Tracheostomy During the COVID-19 Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries

Objective The coronavirus disease 2019 (COVID-19) pandemic has led to a global surge in critically ill patients requiring invasive mechanical ventilation, some of whom may benefit from tracheostomy. Decisions on if, when, and how to perform tracheostomy in patients with COVID-19 have major implicati...

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Veröffentlicht in:Otolaryngology-head and neck surgery 2021-06, Vol.164 (6), p.1136-1147
Hauptverfasser: Bier-Laning, Carol, Cramer, John D., Roy, Soham, Palmieri, Patrick A., Amin, Ayman, Añon, José Manuel, Bonilla-Asalde, Cesar A., Bradley, Patrick J., Chaturvedi, Pankaj, Cognetti, David M., Dias, Fernando, Di Stadio, Arianna, Fagan, Johannes J., Feller-Kopman, David J., Hao, Sheng-Po, Kim, Kwang Hyun, Koivunen, Petri, Loh, Woei Shyang, Mansour, Jobran, Naunheim, Matthew R., Schultz, Marcus J., Shang, You, Sirjani, Davud B., St. John, Maie A., Tay, Joshua K., Vergez, Sébastien, Weinreich, Heather M., Wong, Eddy W. Y., Zenk, Johannes, Rassekh, Christopher H., Brenner, Michael J.
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container_end_page 1147
container_issue 6
container_start_page 1136
container_title Otolaryngology-head and neck surgery
container_volume 164
creator Bier-Laning, Carol
Cramer, John D.
Roy, Soham
Palmieri, Patrick A.
Amin, Ayman
Añon, José Manuel
Bonilla-Asalde, Cesar A.
Bradley, Patrick J.
Chaturvedi, Pankaj
Cognetti, David M.
Dias, Fernando
Di Stadio, Arianna
Fagan, Johannes J.
Feller-Kopman, David J.
Hao, Sheng-Po
Kim, Kwang Hyun
Koivunen, Petri
Loh, Woei Shyang
Mansour, Jobran
Naunheim, Matthew R.
Schultz, Marcus J.
Shang, You
Sirjani, Davud B.
St. John, Maie A.
Tay, Joshua K.
Vergez, Sébastien
Weinreich, Heather M.
Wong, Eddy W. Y.
Zenk, Johannes
Rassekh, Christopher H.
Brenner, Michael J.
description Objective The coronavirus disease 2019 (COVID-19) pandemic has led to a global surge in critically ill patients requiring invasive mechanical ventilation, some of whom may benefit from tracheostomy. Decisions on if, when, and how to perform tracheostomy in patients with COVID-19 have major implications for patients, clinicians, and hospitals. We investigated the tracheostomy protocols and practices that institutions around the world have put into place in response to the COVID-19 pandemic. Data Sources Protocols for tracheostomy in patients with severe acute respiratory syndrome coronavirus 2 infection from individual institutions (n = 59) were obtained from the United States and 25 other countries, including data from several low- and middle-income countries, 23 published or society-endorsed protocols, and 36 institutional protocols. Review Methods The comparative document analysis involved cross-sectional review of institutional protocols and practices. Data sources were analyzed for timing of tracheostomy, contraindications, preoperative testing, personal protective equipment (PPE), surgical technique, and postoperative management. Conclusions Timing of tracheostomy varied from 3 to >21 days, with over 90% of protocols recommending 14 days of intubation prior to tracheostomy. Most protocols advocate delaying tracheostomy until COVID-19 testing was negative. All protocols involved use of N95 or higher PPE. Both open and percutaneous techniques were reported. Timing of tracheostomy changes ranged from 5 to >30 days postoperatively, sometimes contingent on negative COVID-19 test results. Implications for Practice Wide variation exists in tracheostomy protocols, reflecting geographical variation, different resource constraints, and limited data to drive evidence-based care standards. Findings presented herein may provide reference points and a framework for evolving care standards.
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Y. ; Zenk, Johannes ; Rassekh, Christopher H. ; Brenner, Michael J.</creator><creatorcontrib>Bier-Laning, Carol ; Cramer, John D. ; Roy, Soham ; Palmieri, Patrick A. ; Amin, Ayman ; Añon, José Manuel ; Bonilla-Asalde, Cesar A. ; Bradley, Patrick J. ; Chaturvedi, Pankaj ; Cognetti, David M. ; Dias, Fernando ; Di Stadio, Arianna ; Fagan, Johannes J. ; Feller-Kopman, David J. ; Hao, Sheng-Po ; Kim, Kwang Hyun ; Koivunen, Petri ; Loh, Woei Shyang ; Mansour, Jobran ; Naunheim, Matthew R. ; Schultz, Marcus J. ; Shang, You ; Sirjani, Davud B. ; St. John, Maie A. ; Tay, Joshua K. ; Vergez, Sébastien ; Weinreich, Heather M. ; Wong, Eddy W. Y. ; Zenk, Johannes ; Rassekh, Christopher H. ; Brenner, Michael J.</creatorcontrib><description>Objective The coronavirus disease 2019 (COVID-19) pandemic has led to a global surge in critically ill patients requiring invasive mechanical ventilation, some of whom may benefit from tracheostomy. Decisions on if, when, and how to perform tracheostomy in patients with COVID-19 have major implications for patients, clinicians, and hospitals. We investigated the tracheostomy protocols and practices that institutions around the world have put into place in response to the COVID-19 pandemic. Data Sources Protocols for tracheostomy in patients with severe acute respiratory syndrome coronavirus 2 infection from individual institutions (n = 59) were obtained from the United States and 25 other countries, including data from several low- and middle-income countries, 23 published or society-endorsed protocols, and 36 institutional protocols. Review Methods The comparative document analysis involved cross-sectional review of institutional protocols and practices. Data sources were analyzed for timing of tracheostomy, contraindications, preoperative testing, personal protective equipment (PPE), surgical technique, and postoperative management. Conclusions Timing of tracheostomy varied from 3 to &gt;21 days, with over 90% of protocols recommending 14 days of intubation prior to tracheostomy. Most protocols advocate delaying tracheostomy until COVID-19 testing was negative. All protocols involved use of N95 or higher PPE. Both open and percutaneous techniques were reported. Timing of tracheostomy changes ranged from 5 to &gt;30 days postoperatively, sometimes contingent on negative COVID-19 test results. Implications for Practice Wide variation exists in tracheostomy protocols, reflecting geographical variation, different resource constraints, and limited data to drive evidence-based care standards. Findings presented herein may provide reference points and a framework for evolving care standards.</description><identifier>ISSN: 0194-5998</identifier><identifier>EISSN: 1097-6817</identifier><identifier>DOI: 10.1177/0194599820961985</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>aerosol generating procedure ; AGP ; COVID‐19 ; ethics ; health care workers ; infectivity ; intensive care ; intensive care unit ; novel coronavirus ; pandemic ; patient safety ; quality improvement ; SARS‐CoV‐2 ; timing ; tracheostomy ; tracheotomy ; ventilator ; weaning</subject><ispartof>Otolaryngology-head and neck surgery, 2021-06, Vol.164 (6), p.1136-1147</ispartof><rights>American Academy of Otolaryngology–Head and Neck Surgery Foundation 2020</rights><rights>2021 American Association of Otolaryngology‐Head and Neck Surgery Foundation (AAO‐HNSF)</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3583-854042a5d27fe09b1b05798b28a8f6a5b74b5dbf123eed74a0ef92f00c822cfa3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0194599820961985$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0194599820961985$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>313,314,776,780,788,1411,21798,27899,27901,27902,43597,43598,45550,45551</link.rule.ids></links><search><creatorcontrib>Bier-Laning, Carol</creatorcontrib><creatorcontrib>Cramer, John D.</creatorcontrib><creatorcontrib>Roy, Soham</creatorcontrib><creatorcontrib>Palmieri, Patrick A.</creatorcontrib><creatorcontrib>Amin, Ayman</creatorcontrib><creatorcontrib>Añon, José Manuel</creatorcontrib><creatorcontrib>Bonilla-Asalde, Cesar A.</creatorcontrib><creatorcontrib>Bradley, Patrick J.</creatorcontrib><creatorcontrib>Chaturvedi, Pankaj</creatorcontrib><creatorcontrib>Cognetti, David M.</creatorcontrib><creatorcontrib>Dias, Fernando</creatorcontrib><creatorcontrib>Di Stadio, Arianna</creatorcontrib><creatorcontrib>Fagan, Johannes J.</creatorcontrib><creatorcontrib>Feller-Kopman, David J.</creatorcontrib><creatorcontrib>Hao, Sheng-Po</creatorcontrib><creatorcontrib>Kim, Kwang Hyun</creatorcontrib><creatorcontrib>Koivunen, Petri</creatorcontrib><creatorcontrib>Loh, Woei Shyang</creatorcontrib><creatorcontrib>Mansour, Jobran</creatorcontrib><creatorcontrib>Naunheim, Matthew R.</creatorcontrib><creatorcontrib>Schultz, Marcus J.</creatorcontrib><creatorcontrib>Shang, You</creatorcontrib><creatorcontrib>Sirjani, Davud B.</creatorcontrib><creatorcontrib>St. John, Maie A.</creatorcontrib><creatorcontrib>Tay, Joshua K.</creatorcontrib><creatorcontrib>Vergez, Sébastien</creatorcontrib><creatorcontrib>Weinreich, Heather M.</creatorcontrib><creatorcontrib>Wong, Eddy W. Y.</creatorcontrib><creatorcontrib>Zenk, Johannes</creatorcontrib><creatorcontrib>Rassekh, Christopher H.</creatorcontrib><creatorcontrib>Brenner, Michael J.</creatorcontrib><title>Tracheostomy During the COVID-19 Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries</title><title>Otolaryngology-head and neck surgery</title><description>Objective The coronavirus disease 2019 (COVID-19) pandemic has led to a global surge in critically ill patients requiring invasive mechanical ventilation, some of whom may benefit from tracheostomy. Decisions on if, when, and how to perform tracheostomy in patients with COVID-19 have major implications for patients, clinicians, and hospitals. We investigated the tracheostomy protocols and practices that institutions around the world have put into place in response to the COVID-19 pandemic. Data Sources Protocols for tracheostomy in patients with severe acute respiratory syndrome coronavirus 2 infection from individual institutions (n = 59) were obtained from the United States and 25 other countries, including data from several low- and middle-income countries, 23 published or society-endorsed protocols, and 36 institutional protocols. Review Methods The comparative document analysis involved cross-sectional review of institutional protocols and practices. Data sources were analyzed for timing of tracheostomy, contraindications, preoperative testing, personal protective equipment (PPE), surgical technique, and postoperative management. Conclusions Timing of tracheostomy varied from 3 to &gt;21 days, with over 90% of protocols recommending 14 days of intubation prior to tracheostomy. Most protocols advocate delaying tracheostomy until COVID-19 testing was negative. All protocols involved use of N95 or higher PPE. Both open and percutaneous techniques were reported. Timing of tracheostomy changes ranged from 5 to &gt;30 days postoperatively, sometimes contingent on negative COVID-19 test results. Implications for Practice Wide variation exists in tracheostomy protocols, reflecting geographical variation, different resource constraints, and limited data to drive evidence-based care standards. Findings presented herein may provide reference points and a framework for evolving care standards.</description><subject>aerosol generating procedure</subject><subject>AGP</subject><subject>COVID‐19</subject><subject>ethics</subject><subject>health care workers</subject><subject>infectivity</subject><subject>intensive care</subject><subject>intensive care unit</subject><subject>novel coronavirus</subject><subject>pandemic</subject><subject>patient safety</subject><subject>quality improvement</subject><subject>SARS‐CoV‐2</subject><subject>timing</subject><subject>tracheostomy</subject><subject>tracheotomy</subject><subject>ventilator</subject><subject>weaning</subject><issn>0194-5998</issn><issn>1097-6817</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNqFkDFPIzEUhC3ESQSOntIlzXK2d7226SAQiIQuKXLXrrzOczDatYO9yykl_xxHoUJCVz2NZr550iB0QckVpUL8IlRVXCnJiKqpkvwITShRoqglFcdosreLvX-CTlN6IYTUtRAT9L6K2jxDSEPod_hujM5v8PAMeLr4O78rqMJL7dfQO3ONp6Hf6uhS8DhYPPcDRK8HF7zu8BKiC1uIWb9lWEfAyxiGYEKXcG7ISpvBGUjYeczqXDb6ITpIP9EPq7sE55_3DP2Z3a-mj8XT4mE-vXkqTMllWUhekYppvmbCAlEtbQkXSrZMamlrzVtRtXzdWspKgLWoNAGrmCXESMaM1eUZujz0bmN4HSENTe-Sga7THsKYGlZxwaRgjOcoOURNDClFsM02ul7HXUNJs1-7-bp2RuQB-ec62P033ywef9_OiGKizGhxQJPeQPMSxrxql75_9QFXrI_Y</recordid><startdate>202106</startdate><enddate>202106</enddate><creator>Bier-Laning, Carol</creator><creator>Cramer, John D.</creator><creator>Roy, Soham</creator><creator>Palmieri, Patrick A.</creator><creator>Amin, Ayman</creator><creator>Añon, José Manuel</creator><creator>Bonilla-Asalde, Cesar A.</creator><creator>Bradley, Patrick J.</creator><creator>Chaturvedi, Pankaj</creator><creator>Cognetti, David M.</creator><creator>Dias, Fernando</creator><creator>Di Stadio, Arianna</creator><creator>Fagan, Johannes J.</creator><creator>Feller-Kopman, David J.</creator><creator>Hao, Sheng-Po</creator><creator>Kim, Kwang Hyun</creator><creator>Koivunen, Petri</creator><creator>Loh, Woei Shyang</creator><creator>Mansour, Jobran</creator><creator>Naunheim, Matthew R.</creator><creator>Schultz, Marcus J.</creator><creator>Shang, You</creator><creator>Sirjani, Davud B.</creator><creator>St. John, Maie A.</creator><creator>Tay, Joshua K.</creator><creator>Vergez, Sébastien</creator><creator>Weinreich, Heather M.</creator><creator>Wong, Eddy W. 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Y.</creatorcontrib><creatorcontrib>Zenk, Johannes</creatorcontrib><creatorcontrib>Rassekh, Christopher H.</creatorcontrib><creatorcontrib>Brenner, Michael J.</creatorcontrib><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Otolaryngology-head and neck surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bier-Laning, Carol</au><au>Cramer, John D.</au><au>Roy, Soham</au><au>Palmieri, Patrick A.</au><au>Amin, Ayman</au><au>Añon, José Manuel</au><au>Bonilla-Asalde, Cesar A.</au><au>Bradley, Patrick J.</au><au>Chaturvedi, Pankaj</au><au>Cognetti, David M.</au><au>Dias, Fernando</au><au>Di Stadio, Arianna</au><au>Fagan, Johannes J.</au><au>Feller-Kopman, David J.</au><au>Hao, Sheng-Po</au><au>Kim, Kwang Hyun</au><au>Koivunen, Petri</au><au>Loh, Woei Shyang</au><au>Mansour, Jobran</au><au>Naunheim, Matthew R.</au><au>Schultz, Marcus J.</au><au>Shang, You</au><au>Sirjani, Davud B.</au><au>St. John, Maie A.</au><au>Tay, Joshua K.</au><au>Vergez, Sébastien</au><au>Weinreich, Heather M.</au><au>Wong, Eddy W. Y.</au><au>Zenk, Johannes</au><au>Rassekh, Christopher H.</au><au>Brenner, Michael J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Tracheostomy During the COVID-19 Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries</atitle><jtitle>Otolaryngology-head and neck surgery</jtitle><date>2021-06</date><risdate>2021</risdate><volume>164</volume><issue>6</issue><spage>1136</spage><epage>1147</epage><pages>1136-1147</pages><issn>0194-5998</issn><eissn>1097-6817</eissn><abstract>Objective The coronavirus disease 2019 (COVID-19) pandemic has led to a global surge in critically ill patients requiring invasive mechanical ventilation, some of whom may benefit from tracheostomy. Decisions on if, when, and how to perform tracheostomy in patients with COVID-19 have major implications for patients, clinicians, and hospitals. We investigated the tracheostomy protocols and practices that institutions around the world have put into place in response to the COVID-19 pandemic. Data Sources Protocols for tracheostomy in patients with severe acute respiratory syndrome coronavirus 2 infection from individual institutions (n = 59) were obtained from the United States and 25 other countries, including data from several low- and middle-income countries, 23 published or society-endorsed protocols, and 36 institutional protocols. Review Methods The comparative document analysis involved cross-sectional review of institutional protocols and practices. Data sources were analyzed for timing of tracheostomy, contraindications, preoperative testing, personal protective equipment (PPE), surgical technique, and postoperative management. Conclusions Timing of tracheostomy varied from 3 to &gt;21 days, with over 90% of protocols recommending 14 days of intubation prior to tracheostomy. Most protocols advocate delaying tracheostomy until COVID-19 testing was negative. All protocols involved use of N95 or higher PPE. Both open and percutaneous techniques were reported. Timing of tracheostomy changes ranged from 5 to &gt;30 days postoperatively, sometimes contingent on negative COVID-19 test results. Implications for Practice Wide variation exists in tracheostomy protocols, reflecting geographical variation, different resource constraints, and limited data to drive evidence-based care standards. Findings presented herein may provide reference points and a framework for evolving care standards.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><doi>10.1177/0194599820961985</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record>
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source Wiley Online Library Journals Frontfile Complete; SAGE Complete
subjects aerosol generating procedure
AGP
COVID‐19
ethics
health care workers
infectivity
intensive care
intensive care unit
novel coronavirus
pandemic
patient safety
quality improvement
SARS‐CoV‐2
timing
tracheostomy
tracheotomy
ventilator
weaning
title Tracheostomy During the COVID-19 Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries
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