Global health care is experiencing an unprecedented surge in the number of critically ill patients who require mechanical ventilation due to the COVID-19 pandemic. The requirement for relatively long periods of ventilation in those who survive means that many are considered for tracheostomy to free patients from ventilatory support and maximise scarce resources. COVID-19 provides unique challenges for tracheostomy care: health-care workers need to safely undertake tracheostomy procedures and manage patients afterwards, minimising risks of nosocomial transmission and compromises in the quality of care. Conflicting recommendations exist about case selection, the timing and performance of tracheostomy, and the subsequent management of patients. In response, we convened an international working group of individuals with relevant expertise in tracheostomy. We did a literature and internet search for reports of research pertaining to tracheostomy during the COVID-19 pandemic, supplemented by sources comprising statements and guidance on tracheostomy care. By synthesising early experiences from countries that have managed a surge in patient numbers, emerging virological data, and international, multidisciplinary expert opinion, we aim to provide consensus guidelines and recommendations on the conduct and management of tracheostomy during the COVID-19 pandemic.
A Mcgrath 1, B., J Brenner 2, M., J Warrillow 3, S., 4, V. P., 5, A. A., S Cameron 3, T., 6, J. M. A., 7, G. H. M., D Truog 8, R., D Block 9, S., Y Lui 10, G. C., Mcdonald 11, C., H Rassekh 12, C., Atkins 12, J., Qiang 13, L., Vergez 14, S., Dulguerov 15, P., Zenk 16, J., Antonelli, M., Pelosi 18, P., K Walsh 19, B., Ward 20, E., Shang 21, Y., Gasparini 22, S., Donati 22, A., Singer 23, M., M Openshaw 24, P. J., Tolley 25, N., 2, H. M., J Feller-Kopman 26, D., Tracheostomy in the COVID-19 era: global and multidisciplinary guidance, <<THE LANCET. RESPIRATORY MEDICINE>>, 2020; 8 (7): 717-725. [doi:10.1016/S2213-2600(20)30230-7] [http://hdl.handle.net/10807/165550]
Tracheostomy in the COVID-19 era: global and multidisciplinary guidance
Antonelli, Massimo
Primo
Investigation
;
2020
Abstract
Global health care is experiencing an unprecedented surge in the number of critically ill patients who require mechanical ventilation due to the COVID-19 pandemic. The requirement for relatively long periods of ventilation in those who survive means that many are considered for tracheostomy to free patients from ventilatory support and maximise scarce resources. COVID-19 provides unique challenges for tracheostomy care: health-care workers need to safely undertake tracheostomy procedures and manage patients afterwards, minimising risks of nosocomial transmission and compromises in the quality of care. Conflicting recommendations exist about case selection, the timing and performance of tracheostomy, and the subsequent management of patients. In response, we convened an international working group of individuals with relevant expertise in tracheostomy. We did a literature and internet search for reports of research pertaining to tracheostomy during the COVID-19 pandemic, supplemented by sources comprising statements and guidance on tracheostomy care. By synthesising early experiences from countries that have managed a surge in patient numbers, emerging virological data, and international, multidisciplinary expert opinion, we aim to provide consensus guidelines and recommendations on the conduct and management of tracheostomy during the COVID-19 pandemic.
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