Timing of tracheotomy in patients with COVID-19 (Table 3)
Currently, most guidelines for tracheotomy in the era of the COVID-19 pandemic recommend that tracheotomy be delayed until at least 10 days after intubation, citing reasons such as high transmission risks to HCWs and increased mortality. (6) (Table 3) However, the decision for tracheotomy should be based on the clinical indications of the patient. This is because appropriate PPE is adequate in reducing the risks of transmission to HCWs. Clinical indications for tracheotomy among COVID-19 patients should hence remain largely similar to previous guidelines for patients needing prolonged intubation. A tracheotomy should be done when patients cannot be intubated or ventilated, or when prolonged (longer than 14 days) mechanical ventilation is required.
Tracheotomy may also be delayed depending on the patient’s condition. Current guidelines from the French Intensive Care Society and the French Society of Anaesthesia and Intensive Care Medicine do not recommend tracheotomy being done when there is severe hypoxemia (PaO2/FiO2 less than 100mmHg or positive end expiratory pressure (PEEP)>10cmH2O). (7) Instead, the patient should be intubated until their condition stabilises. The need for tracheotomy can then be reassessed. Furthermore, if the patient meets weaning targets (FiO2 less than 40%, PEEP < 8, PaO2/FiO2 > 200, pressure support < 8 cmH2O), extubation could be reached between 7 and 14 days and tracheotomy should be postponed. (8)