'A Systematic Review on Guidelines and Recommendations for Tracheostomy During COVID-19 Pandemic'

Aim: Global health care is experiencing an unprecedented surge in the number of critically ill patients who require mechanical ventilation due to the COVID-19 pandemic. The requirement for relatively long periods of ventilation in those who survive means that many are considered for tracheostomy to free patients from ventilatory support and maximise scarce resources. COVID-19 provides unique challenges for tracheostomy care: health-care workers need to safely undertake tracheostomy procedures and manage patients afterwards, minimising risks of nosocomial transmission and compromises in the quality of care. Conflicting recommendations exist about the timing and performance of tracheostomy and the subsequent management of patients. This is due to a number of factors including prognosis, optimal healthcare resource utilisation, and safety of healthcare workers when performing such a high-risk aerosol-generating procedure.Methods: MEDLINE (accessed from PubMed) from 6 august 2019 to 7 august 2020 were systematically searched using: “COVID 19” OR “CORONAVIRUS” OR “SARS COV-2” AND “TRACHEOSTOMY” with filters as ‘2020’ year of study, English language, full article available on 7/08/2020 at 11.30 Am.Results: Total of 56 articles were obtained on search and the final 15 articles extracted based on our selection criteria were reviewed. A synthesis of the current international literature and reported experience is presented with respect to timing of tracheostomy, ideal place for tracheostomy, staff safety, procedure modification and post tracheostomy care thus leading to a pragmatic recommendation that tracheostomy is not performed until at least 14 days after endotracheal intubation in COVID-19 patients and if indicated should be done in negative pressure isolated ICU room with full PPE protection with some modification during procedure.Conclusion: In selected COVID-19 patients, there is a role for tracheostomy to aid in weaning and optimise healthcare resource utilisation. Tracheostomy can be performed safely with careful modifications to technique and appropriate enhanced personal protective equipment.