Abstract: Background
The rapid spread of SARS-CoV-2 in 2019 and 2020 has resulted in a
worldwide pandemic.[1-4]The dramatic proinflammatory effects of
COV-SARS-CoV-2 results in a wide variety of clinical presentations,
however severe pulmonary inflammation, effusions, and rapid respiratory
compromise are a hallmark of this disease.[5-7]Subsequent pneumonia,
acute respiratory distress syndrome and death have been reported not
infrequently. The result of this pandemic is a large and increasing
number of patients requiring endotracheal intubation and prolonged
ventilator support.[8-13] Certainly, the rapid rise in endotracheal
intubations coupled with prolonged ventilation requirements will lead to
an increase in tracheostomy procedures in the coming weeks and
months.[14, 15]
While generally a well-tolerated and safe procedure, the risks and
benefits of tracheostomy in terms of outcomes, pulmonary care, and risks
to the health care team remain unknown [16, 17]. Fortunately, while
not perfect, rapid testing protocols have allowed us the ability to
detect active infection in patients who are affected by
SARS-CoV-2.[18-21] What is clear is that the upper aerodigestive
tract, the nasopharynx and the trachea harbor a high viral load during
the acute stages of the infection.[22-24] Therefore, performing
tracheostomy in the setting of active COV-SARS-CoV-2 when necessary,
poses a unique situation, with unique risks and benefits for both the
patient and the health care providers. The risk of this procedure has to
be balanced with the known risks of prolonged intubation, primarily
tracheal and subglottic stenosis the management of which can be
problematic if significant mucosal injury and subsequent stenosis
occurs.
The New York Head and Neck Society is a non-profit organization founded
in 1979, which encourages the exchange and advancement of scientific
knowledge relative to the management of head and neck cancer and
includes several member institutions including Columbia University
Medical Center, Cornell Medical College, Icahn School of Medicine at
Mount Sinai, Memorial Sloan Kettering Cancer Center, New York University
Medical Center, Montefiore Medical Center Albert Einstein College of
Medicine, and has several other affiliate institutions in the greater
New York City area. The New York Head and Neck Society has collaborated
on this document to provide guidance on the performance of tracheostomy
during the SARS-CoV-2 pandemic.