Background
The COVID-19 global pandemic has caused an increased number of patients
requiring prolonged mechanical ventilation and subsequently requiring
tracheostomy for weaning of mechanical ventilation. Aerosolāgenerating
procedures (AGP) such as intubation and tracheostomy poses significant
viral transmissions risks to healthcare workers. A systematic review
evaluating transmission of acute respiratory infection to health care
workers during the SARS outbreak in 2003 estimated odds of transmission
from tracheostomy and intubation of OR 4.2 and OR 6.6 respectively (1).
Several tracheostomy guidelines have emerged worldwide which have
provided invaluable input including international multidisciplinary
guidance (2), and society guidance by ENT UK (3), and British
Laryngology Association (4), amongst others.
Tracheostomy can be performed as an open surgical procedure,
percutaneous, or hybrid. The decision about the optimal location for a
tracheostomy procedure depends on a multitude of local factors with no
available studies to suggest the superior option. The purpose of this
article is to share our approach to performing bedside surgical
tracheostomy in COVID-19 patients in a safe and effective manner, whilst
minimising the risk of viral transmission.