Table 5: Perioperative considerations during tracheotomy in COVID-19 positive patients
Precautions Global and multidisciplinary guidance (21) China experience France experience (24) United States experience (6) Spanish experience (25) UK experience (22) Canada experience (23) Italy experience (8)
Society Experts from renowned medical centers globally Tongji Medical College, Beijing TongRen Hospital, Capital Medical University, Beijing Institute of Otolaryngology French Society of Otorhinolaryngology, Head, Neck Surgery COVID-19 Tracheotomy Task Force, University of Pennsylvania Health System Spanish Society of Otorhinolaryngology and Head and Neck Surgery United Kingdom National Health Service Canadian Society of Otolaryngology S. Orsola-Malpighi University Hospital
Level of evidence 4 5 5 4 5 4 4 4
PPE Enhanced Standard Enhanced Enhanced Standard Enhanced Enhanced Enhanced
Swab before tracheotomy Not done due to lack of available testing
Negative pressure room
Limit medical personnel to only those necessary
Minimise transport through hospital
Closed circuit systems1
Use of antiviral filters
Avoid electric, ultrasonic or any potential aerosol generating system
Preferential use of cold materials and conventional haemostatic systems
Experienced tracheotomy team
PDT over ST
Performance of awake tracheotomy and cricothyroidotomy