• Filippo Di Lella, Edoardo Picetti, Giovanni Ciavarro, Giovanni Pepe, Laura Malchiodi, Giulia D'Angelo, Silvia Grossi, Sandra Rossi, and Maurizio Falcioni.
• Department of Otolaryngology and Otoneurosurgery, Parma University Hospital, Parma, Italy.
• Ann. Otol. Rhinol. Laryngol. 2021 Mar 1; 130 (3): 304-306.

ObjectivesTo describe Otolaryngologists' perspective in managing COVID-19 patients with acute respiratory distress syndrome (ARDS) requiring tracheostomy in the ICUs during the pandemic peak in a dramatic scenario with limited resources.SettingTertiary referral university hospital, regional hub in northern Italy during SARS CoV 2 pandemic peak (March 9th to April 10th, 2020).MethodsTechnical description of open bedside tracheostomies performed in ICUs on COVID-19 patients during pandemic peak with particular focus on resource allocation and healthcare professionals coordination. A dedicated "airway team" was created in order to avoid transportation of critically ill patients and reduce facility contamination.ResultsDuring the COVID-19 pandemic, bedside minimally invasive tracheostomy in the ICU was selected by the Authors over conventional surgical technique or percutaneous procedures for both technical and operational reasons. Otolaryngologists' experience derived from direct involvement in 24 tracheostomies is reported.ConclusionsTracheostomies on COVID-19 patients should be performed in a safe and standardized setting. The limited resources available in the pandemic peak required meticulous organization and optimal allocation of the resources to grant safety of both patients and healthcare workers.

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