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Video Provides Guidance on Temporary Tracheostomy for COVID-19 Patients on Ventilators

In This Article

  • A temporary tracheostomy can be essential for allowing a critically ill patient with COVID-19 to come off a ventilator
  • A new report with an accompanying video, created by clinicians at Massachusetts General Hospital, offers valuable guidance on how to safely perform the procedure
  • Daniel Hashimoto, MD, MS, chief resident in General Surgery, said that this resource can help physicians around the world as they manage critically ill patients with COVID-19

A temporary tracheostomy—an opening created in the neck to facilitate placing a tube into a patient's windpipe—can be essential for allowing a critically ill patient to come off a ventilator. To promote a wider understanding of the procedure, clinicians at Massachusetts General Hospital have created an instructional video (shared on the New England Journal of Medicine) that provides step-by-step instructions on how to perform a tracheostomy quickly and safely at the bedside.

Temporary tracheostomy can help decrease the need for sedating medications and allow family members to more easily interact with their loved ones. However, Hugh G. Auchincloss, MD, MPH, surgeon in the Division of Thoracic Surgery and senior author of the article, said he and his colleagues were concerned that tracheostomy was being underutilized in the management of patients with COVID-19 because of concerns about exposure to the virus among health care workers.

The article and video, therefore, offer modifications to tracheostomy that prevent the generation of aerosols that could contain the virus that causes COVID-19. Instructions start with details on equipment, preparation and positioning before initiating the procedure. The next steps include information on the procedure itself, such as the size and location of the incision and the placement of the bronchoscope that allows the surgeon to visualize the patient's airways.

Daniel Hashimoto, MD, MS, chief resident in the Division of General and Gastrointestinal Surgery and associate director of research in the Surgical Artificial Intelligence & Innovation Laboratory, said he hopes the video will help physicians around the world consider modifications to the percutaneous tracheostomy that reduce the risk of COVID-19 transmission.

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