Hed 20 0648 figure 3

Maria Vargas MD

and 3 more

IntroductionAs the novel coronavirus (2019-nCov) globally spreads, the coronavirus disease (COVID-19) pandemic is straining healthcare workers worldwide [1]. In hospitalized patients with severe COVID-19, endotracheal intubation is one of the most common and indispensable life-saving interventions. In a recent report from the City of New York, 12% of COVID-19 patients required invasive mechanical ventilation [2]. Since difficult weaning and prolonged mechanical ventilation represent the two most common indications for tracheostomy in Intensive Care Unit (ICU), it may play a central role in COVID-19 management [3]. During the 2019-nCov pandemic the aerosol generating procedures, such as tracheostomy, expose physicians at high risk to contract the \soutCOVID-19 infection [4]. Accordingly, special consideration may be done to protect otolaryngologists, general surgeons and critical care physicians from the risk of infection while performing a tracheostomy in COVID-19 patients [5]. Percutaneous tracheostomy (PT) is routinely performed at the bedside in intensive care unit (ICU); unfortunately, a modified protocol to perform PT in COVID-19 patients included several critical steps associated with increased risk of aerosol generation, such as changing the catheter mount, repositioning the endotracheal tube cuff to the level of the vocal cords and removal of large dilator [6]. So far, there has been no prior description in the literature of how to minimize the aerosol generation during PT. We reported a modified percutaneous tracheostomy technique aiming to minimize the risk of aerosol generation and to increase the staff safety in COVID-19 patients.