Tracheostomy Protocol at UPMC
At the University of Pittsburgh Medical Center (UPMC), tracheostomy placement in COVID-19 patients is considered only after 2-3 weeks of mechanical ventilation unless there are compelling clinical reasons necessitating earlier timing. All patients undergoing elective tracheostomy receive pre-operative SARS-CoV-2 testing. As testing capacity increases, retesting prior to the procedure is recommended. The procedure should be performed in a negative pressure room for patients who are COVID-19 positive or have an unknown status. Open surgical tracheostomy is preferred to percutaneous dilation approach in order to reduce the risk of aerosolization. The procedure is to be performed in the ICU whenever possible to reduce exposure to staff and other patients. Full PPE with N95 or powered air-purifying respirator (PAPR) is required for all staff in the procedure room. The entire procedure is done with complete paralysis and a high-flow suction device is recommended whenever cautery is used. Ventilation is held when the respiratory circuit is open. Tracheal suctioning is minimized and a cuffed, non-fenestrated tracheostomy tube is always placed.