- Canadian Society of Otolaryngology-Head and Neck Surgery strongly advise against performing a tracheotomy in still infectious COVID-19 patients.
- In positive patients, requests for tracheotomy should generally not be considered regardless of duration of endotracheal intubation.
- In emergency tracheotomy with unknown COVID-19 status:
- Manage patient as if COVID-19 positive.
- Intubation rather than tracheotomy is highly preferable.
- Avoid use of high flow oxygen/high flow nasal cannula.
- Tracheotomy should always be performed by the most skilled and available airway manager (surgeon and anesthesiologist).
- Limit team members to essential staff.
- All patients undergoing elective tracheotomy should be COVID-19 tested prior to the intervention:
- Decision-making should take in consideration surgical and ICU team in COVID-19 positive patient.
- Avoid circuit disconnection.
- Suction via closed circuit is recommended.
- Heat moister exchanger (HME) with viral filter or a ventilator filter should be placed if the tracheotomy tube is disconnected from mechanical ventilation.
- Avoid disconnecting HME but if necessary, disconnect distal to HME.
- Avoid postoperative tracheostomy tube changes until COVID-19 negative.
These recommendations come from documents produced by the Canadian Society of Otolaryngology-Head and Neck Surgery, the American Academy of Otolaryngology-Head and Neck Surgery and ENT UK in regard of tracheotomy being a high-risk procedure because of aerosol-generation while in COVID-19 pandemic.
- Engels P., Weitzel E., Witterick I., et al (March 22, 2020). Recommendations from the CSO-HNS Taskforce on Performance of Tracheotomy During the COVID-19 Pandemic. Canadian Society of Otolaryngology-Head and Neck Surgery. Retrieved from https://www.entcanada.org/news-events/covid-19-alerts/
- Harrison L., Ramsden J., Winter S., et al (March 19, 2020). Guidance for Surgical Tracheostomy and Tracheostomy Tube Change during the COVID-19 pandemic. ENT UK. Retrieved from https://www.entuk.org/tracheostomy-guidance-during-covid-19-pandemic
- Noah P., A.Schiff B., A.Fritz M., et al (March 27, 2020). Tracheotomy Recommendations During the COVID-19 Pandemic. American Academy of Otolaryngology-Head and Neck Surgery. Retrieved from https://www.entnet.org/content/tracheotomy-recommendations-during-covid-19-pandemic