Methods
At the University of California, San Francisco (UCSF) Medical Center, an
ad hoc work group consisting of stakeholders in the departments of
Otolaryngology -Head and Neck Surgery (OHNS), Infectious Diseases,
Critical Care Medicine and Anesthesiology, was developed to analyze the
impact of COVID-19 at various levels of clinical care and
administration. Several COVID-19 related factors were considered,
including availability of viral testing, critical care capacity,
availability of PPE, and risk to healthcare providers. All phases of
routine tracheostomy care were considered in the review and modification
of existing tracheostomy guidelines and clinical pathways. The
concurrent goals of these modifications were to (1) mitigate risk to the
health care providers while (2) preserving the risk-benefit profile for
patients. Published reports from countries with previous COVID-19
pandemic experience and the published literature from the 2003 severe
acute respiratory syndrome (SARS) pandemic were reviewed and augmented
by individual expertise in order to develop working guidelines for
management of tracheostomy at UCSF.