Introduction
The novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is impacting hospital care globally at multiple levels. Otolaryngologists and other surgeons will be called to assess and manage airways during this time period. Since the primary morbidity associated with COVID-19 is acute respiratory distress syndrome (ARDS), tracheostomy for patients requiring prolonged ventilation has emerged as an important element of care. The impact of COVID-19 on hospital resources includes heightened need for intensive care unit (ICU) capacity and ability to provide ventilatory support. Performance of tracheostomy has traditionally played an important role in ventilatory weaning, and its role in COVID-19 is now a primary focus.
Transmission of the SARS-CoV-2 virus is primarily thought to occur through aerosolization or contact with contaminated surfaces.1 As an aerosol generating procedure (AGP), tracheostomy is associated with high droplet and particle generation, placing healthcare providers at increased risk for transmission of respiratory viral infections.2 The predominant response during this pandemic has been to increase the level of personal protective equipment (PPE) to airborne-level precaution during tracheostomy. While effective PPE is of critical importance, additional consideration and modification of routine tracheostomy guidelines is prudent. Clinical decision-making regarding indications and timing should be considered in the context of resource utilization, risk to health care providers and patient benefit.