Controversies in Tracheostomy for Patients With COVID-19: The When, Where, and How

COVID-19 has impacted how we deliver care to patients, and much remains unknown regarding optimal management of respiratory failure in this patient population. There are significant controversies regarding tracheostomy in patients with COVID-19 related to timing, location of procedure, and technique...

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Bibliographic Details
Published in:Respiratory care 2020-11, Vol.65 (11), p.1767-1772
Main Authors: Chiang, Stephen S, Aboutanos, Michel B, Jawa, Randeep S, Kaul, Sanjeev K, Houng, Abraham P-H, Dicker, Rochelle A, Guo, Weidun A
Format: Article
Language:English
Subjects:
Betacoronavirus
Care and treatment
Clinical Protocols
Coronavirus Infections - complications
Coronavirus Infections - therapy
COVID-19
Health aspects
Humans
Infection Control - instrumentation
Infection Control - methods
Infection Control - standards
Medical personnel
Pandemics
Pneumonia, Viral - complications
Pneumonia, Viral - therapy
Practice Guidelines as Topic
Respiratory Insufficiency - etiology
Respiratory Insufficiency - surgery
SARS-CoV-2
Time-to-Treatment
Tracheostomy
Tracheostomy - methods
Tracheostomy - standards
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Summary:COVID-19 has impacted how we deliver care to patients, and much remains unknown regarding optimal management of respiratory failure in this patient population. There are significant controversies regarding tracheostomy in patients with COVID-19 related to timing, location of procedure, and technique. In this narrative review, we explore the recent literature, publicly available guidelines, protocols from different institutions, and clinical reports to provide critical insights on how to deliver the most benefit to our patients while safeguarding the health care force. Consensus can be reached that patients with COVID-19 should be managed in a negative-pressure environment with proper personal protective equipment, and that performing tracheostomy is a complex decision that should be made through multidisciplinary discussions considering patient prognosis, institutional resources, staff experience, and risks to essential health care workers. A broad range of practices exist because there is no conclusive guidance regarding the optimal timing or technique for tracheostomy.
ISSN:0020-1324
1943-3654
DOI:10.4187/respcare.08100