Use of Tracheostomy During the COVID-19 Pandemic: CHEST/AABIP/AIPPD: Expert Panel Report

Lamb, Carla R.; Desai, Neeraj R.; Angel, Luis; Chaddha, Udit; Sachdeva, Ashutosh; Sethi, Sonali; Bencheqroun, Hassan; Mehta, Hiren; Akulian, Jason; Argento, A. Christine; Diaz-Mendoza, Javier; Musani, Ali; Murgu, Septimiu

Abstract Background The role of tracheostomy during the COVID-19 pandemic remains unknown. The goal of this consensus statement is to examine the current evidence for performing tracheostomy in patients with respiratory failure from COVID-19 and offer guidance to physicians on the preparation, timing and technique while minimizing the risk of infection to health care workers (HCW). Methods A panel comprised of intensivists and interventional pulmonologists from three professional societies representing 13 institutions with experience in managing COVID-19 patients across a spectrum of healthcare environments developed key clinical questions addressing specific topics on tracheostomy in COVID-19. A systematic review of the literature and an established modified Delphi consensus methodology were applied to provide a reliable evidenced based consensus statement and expert panel report. Results Eight key questions, corresponding to 14 decision points, were rated by the panel. The results were aggregated, resulting in eight main recommendations and five additional remarks intended to guide health care providers in the decision-making process pertinent to tracheostomy in patients with COVID-19 related respiratory failure. Conclusion This panel suggests performing tracheostomy in patients expected to require prolonged mechanical ventilation. A specific timing of tracheostomy cannot be recommended. There is no evidence for routine repeat RT- PCR testing in patients with confirmed Covid-19 evaluated for tracheostomy. To reduce the risk of infection in HCW, we recommend performing the procedure using techniques that minimize aerosolization while wearing enhanced personal protective equipment (PPE). The recommendations presented in this statement may change as more experience is gained during this pandemic.