Tracheostomy and personal protective equipment (PPE) in the midst of the COVID-19 pandemic

The primary aim was to review the guidelines published by Otolaryngology Societies for performing tracheostomies in the COVID-19 pandemic. A secondary aim was to briefly review the literature for the effectiveness of surgical masks, N-95 and FFP-3 respirators, and power air purifying respirators (PAPRs) in reducing transmission of respiratory viral infections to health care workers while performing tracheostomy. Recommendations are mainly derived from clinical case series/retrospective observational studies from the SARS 2003/2004 outbreaks or experimental evidence for effectiveness for N-95/FFP-3 respirators and PAPRs. Differences do occur due to lack of evidence for COVID-19 as to whether N-95 and FFP-3 respirators are sufficient, or PAPRs should be recommended for tracheostomy. We would recommend adopting a conservative (protective) approach for HCWs teams performing tracheostomies, by routinely utilizing additional PPE such as PAPRs. Recommendations for the timing of tracheostomy also varied, however, almost all recommend a period of delay. The optimum duration of which is still unclear.