AI Article Synopsis
- The COVID-19 pandemic has increased the demand for critical care and raised questions about the safety and timing of tracheostomy for ventilated patients with COVID-19 pneumonia.
- A literature review and guidelines based on experiences from a tertiary healthcare institution suggested that tracheostomy should ideally be done at least 14 days after intubation due to concerns over prognosis and staff safety.
- In certain cases, tracheostomy can be helpful for weaning patients and optimally using healthcare resources, and both techniques can be performed safely with proper precautions and team support from ORL-HNS surgeons.
Article Abstract
Purpose: The COVID-19 pandemic is placing unprecedented demand upon critical care services for invasive mechanical ventilation. There is current uncertainty regarding the role of tracheostomy for weaning ventilated patients with COVID-19 pneumonia. This is due to a number of factors including prognosis, optimal healthcare resource utilisation, and safety of healthcare workers when performing such a high-risk aerosol-generating procedure.
Methods: Literature review and proposed practical guideline based on the experience of a tertiary healthcare institution with 195 critical care admissions for COVID-19 up until 4th April 2020.
Results: A synthesis of the current international literature and reported experience is presented with respect to prognosis, viral load and staff safety, thus leading to a pragmatic recommendation that tracheostomy is not performed until at least 14 days after endotracheal intubation in COVID-19 patients. Practical steps to minimise aerosol generation in percutaneous tracheostomy are outlined and we describe the process and framework for setting up a dedicated tracheostomy team.
Conclusion: In selected COVID-19 patients, there is a role for tracheostomy to aid in weaning and optimise healthcare resource utilisation. Both percutaneous and open techniques can be performed safely with careful modifications to technique and appropriate enhanced personal protective equipment. ORL-HNS surgeons can play a valuable role in forming tracheostomy teams to support critical care teams during this global pandemic.
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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7170707 | PMC |
| http://dx.doi.org/10.1007/s00405-020-05993-x | DOI Listing |
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