<div></div><div>KEYPOINTS</div><ul><li>COVID-19 patients often require prolonged mechanical ventilation, and
tracheostomy is a common choice.</li><li>Shared guidelines for intensive care unit patient tracheostomies for
COVID-19 patients do not exist.</li><li>Our survey indicates the timing and technique of COVID-19
tracheostomies vary considerably among hospitals in Lombardy, Italy.</li><li>Otolaryngologists are seldom involved with decision-making regarding
tracheostomies for intensive care unit COVID-19 patients.</li><li>Evidence-based interventions are essential for providing the best care
to invasively ventilated COVID-19 patients.</li></ul><div>KEYWORDS</div><div>SARS-Cov-2; COVID-19; coronavirus; tracheostomy; percutaneous
tracheotomy; surgical tracheostomy; intubation; ventilation.</div><div>INTRODUCTION</div><div>After identifying the first Italian COVID-19 infected patient on 20
February 2020, a rapidly escalating infection cluster was discovered. On
21 February, a response coordinated by a governmental task force
progressively led to a countrywide lockdown beginning on 9 March. Italy
became the first Western country to address COVID-19, which on 20 March,
the World Health Organization declared a pandemic.</div><div>Although pneumology, infectious disease, and intensive care units
(ICUs), as well as emergency departments, have carried the heaviest
healthcare burden during this outbreak,<sup>1</sup> other
departments must also address the increased infectious risk while
meeting patient needs. Given the number of COVID-19 patients requiring
long-term invasive ventilation, a surge in tracheostomies have ensued.
Otolaryngologists have quickly become involved in patient management,
despite previously having been ’second-line’ specialists during
infectious outbreaks.<sup>2</sup> This unprecedented need for
tracheostomies reopened decades-old debates about ICU patient
tracheostomy timing, techniques and operators: supporters of late versus
early tracheostomies, percutaneous tracheostomies (PTs) versus open
surgical tracheostomies (STs) and otolaryngologists versus
anaesthesiologists.</div><div>This unprecedented situation similarly affected all hospitals in the
region, overburdening ICUs and inpatient units. Our study aimed to
illustrate the COVID-19 healthcare situation and investigate ICU
tracheostomy management decisions.</div><div>MATERIALS AND METHODS</div><div>We prepared a 13-item questionnaire asking the following: the number of
COVID-19 patients treated, ICU dedicated beds, tracheostomies performed
and their timing, preferred tracheostomy techniques with reasons for
choosing PT or ST. The questionnaire was sent to each otolaryngology
department in the Lombardy region, during the first week of April 2020.
Department directors, instructed to collect data by collaborating
directly with their respective ICUs, responded by phone the following
week.</div>