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.