Indications and timing for tracheostomy in the COVID-19 positive
or person under investigation (PUI) patient
The decision to proceed with tracheostomy should involve a
multidisciplinary discussion and should be supported by multiple OHNS
team members. Notably, survival is reported to be extremely poor
(<20%) in patients with COVID-19 requiring mechanical
ventilation, which argues against early
tracheostomy.3-5 When the determination is made to
perform tracheostomy, a delay in timing from 14 days post-intubation to
21 days post-intubation should be considered to allow for sufficient
decline in viral load. In the event of a surge with need for ventilator
rationing, reconsideration of timing may need to occur. Ventilator
parameters to qualify for safe tracheostomy placement include positive
end expiratory pressure (PEEP) < 12 and fraction of inspired
oxygen (FiO2) < 0.60.