KEYPOINTSCOVID-19 patients often require prolonged mechanical ventilation, and tracheostomy is a common choice.Shared guidelines for intensive care unit patient tracheostomies for COVID-19 patients do not exist.Our survey indicates the timing and technique of COVID-19 tracheostomies vary considerably among hospitals in Lombardy, Italy.Otolaryngologists are seldom involved with decision-making regarding tracheostomies for intensive care unit COVID-19 patients.Evidence-based interventions are essential for providing the best care to invasively ventilated COVID-19 patients.KEYWORDSSARS-Cov-2; COVID-19; coronavirus; tracheostomy; percutaneous tracheotomy; surgical tracheostomy; intubation; ventilation.INTRODUCTIONAfter identifying the first Italian COVID-19 infected patient on 20 February 2020, a rapidly escalating infection cluster was discovered. On 21 February, a response coordinated by a governmental task force progressively led to a countrywide lockdown beginning on 9 March. Italy became the first Western country to address COVID-19, which on 20 March, the World Health Organization declared a pandemic.Although pneumology, infectious disease, and intensive care units (ICUs), as well as emergency departments, have carried the heaviest healthcare burden during this outbreak,1 other departments must also address the increased infectious risk while meeting patient needs. Given the number of COVID-19 patients requiring long-term invasive ventilation, a surge in tracheostomies have ensued. Otolaryngologists have quickly become involved in patient management, despite previously having been ’second-line’ specialists during infectious outbreaks.2 This unprecedented need for tracheostomies reopened decades-old debates about ICU patient tracheostomy timing, techniques and operators: supporters of late versus early tracheostomies, percutaneous tracheostomies (PTs) versus open surgical tracheostomies (STs) and otolaryngologists versus anaesthesiologists.This unprecedented situation similarly affected all hospitals in the region, overburdening ICUs and inpatient units. Our study aimed to illustrate the COVID-19 healthcare situation and investigate ICU tracheostomy management decisions.MATERIALS AND METHODSWe prepared a 13-item questionnaire asking the following: the number of COVID-19 patients treated, ICU dedicated beds, tracheostomies performed and their timing, preferred tracheostomy techniques with reasons for choosing PT or ST. The questionnaire was sent to each otolaryngology department in the Lombardy region, during the first week of April 2020. Department directors, instructed to collect data by collaborating directly with their respective ICUs, responded by phone the following week.