Tracheostomy guidelines developed at a large academic medical center during the COVID‐19 pandemic

Abstract

Background: During the SARS-CoV-2 pandemic, tracheostomy may be required for COVID-19 patients requiring long-term ventilation in addition to other conditions such as airway compromise from head and neck cancer. As an aerosol-generating procedure, tracheostomy increases the exposure of health care workers to COVID-19 infection. Performing surgical tracheostomy and tracheostomy care requires a strategy that mitigates these risks and maintains the quality of patient care.Methods: This study is a multidisciplinary review of institutional tracheostomy guidelines and clinical pathways. Modifications to support clinical decision making in the context of COVID-19 were derived by consensus and available evidence.Results: Modified guidelines for all phases of tracheostomy care at an academic tertiary care center in the setting of COVID-19 are presented. Discussion: During the various phases of the COVID-19 pandemic, clinicians must carefully consider the indications, procedural precautions, and postoperative care for tracheostomies. We present guidelines to mitigate risk to health care workers while preserving the quality of care.

Tracheostomy in 80 COVID-19 patients: a multicenter, retrospective, observational study

“…Sixty (69.0%) patients had chronic medical illnesses, and the most common illnesses were hypertension (40.0%), coronary heart disease (21.1%), diabetes (17.5%) and cerebrovascular disease (10.0%) ( Table 1). Thirty (37.5%) patients received tracheostomies within 14 days after intubation, and their median duration between intubation and tracheostomy was signi cantly shorter than that of the late tracheostomy group ( [11][12][13][14][15][16][17][18][19][20][21], p = 0.034) at ICU admission and lower APACHE II scores (13 (SD 4) vs 17 (SD 6), p = 0.010) before tracheostomy. Among all 80 patients, lymphocytopenia and hypoalbuminemia at hospital admission and hypoxemia at ICU admission were prominent (Table 2).…”

“…During the pandemic of COVID-19, it remains unclear whether early tracheostomy performance is bene cial to critically ill COVID-19 patients. Some guidelines [16][17][18] suggested that tracheostomy should be delayed until at least 14 days from endotracheal intubation because viral load in the upper and lower airway may be high in the early course of the infection in COVID-19 patients.…”

A Systematic Review on Tracheostomy in COVID-19 Patients: Current Guidelines and Safety Measures

“…Sometimes the secretions are thick, so water based humidification is required but their use should be assessed on patient to patient basis. Nebulisers is helpful in secretion clearance by reducing the tenacity but require additional handling of ventilator circuits which can be avoided if possible and can waterlog HME filters; they should therefore be used only after careful consideration [29]. Above all patients inside ICU should be consulted in full PPE, facemask and shield.…”

Special considerations for elderly patients with head and neck cancer during the COVID‐19 pandemic

“…Since initial reports suggest high viral load in the pharynx and respiratory secretions, there are important ramifications for optimal management of patients with head and neck cancer. This is especially true of patients with mucosal malignancies and those who require tracheotomy or laryngectomy 4‐6 . As is standard for management of head and neck cancers, multidisciplinary tumor board and conferences are critical for ensuring the safety of patients, caregivers, family members, health care providers, and the greater community 6‐8 .…”