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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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. |
doi_str_mv | 10.1177/0194599820961985 |
format | Article |
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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.</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 >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.</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. Y.</creator><creator>Zenk, Johannes</creator><creator>Rassekh, Christopher H.</creator><creator>Brenner, Michael J.</creator><general>SAGE Publications</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202106</creationdate><title>Tracheostomy During the COVID-19 Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries</title><author>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.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3583-854042a5d27fe09b1b05798b28a8f6a5b74b5dbf123eed74a0ef92f00c822cfa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>aerosol generating procedure</topic><topic>AGP</topic><topic>COVID‐19</topic><topic>ethics</topic><topic>health care workers</topic><topic>infectivity</topic><topic>intensive care</topic><topic>intensive care unit</topic><topic>novel coronavirus</topic><topic>pandemic</topic><topic>patient safety</topic><topic>quality improvement</topic><topic>SARS‐CoV‐2</topic><topic>timing</topic><topic>tracheostomy</topic><topic>tracheotomy</topic><topic>ventilator</topic><topic>weaning</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><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><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 >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.</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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