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Recommendations from the CSO-HNS taskforce on performance of tracheotomy during the COVID-19 pandemic

D D Sommer1, P T Engels2, E K Weitzel3

  • 1Division of Otolaryngology - Head & Neck Surgery - Department of Surgery, McMaster University Medical Centre, McMaster University, 3V1 Clinic, 1200 Main St West, Hamilton, ON, L8N 3Z5, Canada. cso.hns@sympatico.ca.

Journal of Otolaryngology - Head & Neck Surgery = Le Journal D'Oto-Rhino-Laryngologie Et De Chirurgie Cervico-Faciale
|April 29, 2020
PubMed

Insights

To minimize healthcare worker exposure to COVID-19, avoid tracheotomies in positive patients when possible. Extended endotracheal intubation is recommended, with specific PPE guidelines for all cases.

Area of Science:

  • Medicine
  • Surgery
  • Infectious Diseases

Background:

  • Tracheotomy is a frequent procedure requested by critical care units.
  • The COVID-19 pandemic necessitated new guidelines for surgical procedures.
  • A multi-specialty task force was formed by the Canadian Society of Otolaryngology - Head & Neck Surgery (CSO-HNS).

Purpose of the Study:

  • To develop recommendations for performing tracheotomies during the COVID-19 pandemic.
  • To ensure the safety of healthcare professionals during aerosol-generating procedures.
  • To provide guidance on managing tracheotomies for COVID-19 positive, negative, and unknown patients.

Main Methods:

  • A multi-specialty task force was convened.
  • Recommendations were developed based on the risks of aerosol generation and viral transmission.
  • Guidelines for personal protective equipment (PPE) and environmental controls were established.

Main Results:

  • Tracheotomy is a highly aerosol-generating procedure, increasing transmission risk to surgical teams.
  • Extended endotracheal intubation is proposed as the standard of care for ventilated patients.
  • Pre-operative COVID-19 testing is recommended for non-emergent procedures.

Conclusions:

  • Tracheotomy should be avoided in COVID-19 positive patients whenever feasible.
  • Specific recommendations for PPE and environmental controls are provided for varying COVID-19 statuses.
  • Prioritizing the safety of healthcare professionals is paramount during patient care.
Abstract

Keywords:
AGMPAerosolAerosol generating medical procedureAirwayCoronavirusCovid-19Global pandemicICUPersonal protective equipmentRecommendationsSARS-CoV-2TracheostomyTracheotomyVentilator

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