Background: During the SARS-CoV-2 pandemic, tracheostomy may be required for COVID-19 patients requiring long term ventilation in addition to other conditions such as airway compromise from head and neck cancer. As an aerosol generating procedure, tracheostomy increases healthcare worker exposure to COVID-19 infection. Performing surgical tracheostomy and tracheostomy care requires a strategy that mitigates these risks and maintains the quality of patient care.

Methods: A multidisciplinary review of institutional tracheostomy guidelines and clinical pathways. Modifications to support clinical-decision making in the context of COVID-19 were derived by consensus and available evidence. 

Results: Modified guidelines for all phases of tracheostomy care at an academic tertiary care center in the setting of COVID-19 are presented.

Discussion: During the various phases of the  COVID-19 pandemic,  clinicians must carefully consider the indications, procedural precautions, and post-operative care for tracheostomies. We present guidelines to mitigate risk to healthcare workers while preserving the quality of care.