POINT: Tracheostomy in Patients With COVID-19

Tracheostomy care and communication during COVID-19: Global interprofessional perspectives

“…This study on challenges in tracheostomy care complements the spirited national discourse on aerosol-generating procedures [42] , [43] , [44] , [45] , [46] and overall pandemic related acute-care practices in tracheostomy care [47] , [48] , [49] , [50] . This survey of a diverse sample of healthcare professionals, patients, and families identified pervasive concerns regarding tracheostomy-related communication and safety for both patients and professionals.…”

From Fog of War to Tailored Tracheostomy Timing

“…Tracheostomy is not without risk, but it can reduce the morbidity of prolonged translaryngeal intubation, alleviate the cumulative effects of sedation, and allow swifter rehabilitation, which includes hastening walking, talking, and eating. 4 Early in the pandemic, performing tracheostomy before 14 days raised questions of risk of transmission to health-care professionals and of benefit for patients; yet, proactive approaches to tracheostomy also offered the possibility of accelerating weaning from ventilation and thereby addressing scarcity of equipment, personnel, and hospital or ICU beds. 4 Although guidance documents and international protocols have proliferated, 5-7 significant questions remained.…”

“…4 Early in the pandemic, performing tracheostomy before 14 days raised questions of risk of transmission to health-care professionals and of benefit for patients; yet, proactive approaches to tracheostomy also offered the possibility of accelerating weaning from ventilation and thereby addressing scarcity of equipment, personnel, and hospital or ICU beds. 4 Although guidance documents and international protocols have proliferated, 5-7 significant questions remained.…”

“…In this issue of CHEST, Hernández et al 8 shed new light on the outcomes of early tracheostomy in their study of outcomes of patients with COVID-19 who were admitted to ICUs in Spain. Although previous studies have reported on cohorts of patients with COVID-19 respiratory failure that required tracheostomy, 4,9,10 risk of bias has limited many analyses. Retrospective studies are inherently susceptible to bias because of differences in the groups being compared, lack of randomization, or systematic confounders in how patients were selected for treatment, with both known and unknowable factors affecting outcomes.…”

Small Steps Towards Better Tracheostomy Care During the Evolving COVID-19 Pandemic

“…16 Importantly, waiting for patients to have a negative polymerase chain reaction test for the SARS-CoV-2 virus seems less important, both for the patient and for the healthcare team. 17 Appropriate provision of respiratory personal protective equipment (PPE) is one of the main factors driving the confidence of healthcare teams to undertake earlier tracheostomy in this cohort, regardless of potential infectivity. Steps can be taken to increase the safety of the insertion for both staff and the patient.…”