Introduction
The first cases of severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2), the virus causing coronavirus disease (COVID-19), began as
only a few cases in rural China and has now grown into a global
pandemic. While this virus does not appear to be as deadly as the
coronavirus outbreak in 2003 known as SARS, it unfortunately has proven
to be much more infectious. SARS-CoV-2 has an incubation period of an
estimated 4 days and a relatively slow onset of symptoms, allowing
infected persons to unknowingly transmit the virus (1).
Although most cases range from relatively asymptomatic to mild flu-like
symptoms, approximately 20-30% of COVID-19 patients require admission
to the intensive care unit (ICU) for respiratory support (2). This rapid
influx of patients has challenged institutions and medical practitioners
alike. In response, many guidelines continue to be updated by the
Centers for Disease Control and Prevention (CDC), World Health
Organization (WHO), and individual societies from around the world.
Due to the spread of SARS-CoV-2 through aerosol and fine droplets,
medical personnel are in direct danger of occupational exposure while
caring for these patients. This is especially true for
aerosol-generating airway procedures which can potentially expose
everyone in the room (3). A report from the outbreak in Wuhan, China
warns that otolaryngologists are exceptionally at risk, citing an event
in which 14 medical personnel contracted COVID-19 during an endoscopic
pituitary surgery (4). Therefore, the risk posed to otolaryngologists
during many commonly performed surgeries cannot be understated. A
statement from American Academy of Otolaryngology – Head and Neck
Surgery “strongly recommends that all otolaryngologists provide only
time-sensitive or emergent care” in order to mitigate this risk (5).
Tracheostomies and tracheostomy care, however, play a critical role in
the management of COVID-19 patients: electively to provide
closed-circuit ventilation in prolonged endotracheal intubation or
emergently for airway access. These interventions are necessary to
provide adequate care, but they also demand special precautions be taken
in order to mitigate occupational risk.
The purpose of this study was to evaluate the current practice
guidelines and recommendations in regards to SARS-CoV-2 as they pertain
to tracheostomy and provide a collective summary of recommendations.
Individual guidelines have been published from groups around the world
to guide medical personnel during aerosol-generating procedures, such as
a tracheostomy. It is essential that all those potentially involved are
aware of these guidelines and implement them when appropriate.