Editor’s note: Due to the COVID-19 pandemic, the 2021 Triological Society Combined Sections Meeting was held virtually on Jan. 29-30. The physical distance didn’t stop otolaryngologists in every specialty area from discussing the latest treatments, techniques, and issues in otolaryngology research and clinical practice.
Explore This IssueMarch 2021
At Ohio State University Wexner Medical Center during the early days of COVID-19, doctors tried to quickly fashion a way to think about whether and when to perform tracheotomies on patients who had been stricken with the disease and were on mechanical ventilation, said Laura Matrka, MD, an assistant professor of otolaryngology–head and neck surgery at Ohio State in Columbus. It was no small task—it required balancing important medical and resource needs with the possibly grave infection risks to medical personnel.
To solve the problem, a kind of “ad hoc committee” formed, said Dr. Matrka. “It was just simply all of us emailing in a group email each time a consult came through,” she said. “I remember those days as distinct from where we are now—we came up with some protocols, whether it was open at the bedside or in the OR.”
A panel of laryngologists shared their experience with evolving tracheostomy and COVID-19 processes during a session at the virtual Triological Society Combined Sections Meeting in January. Dr. Matrka, like the rest of the panel, said the comfort level with performing tracheotomies on COVID-19 patients has grown over time, and now they are more likely to perform them more closely to the time of intubation than they did at the start of the pandemic.
“Since then, I think the biggest thing that’s happened is that we all trust PPE now in a way that I don’t think any of us did initially,” Dr. Matrka said. She added that otolaryngologists don’t do any percutaneous tracheostomies at Ohio State unless they’re consulted in certain cases, such as unfavorable anatomy.
Michael Johns III, MD, professor of clinical otolaryngology–head and neck surgery at the Keck School of Medicine of the University of Southern California in Los Angeles, said that early in the pandemic, tracheotomies were considered and handled by a team of all of the services that perform them: otolaryngology, thoracic surgery, pulmonary-critical care, neurocritical care, and respiratory therapy. They developed practices collectively, he said.
“Each service has been performing them for their patients as they would before and according to the group-developed protocols,” he said. “We do both perc trachs and open trachs, mostly in the ICU at the bedside with critical care running meds, a respiratory therapist, a nurse, and a surgical team.”
Julina Ongkasuwan, MD, an associate professor of otolaryngology at the Baylor College of Medicine in Houston, explained that her institution has no set protocol. She said the surgical intensive care unit was performing more percutaneous tracheotomies, and the complication rate rose because the procedure was newer to that unit. “The pendulum has definitely swung back to us doing the open tracheotomies,” she said.