TABLE 2.

Summary of mitigation strategies at various phases of tracheostomy care

Phase of care	Considerations and mitigation strategies
Preoperative	Decrease in viral shedding: Testing available—Deisolation after two negative PCR tests in 24 h Testing unavailable—Consider delaying tracheostomy until 21 d postintubation
Perioperative	Location: ICU preferable‐ minimizes transport Negative pressure room Surgical team: Minimize number of staff members during the procedure Use of appropriate PPE (airborne and contact precautions) Technical considerations: Patient paralysis to prevent coughing Holding ventilation during tracheotomy until cuff inflated and circuit reconnected
Postoperative	Droplet precautions during tracheostomy care Use of closed, inline suctioning Closed circuit with HEPA filter if on mechanical ventilatory support HME when off ventilatory support Delaying the first tracheostomy change to 1 mo or after deisolation occurs for COVID‐19 positive patients

Abbreviations: COVID‐19, coronavirus disease 2019; HEPA, high‐efficiency particulate arrestance; HME, heat and moisture exchange; ICU, intensive care unit; PCR, polymerase chain reaction; PPE, personal protective equipment.