Framework for open tracheostomy in COVID-19 patients

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COVID tracheostomy guidance

Dear Colleagues,


You will have last week received ENT UK’s recommendations regarding PPE along with a timely paper by James Ramsden & colleagues on the subject of tracheostomy in a COVID patient. There has also been further information from the National Tracheostomy Safety Project (NTSP).

The requests for a tracheostomy in suspected or confirmed COVID ventilated patients are likely to begin coming our way very soon. It is difficult to predict the level of burden at this point but we ought to prepare for the worst. We (ENT UK) believe it is appropriate therefore to release further guidance and cognitive aids to help departments in the preparation for COVID tracheostomies.

We would like to reiterate that a tracheostomy is a high risk procedure in this patient cohort and most certainly is an Aerosol Generating Procedure (AGP) representing significant risk to surgeons and our immediate colleagues. Decisions regarding the requirement for tracheostomy in critically ill COVID patients should not be taken lightly, balancing the risks and burdens to both patients and staff. Emerging outcome data will help to inform consultant-level decisions. It is beyond the remit of this document to try and stipulate when and in whom a tracheostomy ought to be considered as there are just too many evolving variables at play. It must be also made clear that these guidelines should be regarded as an early framework and an aspirational model, as the available resources in various trusts could have an enormous impact on how best practice can be delivered.

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