World is under threat of COVID-19 pandemic, associated with many numbers of critically ill patients. To manage these intubated patients there are need of more ventilators but world is not prepared for this type of situation and there are lacunae of such arrangements in most of the countries. As we know patients cannot be intubated for long time and they should be given preference to alternative airway in the form of tracheostomy. COVID-19 is aerosol transmitted disease which lead to indeed challenge to health care providers to safely perform tracheostomy and provide post tracheostomy care to these patients with minimising risks of nosocomial transmission to themselves and accompanying nursing staff. There are so many guidelines and recommendations for the timing, desired place of tracheostomy, change in tracheostomy steps related to conventional method and the subsequent management of patients. So, the aim of this systematic review is to give a brief review of available data on COVID-19 related to the timing, personal protections, operative steps modifications, and subsequent post tracheostomy care during this pandemic.
Aim: Global health care is experiencing an unprecedented surge in the number of critically ill patients who require mechanical ventilation due to the COVID-19 pandemic. The requirement for relatively long periods of ventilation in those who survive means that many are considered for tracheostomy to free patients from ventilatory support and maximise scarce resources. COVID-19 provides unique challenges for tracheostomy care: health-care workers need to safely undertake tracheostomy procedures and manage patients afterwards, minimising risks of nosocomial transmission and compromises in the quality of care. Conflicting recommendations exist about the timing and performance of tracheostomy and the subsequent management of patients. 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: MEDLINE (accessed from PubMed) from 6 august 2019 to 7 august 2020 were systematically searched using: “COVID 19” OR “CORONAVIRUS” OR “SARS COV-2” AND “TRACHEOSTOMY” with filters as ‘2020’ year of study, English language, full article available on 7/08/2020 at 11.30 Am.Results: Total of 56 articles were obtained on search and the final 15 articles extracted based on our selection criteria were reviewed. A synthesis of the current international literature and reported experience is presented with respect to timing of tracheostomy, ideal place for tracheostomy, staff safety, procedure modification and post tracheostomy care thus leading to a pragmatic recommendation that tracheostomy is not performed until at least 14 days after endotracheal intubation in COVID-19 patients and if indicated should be done in negative pressure isolated ICU room with full PPE protection with some modification during procedure.Conclusion: In selected COVID-19 patients, there is a role for tracheostomy to aid in weaning and optimise healthcare resource utilisation. Tracheostomy can be performed safely with careful modifications to technique and appropriate enhanced personal protective equipment.
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