Document: Surgical Considerations for Tracheostomy During the COVID-19 Pandemic
ESAIC Academy. Shyang Loh W. 03/31/20; 293211
Topic: Respiration and Airway Management
Woei Shyang Loh
Contributions
Contributions
Abstract
Summary
Since the emergence of the coronavirus disease 2019 (COVID-19) in December, 155 countries have reported casesofCOVID-19, includingsustainedcommunity transmission in several countries, such as China, Italy,andIran. As of March 21, 2020, there have been 275 434 cases confirmed globally, including 11 399 deaths.1 While the situation in China has improved, many countries continue to struggle with escalating case numbers and strained health care systems that are threatened to be overwhelmed by the pandemic. Oneof theWorld Health Organization’s strategic priorities is to limit human-to-human transmission, including secondary infections among health care workers, whichwas a key feature of the severe acute respiratory syndrome (SARS) epidemic in 2003 and accounted for one-fifth of all cases globally. Although SARS and COVID-19 arebothtransmittedbydroplets, it isnowclear that the infectivity and extent of spread ofCOVID-19 will far exceed that of SARS. Despite the lower mortality rate in COVID-19 compared with SARS (2.3%vs 11%), a notable fraction of infected people (9.8%-15.2%) require invasive mechanical ventilation or extracorporeal membrane oxygenation.2-4 In an epidemic setting, intensive care units (ICUs) will quickly reach capacity.Patients with prolonged ventilation may require tracheostomy to optimize weaning from ventilatory support. Unsurprisingly, opentracheostomywas themostcommonsurgical procedure performed on infected patients during the SARS outbreak.5,6 We performed a literature review of tracheostomies during the SARS epidemic consisting of a PubMed search with the terms SARS and tracheostomy, from which 3 case series (Table)and2case reportswere available for review.5-9 Drawing from these experiences as well as our own contingency plans for SARS and COVID-19 outbreaks, we wish to highlight several important perioperative considerationswhenplanning for open tracheostomy in an infected patient during the COVID-19 pandemic.
Since the emergence of the coronavirus disease 2019 (COVID-19) in December, 155 countries have reported casesofCOVID-19, includingsustainedcommunity transmission in several countries, such as China, Italy,andIran. As of March 21, 2020, there have been 275 434 cases confirmed globally, including 11 399 deaths.1 While the situation in China has improved, many countries continue to struggle with escalating case numbers and strained health care systems that are threatened to be overwhelmed by the pandemic. Oneof theWorld Health Organization’s strategic priorities is to limit human-to-human transmission, including secondary infections among health care workers, whichwas a key feature of the severe acute respiratory syndrome (SARS) epidemic in 2003 and accounted for one-fifth of all cases globally. Although SARS and COVID-19 arebothtransmittedbydroplets, it isnowclear that the infectivity and extent of spread ofCOVID-19 will far exceed that of SARS. Despite the lower mortality rate in COVID-19 compared with SARS (2.3%vs 11%), a notable fraction of infected people (9.8%-15.2%) require invasive mechanical ventilation or extracorporeal membrane oxygenation.2-4 In an epidemic setting, intensive care units (ICUs) will quickly reach capacity.Patients with prolonged ventilation may require tracheostomy to optimize weaning from ventilatory support. Unsurprisingly, opentracheostomywas themostcommonsurgical procedure performed on infected patients during the SARS outbreak.5,6 We performed a literature review of tracheostomies during the SARS epidemic consisting of a PubMed search with the terms SARS and tracheostomy, from which 3 case series (Table)and2case reportswere available for review.5-9 Drawing from these experiences as well as our own contingency plans for SARS and COVID-19 outbreaks, we wish to highlight several important perioperative considerationswhenplanning for open tracheostomy in an infected patient during the COVID-19 pandemic.
Summary
Since the emergence of the coronavirus disease 2019 (COVID-19) in December, 155 countries have reported casesofCOVID-19, includingsustainedcommunity transmission in several countries, such as China, Italy,andIran. As of March 21, 2020, there have been 275 434 cases confirmed globally, including 11 399 deaths.1 While the situation in China has improved, many countries continue to struggle with escalating case numbers and strained health care systems that are threatened to be overwhelmed by the pandemic. Oneof theWorld Health Organization’s strategic priorities is to limit human-to-human transmission, including secondary infections among health care workers, whichwas a key feature of the severe acute respiratory syndrome (SARS) epidemic in 2003 and accounted for one-fifth of all cases globally. Although SARS and COVID-19 arebothtransmittedbydroplets, it isnowclear that the infectivity and extent of spread ofCOVID-19 will far exceed that of SARS. Despite the lower mortality rate in COVID-19 compared with SARS (2.3%vs 11%), a notable fraction of infected people (9.8%-15.2%) require invasive mechanical ventilation or extracorporeal membrane oxygenation.2-4 In an epidemic setting, intensive care units (ICUs) will quickly reach capacity.Patients with prolonged ventilation may require tracheostomy to optimize weaning from ventilatory support. Unsurprisingly, opentracheostomywas themostcommonsurgical procedure performed on infected patients during the SARS outbreak.5,6 We performed a literature review of tracheostomies during the SARS epidemic consisting of a PubMed search with the terms SARS and tracheostomy, from which 3 case series (Table)and2case reportswere available for review.5-9 Drawing from these experiences as well as our own contingency plans for SARS and COVID-19 outbreaks, we wish to highlight several important perioperative considerationswhenplanning for open tracheostomy in an infected patient during the COVID-19 pandemic.
Since the emergence of the coronavirus disease 2019 (COVID-19) in December, 155 countries have reported casesofCOVID-19, includingsustainedcommunity transmission in several countries, such as China, Italy,andIran. As of March 21, 2020, there have been 275 434 cases confirmed globally, including 11 399 deaths.1 While the situation in China has improved, many countries continue to struggle with escalating case numbers and strained health care systems that are threatened to be overwhelmed by the pandemic. Oneof theWorld Health Organization’s strategic priorities is to limit human-to-human transmission, including secondary infections among health care workers, whichwas a key feature of the severe acute respiratory syndrome (SARS) epidemic in 2003 and accounted for one-fifth of all cases globally. Although SARS and COVID-19 arebothtransmittedbydroplets, it isnowclear that the infectivity and extent of spread ofCOVID-19 will far exceed that of SARS. Despite the lower mortality rate in COVID-19 compared with SARS (2.3%vs 11%), a notable fraction of infected people (9.8%-15.2%) require invasive mechanical ventilation or extracorporeal membrane oxygenation.2-4 In an epidemic setting, intensive care units (ICUs) will quickly reach capacity.Patients with prolonged ventilation may require tracheostomy to optimize weaning from ventilatory support. Unsurprisingly, opentracheostomywas themostcommonsurgical procedure performed on infected patients during the SARS outbreak.5,6 We performed a literature review of tracheostomies during the SARS epidemic consisting of a PubMed search with the terms SARS and tracheostomy, from which 3 case series (Table)and2case reportswere available for review.5-9 Drawing from these experiences as well as our own contingency plans for SARS and COVID-19 outbreaks, we wish to highlight several important perioperative considerationswhenplanning for open tracheostomy in an infected patient during the COVID-19 pandemic.
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