Systematic review of international guidelines for tracheostomy in COVID-19 patients

Abstract

At this moment, the world leaves under the SARS-CoV-2 outbreak pandemic.As Otolaryngologists -Head & Neck Surgeons, we need to perform and participate in examinations and procedures within the head and neck region and airway that are at particularly high risk of exposure and infection because of aerosol and droplet contamination. One of those surgical procedures on demand at this moment is tracheostomy, due the increasing admission in ICU departments and the increased need of ventilatory support secondary to respiratory distress syndrome. This review of international guidelines for tracheostomy in COVID-19 infected patients, aiming to summarize in a systematic way the available recommendations from 18 guidelines from all over the world.

Tracheostomy in 80 COVID-19 patients: a multicenter, retrospective, observational study

“…Sixty (69.0%) patients had chronic medical illnesses, and the most common illnesses were hypertension (40.0%), coronary heart disease (21.1%), diabetes (17.5%) and cerebrovascular disease (10.0%) ( Table 1). Thirty (37.5%) patients received tracheostomies within 14 days after intubation, and their median duration between intubation and tracheostomy was signi cantly shorter than that of the late tracheostomy group ( [11][12][13][14][15][16][17][18][19][20][21], p = 0.034) at ICU admission and lower APACHE II scores (13 (SD 4) vs 17 (SD 6), p = 0.010) before tracheostomy. Among all 80 patients, lymphocytopenia and hypoalbuminemia at hospital admission and hypoxemia at ICU admission were prominent (Table 2).…”

“…Regarding the type of tracheostomy performance, some argued against percutaneous tracheostomy performed in COVID-19 patients because it usually involves opening the ventilator circuit more frequently than surgical tracheostomy, and serial dilations during the procedure may put surgeons in face of the airway from the beginning [12]. However, there is currently no evidence across the literature to advise which approach is less aerosol generating [13]. In addition to standard personal protective equipment (PPE), PAPR is bene cial in preventing contracting.…”

Tracheostomy in the coronavirus disease 2019 patient: evaluating feasibility, challenges and early outcomes of the 14-day guidance

“…The number of challenges associated with performing tracheostomies in patients with Covid-19 has led to the recent publication of numerous guidelines and recommendations worldwide. 17 Severe acute respiratory syndrome coronavirus-2 can be transmitted via a number of routes including droplets, fomites and aerosols, 18 with a high viral load present in sputum and upper airway secretions. 19 Tracheostomy formation is considered an aerosol-generating procedure, hence posing an infection risk to those healthcare professionals involved intra-operatively.…”

“…The number of challenges associated with performing tracheostomies in patients with Covid-19 has led to the recent publication of numerous guidelines and recommendations worldwide. 17…”

Open versus percutaneous tracheostomy in COVID-19: a multicentre comparison and recommendation for future resource utilisation

“…The online version contains supplementary material available at https ://doi.org/10.1007/s0040 5-020-06597 -1. providing patient care, utilising all available resources [16]. Five of our acute hospitals in South London responded to the unprecedented increase in demand for tracheostomy in a variety of ways, depending on individual resource availability.…”