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The Royal College of surgeons multidisciplinary guidelines on elective tracheostomy insertion in COVID-19 ventilated
Holly Jones1, Adrien Gendre1, Peter Walshe1
1Department of Otolaryngology, Head and Neck Surgery, The Royal College of Surgeons, Ireland.
Insights
Performing tracheostomy in patients with COVID-19 requires careful consideration due to SARS-CoV-2 risks. Guidelines emphasize multidisciplinary team decisions and minimizing healthcare worker exposure during this procedure.
Area of Science:
- Critical Care Medicine
- Otolaryngology
- Head and Neck Surgery
- Respiratory Medicine
Background:
- The COVID-19 pandemic has strained healthcare systems globally.
- COVID-19 pneumonia can cause respiratory failure, increasing the need for mechanical ventilation.
- Mechanical ventilation may necessitate tracheostomies in COVID-19 patients, presenting unique challenges.
Purpose of the Study:
- To propose guidelines for elective tracheostomy insertion in patients with COVID-19.
- To address the challenges of performing tracheostomies in patients with active SARS-CoV-2 infection.
Main Methods:
- Multidisciplinary agreement between Otolaryngology, Head and Neck Surgery, Respiratory Medicine, and Anaesthetics and Critical Care Medicine.
- Literature review to inform guideline development.
Main Results:
- Guidelines for elective tracheostomy in COVID-19 patients were developed.
- Focus on minimizing risks to healthcare workers during the procedure.
Conclusions:
- Tracheostomy decisions for COVID-19 patients must be made by senior multidisciplinary team members.
- Implementation of steps to minimize risks to healthcare workers is crucial.
Background:
The current COVID-19 pandemic has placed enormous strain on healthcare systems worldwide. Understanding of COVID-19 is rapidly evolving. Pneumonia associated with COVID-19 may lead to respiratory failure requiring mechanical ventilation. The rise in patients requiring mechanical ventilation may lead to an increase in tracheostomies being performed in patients with COVID-19. Performing tracheostomy in patients with active SARS-CoV-2 infection poses a number of challenges.
Methods:
These guidelines were written following multidisciplinary agreement between Otolaryngology, Head and Neck Surgery, Respiratory Medicine and the Department of Anaesthetics and Critical Care Medicine in the Royal College of Surgeons in Ireland. A literature review was performed and a guideline for elective tracheostomy insertion in patients with COVID-19 proposed.
Conclusion:
The decision to perform tracheostomy in patients with COVID-19 should be undertaken by senior members of the multidisciplinary team. Steps should be taken to minimise risks to healthcare workers.
