Safe surgical tracheostomy in patients with COVID-19: key clinical considerations

Surgical tracheostomy is a high aerosol-generating procedure that is an essential aid to the recovery of patients who are critically ill with COVID-19 pneumonia. We present a single-centre case series of 16 patients with COVID-19 pneumonia who underwent tracheostomy. We recommend that the patient selection criteria for achieving a favourable outcome should be based on fraction of inspired oxygen together with prone-position ventilation. As with any challenging situation, the importance of effective communication is paramount. The critical modifications in the surgical steps are clearly explained. Timely tracheostomy also leads to an earlier freeing up of ventilator space during a period of a rapidly escalating pandemic. The outcomes in terms of swallow and speech function were also assessed. The study has also helped to remove the anxiety around open a tracheostomy in patients who are COVID-19 positive.