#Video provides guidance on surgery to wean patients with COVID-19 off ventilators

A temporary tracheostomy—an opening created in the neck to facilitate placing a tube into a person’s windpipe—can be essential for allowing a critically ill patient to come off a ventilator. A new article, with an accompanying video, published in the New England Journal of Medicine by clinicians at Massachusetts General Hospital (MGH) offers valuable guidance on how to safely perform the procedure in patients with COVID-19.

“Tracheostomy facilitates ventilator weaning, decreasing the need for sedating medications and allows family members to more easily interact with their loved ones,” said senior author Hugh G. Auchincloss, MD, MPH, a thoracic surgeon at MGH. “We were concerned that tracheostomy was being underutilized in the management of patients with severe disease in the setting of COVID-19 because of concern that performing the procedure would expose health care workers to the virus.”

The article and video provide step-by-step instructions on how to perform a tracheostomy quickly and safely at the bedside, with modifications to prevent generating aerosols that could contain the virus that causes COVID-19. Instructions start with details on equipment, preparation and positioning before initiating the procedure. 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. The article and video also offer guidance on what to do if difficulties or complications arise, and on care that is required after the surgery.

“We hope that this video can help physicians around the world consider the modifications to percutaneous tracheostomy that can reduce the risk of procedural aerosolized transmission of COVID-19 and other viruses,” said lead author Daniel Hashimoto, MD, MS, chief resident in General Surgery at MGH and associate director of research of MGH’s Surgical Artificial Intelligence & Innovation Laboratory. “This work helps provide education on performing percutaneous tracheostomy for non-COVID-19 infected patients as well.”