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. 2020 May 5.
doi: 10.1002/lary.28734. Online ahead of print.

Utility of Tracheostomy in Patients With COVID-19 and Other Special Considerations

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Utility of Tracheostomy in Patients With COVID-19 and Other Special Considerations

Jeffrey C Mecham et al. Laryngoscope. .

Abstract

Introduction: Patients who become severely ill from coronavirus disease 2019 (COVID-19) have a high likelihood of needing prolonged intubation, making tracheostomy a likely consideration. The infectious nature of COVID-19 poses an additional risk of transmission to healthcare workers that should be taken into consideration.

Methods: We explore current literature and recommendations for tracheostomy in patients with COVID-19 and look back at previous data from severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1), the virus responsible for the SARS outbreak of 2003.

Results: Given the severity and clinical uncertainty of patients with COVID-19 and the increased risk of transmission to clinicians, careful consideration should be taken prior to performing tracheostomy. If tracheostomy is performed, we recommend a bedside approach to limit exposure time and number of exposed personnel. Bronchoscopy use with a percutaneous approach should be limited in order to decrease viral exposure.

Conclusion: Thorough preprocedural planning, use of experienced personnel, enhanced personal protective equipment where available, and a thoughtful anesthesia approach are instrumental in maximizing positive patient outcomes while successfully protecting the safety of healthcare personnel. Laryngoscope, 2020.

Keywords: COVID-19, percutaneous tracheostomy, open tracheostomy, bedside tracheostomy.

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References

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