Carol Bier-Laning1, John D Cramer2, Soham Roy3, Patrick A Palmieri4,5, Ayman Amin6, José Manuel Añon7, Cesar A Bonilla-Asalde8,9, Patrick J Bradley10, Pankaj Chaturvedi11, David M Cognetti12, Fernando Dias13, Arianna Di Stadio14, Johannes J Fagan15, David J Feller-Kopman16, Sheng-Po Hao17,18, Kwang Hyun Kim19, Petri Koivunen20, Woei Shyang Loh21, Jobran Mansour22, Matthew R Naunheim23, Marcus J Schultz24,25,26, You Shang27, Davud B Sirjani28, Maie A St John29,30,31, Joshua K Tay32, Sébastien Vergez33, Heather M Weinreich34, Eddy W Y Wong35, Johannes Zenk36, Christopher H Rassekh37, Michael J Brenner38,39. 1. Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Maywood, Illinois, USA. 2. Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA. 3. Department of Otorhinolaryngology-Head and Neck Surgery, Children's Memorial Hermann Hospital, University of Texas Medical School, Houston, Texas, USA. 4. Office of the Vice Chancellor for Research, Universidad Norbert Wiener, Lima, Peru. 5. EBHC South America: A Joanna Briggs Affiliated Group, Lima, Peru. 6. Head and Neck Department, National Cancer Institute, Cairo University, Egypt. 7. La Paz-Carlos III University Hospital, IdiPAZ, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain. 8. Hospital Nacional Daniel Alcides Carrión, Lima, Perú. 9. Universidad Privada San Juan Bautista, Lima, Perú. 10. Department of Otolaryngology, Head and Neck Oncologic Surgery, University of Nottingham, Nottingham, UK. 11. Department of Head & Neck Surgical Oncology, Tata Memorial Centre, Mumbai, India. 12. Department of Otolaryngology-Head & Neck Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Philadelphia, USA. 13. Head and Neck Surgery Service, Brazilian National Cancer Institute, Chairman, Department of Head and Neck Surgery, Post-Graduation School of Medicine, Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil. 14. Department of Otolaryngology, University of Perugia, Perugia, Italy. 15. Division of Otorhinolaryngology (ENT), University of Cape Town, Cape Town, South Africa. 16. Departments of Medicine, Anesthesiology and Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 17. Department of Otorhinolaryngology-Head & Neck Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei. 18. Department of Otorhinolaryngology-Head & Neck Surgery, Fu Jen Catholic University School of Medicine, New Taipei City. 19. Department of Otolaryngology-Head and Neck Surgery and Cancer Research Institute, Bundang Jesaeng Hospital Seoul National University College of Medicine, Seoul, Korea. 20. Department of Otolaryngology, Oulu University Hospital, Oulu, Finland. 21. Department of Otolaryngology-Head and Neck Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. 22. Department of Otorhinolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel Hashomer, Israel. 23. Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA. 24. Department of Intensive Care & Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·CA), Amsterdam University Medical Centers, location AMC, Amsterdam, the Netherlands. 25. Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand. 26. Nuffield Department of Medicine, University of Oxford, Oxford, UK. 27. Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 28. Department of Otorhinolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA. 29. Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. 30. Jonsson Comprehensive Cancer Center, UCLA Medical Center, Los Angeles, California, USA. 31. UCLA Head and Neck Cancer Program, UCLA Medical Center, Los Angeles, California, USA. 32. Department of Otolaryngology-Head and Neck Surgery, National University of Singapore, Singapore. 33. Department of Otolaryngology-Head & Neck Surgery, University Hospital Rangueil-Larrey, Toulouse, France. 34. Department of Otolaryngology, University of Illinois College of Medicine, Chicago, Illinois, USA. 35. Department of Otorhinolaryngology, Head & Neck Surgery, Chinese University of Hong Kong, Hong Kong. 36. Universitätsklinikum Augsburg Klinik für HNO-Heilkunde, Augsburg, Germany. 37. Department of Otorhinolaryngology-Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 38. Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA. 39. Global Tracheostomy Collaborative, Raleigh, North Carolina, USA.
Abstract
OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has led to a global surge in critically ill patients requiring invasive mechanical ventilation, some of whom may benefit from tracheostomy. Decisions on if, when, and how to perform tracheostomy in patients with COVID-19 have major implications for patients, clinicians, and hospitals. We investigated the tracheostomy protocols and practices that institutions around the world have put into place in response to the COVID-19 pandemic. DATA SOURCES: Protocols for tracheostomy in patients with severe acute respiratory syndrome coronavirus 2 infection from individual institutions (n = 59) were obtained from the United States and 25 other countries, including data from several low- and middle-income countries, 23 published or society-endorsed protocols, and 36 institutional protocols. REVIEW METHODS: The comparative document analysis involved cross-sectional review of institutional protocols and practices. Data sources were analyzed for timing of tracheostomy, contraindications, preoperative testing, personal protective equipment (PPE), surgical technique, and postoperative management. CONCLUSIONS: Timing of tracheostomy varied from 3 to >21 days, with over 90% of protocols recommending 14 days of intubation prior to tracheostomy. Most protocols advocate delaying tracheostomy until COVID-19 testing was negative. All protocols involved use of N95 or higher PPE. Both open and percutaneous techniques were reported. Timing of tracheostomy changes ranged from 5 to >30 days postoperatively, sometimes contingent on negative COVID-19 test results. IMPLICATIONS FOR PRACTICE: Wide variation exists in tracheostomy protocols, reflecting geographical variation, different resource constraints, and limited data to drive evidence-based care standards. Findings presented herein may provide reference points and a framework for evolving care standards.
OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has led to a global surge in critically illpatients requiring invasive mechanical ventilation, some of whom may benefit from tracheostomy. Decisions on if, when, and how to perform tracheostomy in patients with COVID-19 have major implications for patients, clinicians, and hospitals. We investigated the tracheostomy protocols and practices that institutions around the world have put into place in response to the COVID-19 pandemic. DATA SOURCES: Protocols for tracheostomy in patients with severe acute respiratory syndrome coronavirus 2 infection from individual institutions (n = 59) were obtained from the United States and 25 other countries, including data from several low- and middle-income countries, 23 published or society-endorsed protocols, and 36 institutional protocols. REVIEW METHODS: The comparative document analysis involved cross-sectional review of institutional protocols and practices. Data sources were analyzed for timing of tracheostomy, contraindications, preoperative testing, personal protective equipment (PPE), surgical technique, and postoperative management. CONCLUSIONS: Timing of tracheostomy varied from 3 to >21 days, with over 90% of protocols recommending 14 days of intubation prior to tracheostomy. Most protocols advocate delaying tracheostomy until COVID-19 testing was negative. All protocols involved use of N95 or higher PPE. Both open and percutaneous techniques were reported. Timing of tracheostomy changes ranged from 5 to >30 days postoperatively, sometimes contingent on negative COVID-19 test results. IMPLICATIONS FOR PRACTICE: Wide variation exists in tracheostomy protocols, reflecting geographical variation, different resource constraints, and limited data to drive evidence-based care standards. Findings presented herein may provide reference points and a framework for evolving care standards.
Entities:
Keywords:
AGP; COVID-19; SARS-CoV-2; aerosol generating procedure; ethics; health care workers; infectivity; intensive care; intensive care unit; novel coronavirus; pandemic; patient safety; quality improvement; timing; tracheostomy; tracheotomy; ventilator; weaning
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