Table 1

1. Select the patients carefully. If the tracheostomy is assessed as difficult because of anatomy, history of comorbidities, or other factors, consider postponing the procedure.

2. Considerations may be given to percutaneous dilatational tracheotomy if the patient’s anatomy and proceduralist expertise allows it to be done safely with minimal or no bronchoscopy, endotracheal suctioning, and disruption of the ventilator circuit.

3. Provide adequate sedation including paralysis to eliminate the risk of coughing during the procedure. Ventilation should be paused (apnea at end expiration when the trachea is entered and any time the ventilation circuit is disconnected.

4. Choose a non-fenestrated, cuffed. Tracheostomy tube on the smaller side to make the tracheotomy hole smaller overall (Shiley size 6 to 8.5 for both men and women are adequate). Keep the cuff inflated to limit the spread of virus through the upper airway.

5. Perform tracheotomy suctioning using a closed suction system with a viral filter.

6. Use a heat moisture exchanger device instead of a tracheotomy collar during weaning to prevent virus spread or reinfection of patients.

7. Avoid changing the tracheotomy tube until viral load is as low as possible.