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. Aerosol‐generating 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.