Tracheotomy in patients with COVID-19

Coronavirus disease 2019 COVID-19 has become a public health problem by quickly evolving into a global pandemic. Although the disease causes mild to moderate symptoms in large parts of society, severe respiratory distress develops in a significant portion. These patients need to be treated in the intensive care unit, and some of them also need invasive mechanical ventilation due to respiratory failure. Prolonged mechanical ventilation can bring out a need for tracheotomy in these patients. However, tracheotomy is a high-risk procedure in terms of transmission due to the high potential of aerosol generation. Therefore, some recommendations about the measurements to be taken and personal protective equipment PPE use were published. Until now, we performed tracheotomy in six patients with COVID-19 in our center and all these procedures were performed at the bedside. During these procedures, standard and enhanced PPE, including a powered air-purifying respirator, were used. No sign of the infection was seen in any member of the team who performed the procedures. In conclusion, the tracheotomy procedure in the patients with COVID-19 seems to be safe in terms of the transmission risk to the healthcare workers, based on articles published during the severe acute respiratory syndrome epidemic and our experiences. However, we still need data collection and documentation to establish the timing and benefit of tracheotomy in these patients.

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  • Integrated surveillance of COVID-19 in Italy. Available at: https://www.epicentro.iss.it/en/coronavirus/ bollettino/Infografica_3aprile%20ENG.pdf. [Update: 15 April 2020].
  • Zhan M, Qin Y, Xue X, Zhu S. Death from Covid-19 of 23 Health Care Workers in China. N Engl J Med 2020:NEJMc2005696.
  • Republic of Turkey Ministry of Health. Available at: https://covid19.saglik.gov.tr. [Accessed: April 29, 2020]
  • Vukkadala N, Qian ZJ, Holsinger FC, Patel ZM, Rosenthal E. COVID-19 and the Otolaryngologist: Preliminary Evidence-Based Review. Laryngoscope 2020. [Online ahead of print]
  • Harrison L, Ramsden J, Winter S, Rocke J HE. Tracheostomy guidance during the COVID-19 Pandemic. ENT UK. Available at: https://www. entuk.org/tracheostomy-guidance-during- covid-19- pandemic. Published 2020. [Accessed: March 22, 2020].
  • Rameau A, Young VN, Amin MR, Sulica L. Flexible Laryngoscopy and COVID-19. Otolaryngol Head Neck Surg 2020:194599820921395.
  • Givi B, Schiff BA, Chinn SB, Clayburgh D, Iyer NG, Jalisi S, et al. Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic. JAMA Otolaryngol Head Neck Surg 2020. [Online ahead of print]
  • Patel ZM, Fernandez-Miranda J, Hwang PH, Nayak JV, Dodd R, Sajjadi H, et al. Letter: Precautions for Endoscopic Transnasal Skull Base Surgery During the COVID-19 Pandemic. Neurosurgery 2020. [Online ahead of print]
  • Cui C, Yao Q, Zhang D, Zhao Y, Zhang K, Nisenbaum E, et al. Approaching Otolaryngology Patients During the COVID-19 Pandemic. Otolaryngol Head Neck Surg 2020. [Online ahead of print]
  • Tay JK, Khoo ML, Loh WS. Surgical Considerations for Tracheostomy During the COVID-19 Pandemic: Lessons Learned From the Severe Acute Respiratory Syndrome Outbreak. JAMA Otolaryngol Head Neck Surg 2020. [Online ahead of print]
  • World Health Organization. Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations [Internet]. Available at: https://www.who.int/news-room/commentaries/ detail/modes-of-transmission-of-virus-causing-covid- 19-implications-for-ipc-precaution-recommendations. [Accessed: March 27, 2020]
  • Jacob T. Framework for open tracheostomy in COVID- 19 patients. Available at: https://www.entuk.org/ sites/default/files/files/COVID%20tracheostomy%20 guidance_compressed.pdf. [Accessed: April 29, 2020]
  • Noah P. Parker, Schiff BA, Fritz MA, Rapoport SK, Schild S, Altman KW, et al. Tracheotomy Recommendations During the COVID-19 Pandemic. Available at: https://www.entnet.org/content/ tracheotomy-recommendations-during-covid-19- pandemic. [Accessed: April 29, 2020]
  • Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med 2020. [Online ahead of print]
  • Orhan KS, Keles N, Aydemir L, Sen C. COVID Hastalarında Trakeotomi-Öneriler ve Uygulama Videosu. Available at: https://www.kbb.org.tr/haber/ covd-hastalarinda-trakeotomi-oneriler-veuygu-9317. [Accessed: April 29, 2020]