Introduction
As the novel coronavirus (2019-nCov) globally spreads, the coronavirus
disease (COVID-19) pandemic is straining healthcare workers worldwide
[1]. In hospitalized patients with severe COVID-19, endotracheal
intubation is one of the most common and indispensable life-saving
interventions. In a recent report from the City of New York, 12% of
COVID-19 patients required invasive mechanical ventilation [2].
Since difficult weaning and prolonged mechanical ventilation represent
the two most common indications for tracheostomy in Intensive Care Unit
(ICU), it may play a central role in COVID-19 management [3]. During
the 2019-nCov pandemic the aerosol generating procedures, such as
tracheostomy, expose physicians at high risk to contract the
\soutCOVID-19 infection [4]. Accordingly, special consideration
may be done to protect otolaryngologists, general surgeons and critical
care physicians from the risk of infection while performing a
tracheostomy in COVID-19 patients [5]. Percutaneous tracheostomy
(PT) is routinely performed at the bedside in intensive care unit (ICU);
unfortunately, a modified protocol to perform PT in COVID-19 patients
included several critical steps associated with increased risk of
aerosol generation, such as changing the catheter mount, repositioning
the endotracheal tube cuff to the level of the vocal cords and removal
of large dilator [6]. So far, there has been no prior description in
the literature of how to minimize the aerosol generation during PT. We
reported a modified percutaneous tracheostomy technique aiming to
minimize the risk of aerosol generation and to increase the staff safety
in COVID-19 patients.