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Recommendation of a practical guideline for safe tracheostomy during the COVID-19 pandemic

Research output: Contribution to journalReview articlepeer-review

Arunjit Takhar, Abigail Walker, Stephen Tricklebank, Duncan Wyncoll, Nicholas Hart, Tony Jacob, Asit Arora, Christopher Skilbeck, Ricard Simo, Pavol Surda

Original languageEnglish
Pages (from-to)2173-2184
Number of pages12
JournalEuropean Archives of Oto-Rhino-Laryngology
Volume277
Issue number8
Early online date21 Apr 2020
DOIs
Accepted/In press15 Apr 2020
E-pub ahead of print21 Apr 2020
Published1 Aug 2020

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King's Authors

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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