• D D Sommer, P T Engels, E K Weitzel, S Khalili, M Corsten, M A Tewfik, K Fung, D Cote, M Gupta, N Sne, T F E Brown, J Paul, K M Kost, and I J Witterick.
• Division of Otolaryngology - Head & Neck Surgery - Department of Surgery, McMaster University Medical Centre, McMaster University, 3V1 Clinic, 1200 Main St West, Hamilton, ON, L8N 3Z5, Canada. cso.hns@sympatico.ca.
• J Otolaryngol Head N. 2020 Apr 27; 49 (1): 23.

IntroductionThe performance of tracheotomy is a common procedural request by critical care departments to the surgical services of general surgery, thoracic surgery and otolaryngology - head & neck surgery. A Canadian Society of Otolaryngology - Head & Neck Surgery (CSO-HNS) task force was convened with multi-specialty involvement from otolaryngology-head & neck surgery, general surgery, critical care and anesthesiology to develop a set of recommendations for the performance of tracheotomies during the COVID-19 pandemic.Main BodyThe tracheotomy procedure is highly aerosol generating and directly exposes the entire surgical team to the viral aerosol plume and secretions, thereby increasing the risk of transmission to healthcare providers. As such, we believe extended endotracheal intubation should be the standard of care for the entire duration of ventilation in the vast majority of patients. Pre-operative COVID-19 testing is highly recommended for any non-emergent procedure.ConclusionThe set of recommendations in this document highlight the importance of avoiding tracheotomy procedures in patients who are COVID-19 positive if at all possible. Recommendations for appropriate PPE and environment are made for COVID-19 positive, negative and unknown patients requiring consideration of tracheotomy. The safety of healthcare professionals who care for ill patients and who keep critical infrastructure operating is paramount.

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