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.