Tracheostomy Protocol at UPMC
At the University of Pittsburgh Medical Center (UPMC), tracheostomy
placement in COVID-19 patients is considered only after 2-3 weeks of
mechanical ventilation unless there are compelling clinical reasons
necessitating earlier timing. All patients undergoing elective
tracheostomy receive pre-operative SARS-CoV-2 testing. As testing
capacity increases, retesting prior to the procedure is recommended. The
procedure should be performed in a negative pressure room for patients
who are COVID-19 positive or have an unknown status. Open surgical
tracheostomy is preferred to percutaneous dilation approach in order to
reduce the risk of aerosolization. The procedure is to be performed in
the ICU whenever possible to reduce exposure to staff and other
patients. Full PPE with N95 or powered air-purifying respirator (PAPR)
is required for all staff in the procedure room. The entire procedure is
done with complete paralysis and a high-flow suction device is
recommended whenever cautery is used. Ventilation is held when the
respiratory circuit is open. Tracheal suctioning is minimized and a
cuffed, non-fenestrated tracheostomy tube is always placed.