Purpose COVID-19 has become a pandemic with significant consequences worldwide. About 3.2% of patients with COVID-19 will require intubation and invasive ventilation. Moreover, there will be an increase in the number of critically ill patients, hospitalized and intubated due to unrelated acute pathology, who will present underlying asymptomatic or mild forms of COVID-19. Tracheostomy is one of the procedures associated with an increased production of aerosols and higher risk of transmission of the virus to the health personnel. The aim of this paper is to describe indications and recommended technique of tracheostomy in COVID-19 patients, emphasizing the safety of the patient but also the medical team involved. Materials and methods A multidisciplinary group made up of surgeons with privileges to perform tracheostomies, intensive care physicians, infectious diseases specialists and intensive pulmonologists was created to update previous knowledge on performing a tracheostomy in critically ill adult patients (>18 years) amidst the SARS-CoV-2 pandemic in a high-volume referral center. Published evidence was collected using a systematic search and review of published studies. Results A guideline comprising indications, surgical technique, ventilator settings, personal protective equipment and timing of tracheostomy in COVID-19 patients was developed. Conclusions A safe approach to performing percutaneous dilational bedside tracheostomy with bronchoscopic guidance is feasible in COVID-19 patients of appropriate security measures are taken and a strict protocol is followed. Instruction of all the health care personnel involves is key to ensure their safety and the patient's favorable recovery.

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ObjectiveDescribe the clinical and respiratory characteristics of critical patients with coronavirus disease 2019 (COVID-19).DesignObservational and retrospective study over 6 months.SettingIntensive care unit (ICU) of a high complexity hospital in Buenos Aires, Argentina.PatientsPatients older than 18 years with laboratory-confirmed COVID-19 by reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV-2 were included in the study.Variables of interestDemographic characteristics such as sex and age, comorbidities, laboratory results, imaging results, ventilatory mechanics data, complications, and mortality were recorded.ResultsA total of 168 critically ill patients with COVID-19 were included. 66% were men with a median age of 65 years (58-75. 79.7% had at least one comorbidity. The most frequent comorbidity was arterial hypertension, affecting 52.4% of the patients. 67.9 % required invasive mechanical ventilation (MV), and no patient was treated with non-invasive ventilation. Most of the patients in MV (73.7%) required neuromuscular blockade due to severe hypoxemia. 36% of patients were ventilated in the prone position. The length of stay in the ICU was 13 days (6-24) and the mortality in the ICU was 25%.ConclusionsIn this study of critical patients infected by SARS-CoV-2 in a high-complexity hospital, the majority were comorbid elderly men, a large percentage required invasive mechanical ventilation, and ICU mortality was 25%.

Introduction: Pandemics pose a major challenge for public health preparedness, requiring a coordinated international response and the development of solid containment plans. An early and accurate identification of high-risk patients in the course of the actual COVID-19 pandemic is vital for planning and for making proper use of available resources. Objective: The purpose of this study was to identify the key variables to create a predictive model that could be used effectively for triage. Method: A narrative literature review of 651 articles was conducted to assess clinical, laboratory and imaging findings of COVID-19 confirmed cases. After screening, 10 articles met the inclusion criteria and a list of suggested variables was gathered. A modified Delphi process analysis was performed to consult experts in order to generate a final list of variables for the creation of the predictive model. Results: The modified Delphi process analysis identified 44 predictive variables that were used for building a severity prediction score, the COVID-19 Severity Index. Conclusion: Specifically designed for current COVID-19 pandemic, COVID-19 Severity Index could be used as a reliable tool for strategic planning, organization and administration of resources by easily identifying hospitalized patients with higher risk of transfer to Intensive Care Unit (ICU).

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