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Revised recommendations from the CSO-HNS taskforce on performance of tracheotomy during the COVID-19 pandemic - what
D D Sommer1, D Cote2, T McHugh3
1Division of Otolaryngology - Head & Neck Surgery - Department of Surgery, McMaster University, Hamilton, ON, Canada. cso.hns@sympatico.ca.
Insights
Timing for tracheotomy during COVID-19 has been updated. Procedures can now be considered for COVID-19 swab positive patients over 20 days from symptom onset, with both open and percutaneous techniques deemed safe.
Area of Science:
- Otolaryngology
- Infectious Disease
- Surgical Procedures
Background:
- Canadian Society of Otolaryngology - Head & Neck Surgery (CSO-HNS) issued initial tracheotomy guidelines during the COVID-19 pandemic.
- Evolving understanding of SARS-CoV-2 necessitates updated recommendations regarding tracheotomy procedures.
Purpose of the Study:
- To revise and update tracheotomy recommendations based on new scientific evidence.
- To optimize patient outcomes and healthcare system efficiency during the COVID-19 pandemic.
- To minimize risks of COVID-19 transmission during tracheotomy.
Main Methods:
- Re-evaluation of existing literature on COVID-19, tracheotomy, patient outcomes, and healthcare worker risks.
- Analysis of recent evidence regarding reverse transcription polymerase chain reaction (RT-PCR) swab status and timing of tracheotomy.
- Comparison of safety and outcomes for open versus percutaneous tracheotomy techniques.
Main Results:
- Negative COVID-19 swab status is no longer the primary determinant for tracheotomy timing.
- Tracheotomy may be considered for COVID-19 positive patients >20 days post-symptom onset and 2 weeks of mechanical ventilation.
- Both open and percutaneous tracheotomy techniques demonstrate comparable safety and outcomes.
Conclusions:
- Revised recommendations incorporate new evidence to improve patient and system outcomes.
- Updated guidelines aim to reduce COVID-19 transmission risks during aerosol-generating tracheotomy procedures.
- Further evidence may prompt future revisions of these recommendations.
Background:
During the early part of the COVID-19 pandemic, the Canadian Society of Otolaryngology - Head & Neck Surgery (CSO-HNS) task force published recommendations on performance of tracheotomy. Since then, our understanding of the virus has evolved with ongoing intensive research efforts. New literature has helped us better understand various aspects including patient outcomes and health care worker (HCW) risks associated with tracheotomy during the COVID-19 pandemic. Accordingly, the task force has re-evaluated and revised some of the previous recommendations.
Main Body:
Based on recent evidence, a negative reverse transcription polymerase chain reaction (RT-PCR) COVID-19 swab status is no longer the main deciding factor in the timing of tracheotomy. Instead, tracheotomy may be considered as soon as COVID-19 swab positive patients are greater than 20 days beyond initial symptoms and 2 weeks of mechanical ventilation. Furthermore, both open and percutaneous surgical techniques may be considered with both techniques showing similar safety and outcome profiles. Additional recommendations with discussion of current evidence are presented.
Conclusion:
These revised recommendations apply new evidence in optimizing patient and health care system outcomes as well as minimizing risks of COVID-19 transmission during aerosol-generating tracheotomy procedures. As previously noted, additional evidence may lead to further evolution of these and other similar recommendations.
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