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.