• Ehtesham Khan, Shankar Lal, Junaid Hashmi, Jubil Thomas, and Muhammad Anwar Malik.
• Dr. Ehtesham Khan, CAI MSc, FCPS, FCARCSI, FJFI CMI, EDIC, DMMD, Dip Pain RCSI. Department of Anaesthesia and Critical Care Medicine, Our Lady of Lourdes Hospital, Drogheda, Ireland.
• Pak J Med Sci. 2020 Nov 1; 36 (7): 1714-1718.

Background & ObjectiveCOVID 19 patients with severe respiratory failure may require prolonged mechanical ventilation. Placement of a tracheostomy tube often becomes necessary for such patients. The steps of tracheostomy procedure and post tracheostomy care of these patients can be classified as aerosol generating. We wish to highlight our modified technique to address these issues.MethodologyWe performed percutaneous dilation tracheostomy in three clinically challenging COVID-19 patients in our ICU and developed guidelines aiming to minimise aerosolisation during and after the tracheostomy procedure to safeguard healthcare workers.ResultsPercutaneous tracheostomy was performed by a team of three experienced anaesthetists and an ICU nurse.ConclusionThe decision of surgical or percutaneous tracheostomy should be dependent on the experience of the tracheostomy performer, health-care worker safety, resource availability, and patient-centred care. We believe our modified strategic approach of brief bronchoscopy, minimum PEEP and gas flows and step-wise planned approach for PCDT offers an extra level of safety to healthcare workers.Copyright: © Pakistan Journal of Medical Sciences.

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