Introduction
The SARS-CoV-2 pandemic continues to produce a large number of patients
with chronic respiratory failure and ventilator dependence. Surgeons
will be called upon to perform tracheotomy for a subset of these
chronically intubated patients. As seen during the Severe Acute
Respiratory Syndrome(SARS) and the SARS-CoV-2 outbreaks, aerosol
generating procedures (AGP) have been associated with higher rates of
infection of medical personnel and potential acceleration of viral
dissemination throughout the medical center. Therefore, a thoughtful
approach to tracheotomy (and other aerosol generating procedures) is
imperative and maintaining traditional management norms may be
unsuitable or even potentially harmful. In this backdrop, we sought to
review the existing evidence informing best practices and then develop
straightforward guidelines for tracheotomy during the SARS-CoV-2
pandemic. This communication is the product of those efforts and is
based on national and international experience with the current
SARS-CoV-2 pandemic and the SARS epidemic of 2002/2003.
Our priorities in establishing these guidelines included: optimal
patient care, protection of medical personnel, minimizing further spread
of the virus and preservation of important resources (ICU beds,
ventilators and PPE). These recommendations represent a consensus of
stakeholders from our medical center including otolaryngologists, trauma
surgeons, interventional pulmonologists, anesthesiologists and critical
care providers.