key: cord-0946388-ndczpd4j
authors: Smith, T. G.; Ahmad, I.; Takhar, A.; Surda, P.; El‐Boghdadly, K.
title: Unconventional multidisciplinary team strategy for tracheostomy in COVID‐19
date: 2020-11-17
journal: Anaesth Rep
DOI: 10.1002/anr3.12074
sha: c16d072ca3eb2d2e4311682ea89794b7b439da7d
doc_id: 946388
cord_uid: ndczpd4j

nan

favourable with no significant complications or deaths, and no operators have developed COVID-19 (GSTT service evaluation ID 10780; Table 1 ).

The presence of ENT surgeons in the team may have allowed more challenging tracheostomies that would not normally be attempted in ICU (e.g. obese patients) to still be undertaken in the most resource-efficient manner. While the ideal location for performing a tracheostomy on a COVID-19-positive patient is in a negative pressure side room or operating theatre, this may not be available, and transferring critically ill patients to theatre also has major resource and safety implications. Recent preliminary data from a national UK audit (UK COVIDTrach) indicate that percutaneous tracheostomy is at least as safe as surgical tracheostomy in COVID-19 [5] . Anecdotally, percutaneous tracheostomies may be less prone to wound site infections and dislodgement in the presence of thick tenacious secretions in COVID-19.

Until further data are forthcoming, we recommend consideration of this multidisciplinary team model and protocol for tracheostomy in COVID-19 in order to deliver safe patient-centred care and support healthcare worker safety while simultaneously optimising the balance between these priorities and the efficient utilisation of scarce resources. Significant complications from tracheostomy* 0 (0%)

Transmission of COVID-19 to operators 0 (0%) Mortality 0 (0%) *Significant complications are defined as Clavien-Dindo Grade 2 or higher. APACHE II, acute physiology and chronic health evaluation II score; FiO 2 , fraction of inspired oxygen; PaO 2 , arterial partial pressure of oxygen; PEEP, positive end-expiratory pressure; P/F ratio, PaO 2 /FiO 2 ratio.

Tracheostomy in the COVID-19 era: global and multidisciplinary guidance

Awake tracheal intubation in a suspected COVID-19 patient with critical airway obstruction

A prospective, observational, cohort study of airway management of patients with COVID-19 by specialist tracheal intubation teams

Recommendation of a practical guideline for safe tracheostomy during the COVID-19 pandemic

COVIDTrach; the outcomes of mechanically ventilated COVID-19 patients undergoing tracheostomy in the UK: Interim Report 22nd

No external funding or competing interests declared.

 Figure 1 Continued