Tracheotomy in patients with COVID-19

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Coronavirus disease 2019 (COVID-19) has become a public health problem by quickly evolving into a global pandemic. Although the disease causes mild to moderate symptoms in large parts of society, severe respiratory distress develops in a significant portion. These patients need to be treated in the intensive care unit, and some of them also need invasive mechanical ventilation due to respiratory failure. Prolonged mechanical ventilation can bring out a need for tracheotomy in these patients. However, tracheotomy is a high-risk procedure in terms of transmission due to the high potential of aerosol generation. Therefore, some recommendations about the measurements to be taken and personal protective equipment (PPE) use were published. Until now, we performed tracheotomy in six patients with COVID-19 in our center and all these procedures were performed at the bedside. During these procedures, standard and enhanced PPE, including a powered air-purifying respirator, were used. No sign of the infection was seen in any member of the team who performed the procedures. In conclusion, the tracheotomy procedure in the patients with COVID-19 seems to be safe in terms of the transmission risk to the healthcare workers, based on articles published during the severe acute respiratory syndrome epidemic and our experiences. However, we still need data collection and documentation to establish the timing and benefit of tracheotomy in these patients.