Tracheostomy is performed in around 10-13% of all level 3 ICU admissions in the UK. The clinical course of Covid-19 in the critically ill has not yet been fully characterized but there are considerations for patients with new or existing tracheostomies.

This guide considers balancing the risks of infection control regarding the aerosol spread of the virus versus the best management for the patient with a tracheostomy.

Who gets a tracheostomy?

Indications from European ICUs suggest that decision making around access to critical care and organ support is based largely on current practice; the expectation is that this stands for decisions to undertake tracheostomy. The major indication will remain to wean from ventilation when a primary extubation is not possible or has failed.

Currently, in-hospital mortality is around 20% for ICU patient requiring tracheostomy. A tracheostomy may not be in a patients’ best interests if the prospects of long-term independent survival are limited. These decisions may become more focused in a resource-limited, overwhelmed system.