMed
    1. Intensive Care National Audit and Research Centre (2020) ICNARC report on COVID-19 in critical care. https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports. Accessed 10 April 2020

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