Methods for a Seamless Transition from Tracheostomy to Spontaneous Breathing in COVID-19 Patients.

Divo, Miguel J; Oberg, Catherine L; Pritchett, Michael A; Celli, Bartolome R; Folch, Erik E

The COVID-19 pandemic has profoundly impacted healthcare delivery worldwide. A small, yet significant number of patients with respiratory failure will require prolonged mechanical ventilation while recovering from the viral-induced injury. The majority of reports thus far have focused on the epidemiology, clinical factors, and acute care of these patients, with less attention given to the recovery phase and care of those patients requiring extended time on mechanical ventilation. In this monograph, we review the procedures and methods to safely care for COVID-19 patients who require tracheostomy, gastrostomy, weaning from mechanical ventilation, and final decannulation. The guiding principles consist of modifications in the methods of airway care, to safely prevent iatrogenesis and promote safety in patients severely affected by COVID-19, including mitigation of aerosol generation to minimize risk for healthcare workers.