RT Journal Article
SR Electronic
T1 Controversies in Tracheostomy for Patients With COVID-19: The When, Where, and How
JF Respiratory Care
FD American Association for Respiratory Care
SP 1767
OP 1772
DO 10.4187/respcare.08100
VO 65
IS 11
A1 Stephen S Chiang
A1 Michel B Aboutanos
A1 Randeep S Jawa
A1 Sanjeev K Kaul
A1 Abraham P-H Houng
A1 Rochelle A Dicker
A1 Weidun A Guo
YR 2020
UL http://rc.rcjournal.com/content/65/11/1767.abstract
AB COVID-19 has impacted how we deliver care to patients, and much remains unknown regarding optimal management of respiratory failure in this patient population. There are significant controversies regarding tracheostomy in patients with COVID-19 related to timing, location of procedure, and technique. In this narrative review, we explore the recent literature, publicly available guidelines, protocols from different institutions, and clinical reports to provide critical insights on how to deliver the most benefit to our patients while safeguarding the health care force. Consensus can be reached that patients with COVID-19 should be managed in a negative-pressure environment with proper personal protective equipment, and that performing tracheostomy is a complex decision that should be made through multidisciplinary discussions considering patient prognosis, institutional resources, staff experience, and risks to essential health care workers. A broad range of practices exist because there is no conclusive guidance regarding the optimal timing or technique for tracheostomy.