International Journal of Contemporary Pediatrics | March 2021 | Vol 8 | Issue 3 Page 602 International Journal of Contemporary Pediatrics Swain SK et al. Int J Contemp Pediatr. 2021 Mar;8(3):602-608 http://www.ijpediatrics.com pISSN 2349-3283 | eISSN 2349-3291 Review Article Pediatric tracheostomy in COVID-19 pandemic: a review Santosh Kumar Swain 1 *, Ishwar Chandra Behera 2 , Nishtha Ananda 1 INTRODUCTION Tracheostomy is one of the commonest and oldest surgical procedures performed in critically ill patients. Pediatric patients may require treacheostomy for several reasons and children with long standing tracheostomy tube are included in the subgroup at high risk of airway compromise. Children infected with SARS-CoV-2 are often asymptomatic. When the children present with symptoms, they have dry cough, fever, fatigue, nasal congestions and rhinorrhea. Some children may have gastrointestinal symptoms like nausea, vomiting, abdominal discomfort, abdominal pain and diarrhea. 1 So, majority of the pediatric patients have mild clinical presentations with good prognosis. However, in few immunocompromised children, the clinical manifestations may worsen and land in acute respiratory distress and respiratory failure, where they need ventilator support and later on require tracheostomy for prolonged ventilation. 2 As there is rapidly increase in COVID-19 patients, it is expected that many infected pediatric patients will require oro-tracheal intubation and prolonged mechanical ventilation. In present scenario, the requirement of the tracheostomy in COVID-19 pediatric patients will be more. So, awareness about the indications, risks and benefits, steps, preventive measures are important for the clinicians in present situations. The pediatric tracheostomy may be associated with higher chances of morbidity and mortality. The chances of complications associated with pediatric tracheostomy are more in comparison to the adult or elderly age group. 3 Till date, the profile of the pediatric trachesotomy in the COVID-19 pandemic is not reported adequately in medical literature. There are no much studies done in pediatric tracheostomy in COVID-19 pandemic. This review article aims to discuss about indications, risk versus benefits, surgical steps, complications, post- 1 Department of Otorhinolaryngology, 2 Department of Neuro-Critical Care Unit, IMS and SUM Hospital, Siksha “O” Anusandhan University, K8, Kalinganagar, Bhubaneswar, Odisha, India Received: 26 December 2020 Accepted: 30 January 2021 *Correspondence: Dr. Santosh Kumar Swain, E-mail: santoshvoltaire@yahoo.co.in Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Coronavirus disease 2019 (COVID-19) is a highly contagious infection caused by a novel strain of coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The severity of the COVID-19 infection of the pediatric patient varies broadly between a mild cough and fever to severe form of diseases such as acute respiratory distress syndrome (ARDS) for which some may need intubation and followed by mechanical ventilation through tracheostomy in case of prolonged ventilation. Performing tracheostomy in pediatric patient pose a challenge for health care professional as there is high chance of spread of the disease in COVID-19 pandemic. Surgical tracheostomy is an aerosol generating procedure which causes high chance of spread of infections. There is increasing concern for high transmissibility of the virus to the operating surgeon with their assisting staff and other nearby patients. Pediatric tracheostomy should be performed with close association with pediatric otolaryngologists, anesthesiologists and pediatric intensive care physicians along with adequate personal protective equipment (PPE) for smooth and safe execution of the procedure. Keywords: COVID-19 infections, SARS-CoV-2, Pediatric tracheostomy, Mechanical ventilation DOI: https://dx.doi.org/10.18203/2349-3291.ijcp20210675