Guidelines for tracheostomy in COVID-19 pandemic


  • Meenesh Juvekar Bombay Hospital Medical and Research Centre and Grant Medical College and JJ Group of Hospitals, Mumbai, Maharashtra, India
  • Baisali Sarkar Bombay Hospital Medical and Research Centre and Grant Medical College and JJ Group of Hospitals, Mumbai, Maharashtra, India



SARS-CoV-2, Covid-19, Pandemic, Tracheostomy, Guidelines


Measures to be taken by the clinicians involved in doing tracheostomy in light of the recent coronavirus disease, 2019 pandemic are highlighted in current article. Current findings about coronavirus disease, 2019 are evaluated and guidelines to be taken while performing tracheostomy are reviewed. If guidelines for tracheostomy are strictly followed, the probability to get COVID-19 infection drastically reduces. COVID-19 disease has now become pandemic. Many patients admitted in the intensive care require tracheostomy. The aerosol spread of this disease greatly increases the spread and risk of amongst medical and healthcare staff. The protocols for tracheostomy should be clearly defined and followed prior to doing the procedure. This review summarizes the protocols for tracheostomy required to prevent the spread of the disease.

Author Biographies

Meenesh Juvekar, Bombay Hospital Medical and Research Centre and Grant Medical College and JJ Group of Hospitals, Mumbai, Maharashtra, India

Professor and Unit Head  G T Hospital, Mumbai

Surgeon, Bombay Hospital, Mumbai

Baisali Sarkar, Bombay Hospital Medical and Research Centre and Grant Medical College and JJ Group of Hospitals, Mumbai, Maharashtra, India

Consultant ENT surgeon Department  of  Otorhinolaryngology,  Guwahati  Neurological  Research  Centre,  West  Bengal


Coronavirus disease 201, symptoms and causes mayo Clinic. Available at: https://www.mayoclinic. org/diseases-conditions/coronavirus/symptoms-causes/syc-20479963. Accessed on 14 April 2020.

David SH, Esam IA, Tariq AM, Francine N, Richard K, Osman D, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health- The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 91:264-66.

Director-General's opening remarks at the media briefing on COVID-19, World Health Organization. Available at: detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19-11-march-2020. Accessed on 12 March 2020.

How COVID-19 Spreads centers for disease control and prevention. Available at: coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html. Accessed on 3 April 2020.

European centre for disease prevention and control. Available at: Accessed on 30 April 2020.

Anagiotos A, Petrikkos G. Otolaryngology in the COVID-19 pandemic era: the impact on our clinical practice. Eur Arch Otorhinolaryngol. 2020;1-8.

Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1564-7.

Nanshan C, Min Z, Xuan D, Jieming Q, Fengyun G, Yang H, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.

Symptoms of coronavirus centers for disease control and prevention. Available at: coronavirus/2019-ncov/symptoms-testing/ symptoms.html. Accessed on 18 June 2020.

Novel coronavirus information center: expert guidance and commentary. Available at: Accessed on 18 June 2020.

Grant MC, Geoghegan L, Arbyn M, Mohammed Z, McGuinness L, Clarke EL, et al. The prevalence of symptoms in 24,410 adults infected by the novel coronavirus (SARS-CoV-2; COVID-19): A systematic review and meta-analysis of 148 studies from 9 countries. PLoS One. 2020;15(6):e0234765.

Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol. 2020;277(8):2251-61.

Heidari F, Karimi E, Firouzifar M, Khamushian P, Ansari R, Mohammadi Ardehali M, Heidari F. Anosmia as a prominent symptom of COVID-19 infection. Rhinology. 2020;58(3):302-3.

Mehta AB, Syeda SN, Bajpayee L, Cooke CR, Walkey AJ, Wiener RS. Trends in tracheostomy for mechanically ventilated patients in the United States. Am J Resp Crit Care Med. 2015;192:446-54.

Mamary AJ, Kondapaneni S, Vance GB, Gaughan JP, Martin UJ, Criner GJ. Survival in Patients Receiving Prolonged Ventilation: Factors that Influence Outcome. Clin Med Insights Circ Respir Pulm Med. 2011;5:17-26.

Mishra P, Jedge P, Kaushik M, Artham P, Kumari S. Our Experience of Tracheostomy in COVID-19 Patients . Indian J Otolaryngol Head Neck Surg. 2020;1-4.

Wong J, Goh QY, Tan Z, Lie SA, Tay YC, Ng SY, et al. Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore. Se préparer pour la pandémie de COVID-19: revue des moyens déployés dans un bloc opératoire d’un grand hôpital tertiaire au Singapour. Can J Anaesth. 2020;67(6): 732-45.

Guidance for ENT surgeons during the COVID-19 pandemic. Available at: Accessed on 20 March 2020.

General guidance for clinicians in Ireland dealing with head and neck cancer during the current COVID-19 outbreak Irish head and neck society. Available at: Accessed on 10 April 2020.

COVID-19: considerations for optimum surgeon protection before, during, and after operation College of Surgeons. Available at: covid-19/clinical-guidance/surgeon-protection. Accessed on 10 April 2020.

Lu D, Wang H, Yu R, Yang H, Zhao Y. Integrated infection control strategy to minimize nosocomial infection of coronavirus disease 2019 among ENT healthcare workers. J Hosp Infect. 2020;104(4):454-5.

Synopsis of the Toronto approach. Available at: 03/Jonathan-Irish-Synopsis-of-the-Toronto-Approach.pdf. Accessed on 10 April 2020.

Preventing infections in patients with tracheostomy. Available at: infection-control-issues-in-caring-for-patients-with-tracheostomy. Accessed on 10 April 2020.

Tien HC, Chughtai T, Jogeklar A, Cooper AB, Brenneman F. Elective and emergency surgery in patients with severe acute respiratory syndrome. Can J Surg. 2005;48:71-4.

Chee VW, Khoo ML, Lee SF, Lai YC, Chin NM. Infection control measures for operative procedures in severe acute respiratory syndrome-related patients. Anesthesiol. 2005;100:1394-8.

Haddad S. Tachyphylaxis to cisatracurium- case reports and literature review. Middle East J Anaesthesiol. 2008;19:1079-92.

Tschida SJ, Graupe KJ, Hoey LL, Vance-Bryan K. Resistance to nondepolarizing neuromuscular blocking agents. Pharmacotherapy. 1996;16:409-18.

Brendan AM, Brenner MJ, Warrillow SJ. Tracheostomy in the COVID-19 era: global and multidisciplinary guidance. Lancet Respir Med. 2020;8:717-25.

Guidelines for disinfection and sterilization in healthcare facilities 2008. Centers for disease control and prevention. Available at: infectioncontrol/guidelines/disinfection/recommendations.html. Accessed on 10 April 2020.

McGrath BA, Bates L, Atkinson D, Moore JA; National Tracheostomy Safety Project. Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies. Anaesthesia. 2012;67(9):1025-41.

Chan JYK, Wong EWY, Lam W. Practical Aspects of Otolaryngologic Clinical Services During the 2019 Novel Coronavirus Epidemic: An Experience in Hong Kong. JAMA Otolaryngol Head Neck Surg. 2020;146(6):519-20.

Zuo MZ, Huang YG, Ma WH. Expert Recommendations for Tracheal Intubation in Critically ill Patients with Noval Coronavirus Disease 2019. Chin Med Sci J. 2020;35(2):105-109.

Ten Hoorn S, Elbers PW, Girbes AR, Tuinman PR. Communicating with conscious and mechanically ventilated critically ill patients: a systematic review. Crit Care. 2016;20(1):333.

Rovira A, Dawson D, Walker A, et al. Tracheostomy care and decannulation during the COVID-19 pandemic. A multidisciplinary clinical practice guideline. Eur Arch Otorhinolaryngol. 2020;1-9.

Tornari C, Surda P, Takhar A, et al. Tracheostomy, ventilatory wean, and decannulation in COVID-19 patients. Eur Arch Otorhinolaryngol. 2020;1-10.

Mishra P, Jedge P, Kaushik M, Artham P, Kumari S. Our Experience of Tracheostomy in COVID-19 Patients . Indian J Otolaryngol Head Neck Surg. 2020;1-4.

Chao TN, Harbison SP, Braslow BM, et al. Outcomes after Tracheostomy in COVID-19 Patients. Ann Surg. 2020;272(3):e181-6.

Angel L, Kon ZN, Chang SH, et al. Novel Percutaneous Tracheostomy for Critically Ill Patients With COVID-19. Ann Thorac Surg. 2020;110(3): 1006-11.

Wang Y, Lu X, Li Y, Chen H, Chen T, Su N, Huang F, Zhou J, Zhang B, Yan F, Wang J. Clinical Course and Outcomes of 344 Intensive Care Patients with COVID-19. Am J Respir Crit Care Med. 2020 Jun 1;201(11):1430-4.

Zhang J, Wang X, Jia X, Li J, Hu K, Chen G, et al. Risk factors for disease severity, unimprovement, and mortality in COVID-19 patients in Wuhan, China. Clin Microbiol Infect. 2020;26(6):767-72.

Garg S, Kim L, Whitaker M, O’Halloran A, Cummings C. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019- COVID-NET, 14 states. Morb Mortal Wkly Rep. 2020;69(15):458-64.






Review Articles