Recommendations for Tracheotomy During SARS-CoV-2Pandemic
As the number of infected patients requiring intubation and ventilator
support climbs, a growing population of patients would normally qualify
for tracheotomy due to failed extubation or prolonged ventilatory needs.
Considering the clear evidence from both SARS and SARS-CoV-2
infection9, it is
imperative that this patient population be managed appropriately to
minimize infectious risk to the healthcare team.
Currently, there are no published reports on tracheotomy in patients
with COVID-19. We felt there were numerous reasons to develop consensus
guidelines including:
- An anticipated high volume in our center (3rdlargest public hospital in the US)
- Known risk to intraoperative and postoperative medical staff
- Anticipated shortages of resources (ICU beds, ventilators, PPE) which
could be impacted by decisions around tracheotomy
- High potential for conflict between surgeons and critical care staff
over an
emotionally charged issue.
To address these concerns, we assembled a task force of stakeholders in
our medical center involved with tracheotomy including otolaryngology,
trauma surgery, critical care medicine and anesthesiology. The group
reviewed existing literature and met virtually to draft recommendations.
Ideas were refined with final recommendations approved by all Task Force
members as summarized below. The availability of highly predictive
testing for SARS- CoV-2 has greatly simplified the decision process in
our medical center; improving the safety of medical staff, preserving
resources like PPE and freeing up resources like ventilators and ICU
space.