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Tracheostomy during COVID-19 Pandemic: Viewpoint
The wrath of corona virus disease 2019 (COVID-19) pandemic is likely to be with us for some time. So many healthcare organizations and committees, especially those concerned with surgical disciplines and anesthesia and critical care, have formulated specialty-specific guidelines for best practices in managing COVID-19 and non-COVID patients during the pandemic. Viral particles are known to get encapsulated in globs of mucus, saliva, and water, causing known transmission through both direct contacts via droplets (more than 5 µm) or aerosols (less than 5 µm) and indirect contact via fomite and airborne contagion. Physicians from almost all specialties are exposed to this contagious virus in some way or the other. A study analyzing physician deaths from COVID-19 found that general practitioners and emergency room doctors comprise 42% of all deaths and otorhinolaryngologists and anesthesiologists comprise 4% and 2% deaths, respectively. Therefore, it is important for all physicians, especially those dealing with oral, nasal, and pharyngeal secretions and airway directly, to follow strict guidelines during any such procedure.
Patients with neurological disease may develop COVID-19 infection, or neurological symptoms can be the first manifestation of COVID-19. Neuroanesthesiologists in particular handle patients suffering from chronic neurological disease as well as neurosurgical patients who often require tracheostomy. With the spread of COVID-19 infection in the community, it is difficult to demarcate hospitals to COVID and non-COVID areas, and all areas of the hospital should take due precautions during patient handling. Tracheostomy is an aerosol-generating procedure and poses a high-risk of viral transmission to all those involved in the care of the patient, including doctors, nurses, paramedical staff, and family members. We reviewed the literature and various guidelines for tracheostomy during the COVID-19 pandemic and present a viewpoint on the same.
Article published online:
02 September 2020
© 2020. Indian Society of Neuroanaesthesiology and Critical Care. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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