Tracheostomy in COVID-19: Not a decision to be rushed

In the current COVID-19 pandemic intensive care units (ICUs) and hospitals will quickly reach capacity and countries across the world are looking at solutions to expand their ventilated bed-capacity.

In an usual ICU setting, patients with prolonged ventilation requirements may have a planned tracheostomy (percutaneous or surgical) to aid weaning from the ventilator. The recent publication from Tay et al (2020) report that this was the most common surgical procedure performed on infected patients during the SARS outbreak 2002-2003 [1].

However, performing a tracheostomy and subsequent care presents an increased risk to the healthcare professionals looking after the patient (ENT-UK).

The Table below from Tay et al (2020)summarises the precautions used when performing a surgical (open) tracheostomy for SARS patients.

Although there is a lower mortality rate in COVID-19 compared with SARS (2.3% vs 11%), a higher proportion of COVID-19 patients require invasive mechanical ventilation or extracorporeal membrane oxygenation [1-3]

Therefore healthcare professionals should carefully consider the benefits and risks of tracheostomy vs prolonged intubation and ventilation for each patient on a case by case basis. Useful guidance has been provided below with updates on how to minimise risk of COVID-19 transmission for tracheostomy-care.

Useful Resources:

ENT-UK: Guidance for Surgical Tracheostomy and Tracheostomy Tube Change during the COVID-19 Pandemic (Published 19 March 2020)

American Academy of Otolaryngology-Head and Neck Surgery: Tracheotomy Recommendations During the COVID-19 Pandemic (Adopted 27 March 2020)

Medical Journal of Australia (pre-print): Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group (Updated 17 March 2020)


References:

1. Tay JK, Khoo ML, Loh WS. Surgical Considerations for Tracheostomy During the COVID-19 Pandemic: Lessons Learned From the Severe Acute Respiratory Syndrome Outbreak. JAMA Otolaryngol Head Neck Surg. Published online March 31, 2020. doi:10.1001/jamaoto.2020.0764

2. Arentz M, Yim E, Klaff L, et al. Characteristics and Outcomes of 21 Critically Ill Patients With COVID-19 in Washington State. JAMA. Published online March 19, 2020. doi:10.1001/jama.2020.4326

3. Wu C, Chen X, Cai Y, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. Published online March 13, 2020. doi:10.1001/jamainternmed.2020.0994

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