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.