Tracheostomy During the COVID-19 Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries. (June 2021)

• Record Type: Journal Article
• Authors: Bier-Laning, Carol; Cramer, John D.; Roy, Soham; Palmieri, Patrick A.; Amin, Ayman; Añon, José Manuel; Bonilla-Asalde, Cesar A.; Bradley, Patrick J.; Chaturvedi, Pankaj; Cognetti, David M.; Dias, Fernando; Di Stadio, Arianna; Fagan, Johannes J.; Feller-Kopman, David J.; Hao, Sheng-Po; Kim, Kwang Hyun; Koivunen, Petri; Loh, Woei Shyang; Mansour, Jobran; Naunheim, Matthew R.; Schultz, Marcus J.; Shang, You; Sirjani, Davud B.; St. John, Maie A.; Tay, Joshua K.; Vergez, Sébastien; Weinreich, Heather M.; Wong, Eddy W. Y.; Zenk, Johannes; Rassekh, Christopher H.; Brenner, Michael J.;
• Is Part Of: Otolaryngology--head and neck surgery. Volume 164:Number 6(2021)
• Page Start: 1136
• Page End: 1147
• Publication Date: 2021-06
• Subjects: tracheostomy -- tracheotomy -- COVID-19 -- SARS-CoV-2 -- novel coronavirus -- intensive care -- intensive care unit -- ventilator -- weaning -- aerosol generating procedure -- AGP -- patient safety -- quality improvement -- health care workers -- ethics -- pandemic -- timing -- infectivity; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/0194599820961985
• Languages: English
• ISSNs: 0194-5998

Abstract

Objective: The coronavirus disease 2019 (COVID-19) pandemic has led to a global surge in critically ill patients requiring invasive mechanical ventilation, some of whom may benefit from tracheostomy. Decisions on if, when, and how to perform tracheostomy in patients with COVID-19 have major implications for patients, clinicians, and hospitals. We investigated the tracheostomy protocols and practices that institutions around the world have put into place in response to the COVID-19 pandemic. Data Sources: Protocols for tracheostomy in patients with severe acute respiratory syndrome coronavirus 2 infection from individual institutions (n = 59) were obtained from the United States and 25 other countries, including data from several low- and middle-income countries, 23 published or society-endorsed protocols, and 36 institutional protocols. Review Methods: The comparative document analysis involved cross-sectional review of institutional protocols and practices. Data sources were analyzed for timing of tracheostomy, contraindications, preoperative testing, personal protective equipment (PPE), surgical technique, and postoperative management. Conclusions: Timing of tracheostomy varied from 3 to >21 days, with over 90% of protocols recommending 14 days of intubation prior to tracheostomy. Most protocols advocate delaying tracheostomy until COVID-19 testing was negative. All protocols involved use of N95 or higher PPE. Both open and percutaneous techniques were reported. Timing of tracheostomy changes ranged from 5 to >30 days postoperatively, sometimes contingent on negative COVID-19 test results. Implications for Practice: Wide variation exists in tracheostomy protocols, reflecting geographical variation, different resource constraints, and limited data to drive evidence-based care standards. Findings presented herein may provide reference points and a framework for evolving care standards.