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Review
. 2020 Sep-Oct;41(5):102578.
doi: 10.1016/j.amjoto.2020.102578. Epub 2020 Jun 1.

Tracheostomy in the intensive care unit: Guidelines during COVID-19 worldwide pandemic

David Smith  1 , Juan Montagne  1 , Micaela Raices  2 , Agustín Dietrich  1 , Indalecio Carboni Bisso  3 , Marcos Las Heras  3 , Juan E San Román  3 , Gustavo García Fornari  4 , Marcelo Figari  5
Affiliations
Review

Tracheostomy in the intensive care unit: Guidelines during COVID-19 worldwide pandemic

David Smith et al. Am J Otolaryngol. 2020 Sep-Oct.

Abstract

Purpose: COVID-19 has become a pandemic with significant consequences worldwide. About 3.2% of patients with COVID-19 will require intubation and invasive ventilation. Moreover, there will be an increase in the number of critically ill patients, hospitalized and intubated due to unrelated acute pathology, who will present underlying asymptomatic or mild forms of COVID-19. Tracheostomy is one of the procedures associated with an increased production of aerosols and higher risk of transmission of the virus to the health personnel. The aim of this paper is to describe indications and recommended technique of tracheostomy in COVID-19 patients, emphasizing the safety of the patient but also the medical team involved.

Materials and methods: A multidisciplinary group made up of surgeons with privileges to perform tracheostomies, intensive care physicians, infectious diseases specialists and intensive pulmonologists was created to update previous knowledge on performing a tracheostomy in critically ill adult patients (>18 years) amidst the SARS-CoV-2 pandemic in a high-volume referral center. Published evidence was collected using a systematic search and review of published studies.

Results: A guideline comprising indications, surgical technique, ventilator settings, personal protective equipment and timing of tracheostomy in COVID-19 patients was developed.

Conclusions: A safe approach to performing percutaneous dilational bedside tracheostomy with bronchoscopic guidance is feasible in COVID-19 patients of appropriate security measures are taken and a strict protocol is followed. Instruction of all the health care personnel involves is key to ensure their safety and the patient's favorable recovery.

Keywords: Bronchoscopy; COVID-19; Percutaneous; Personal protective equipment; Tracheostomy.

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Figures

Fig. 1
Fig. 1
Surgical sterile level 3 personal protection equipment (PPE) recommended by the Infection Control Committee of the Hospital Italiano de Buenos Aires, for the performance of percutaneous tracheostomy (PT) in patients with suspected or positive COVID-19.
Fig. 2
Fig. 2
Percutaneous tracheostomy set.
See this image and copyright information in PMC

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