OTHER ARTICLES Guidelines for Surgical Tracheostomy and Tracheostomy Tube Change During the COVID-19 Pandemic: A Review Article Suma Radhakrishnan 1 • Hafees Abdullah Perumbally 1 • Sai Surya 1 • Mohammed Shareef Ponneth 1 Received: 26 May 2020 / Accepted: 3 June 2020 / Published online: 22 June 2020 Ó Association of Otolaryngologists of India 2020 Abstract The novel corona virus disease (COVID-19) has unfolded into a pandemic and is continuing to propagate at a frightening speed. The aim of this article is to share our protocol for performing a safe surgical tracheostomy in this COVID-19 era. Tracheostomy procedures have a high risk of aerosol generation. To standardize institutional safety measures with tracheostomy, we advocate using a dedi- cated tracheostomy protocol applicable to all patients including those suspected of having COVID-19. We also did explore the current literature and recommendations for tracheostomy in patients with COVID-19 and studied the previous data from severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1), the virus responsible for the SARS outbreak of 2003. We have prepared a protocol for performing a safe surgical tracheotomy in patients affected by COVID-19. Surgeons who might be involved in per- forming the tracheostomies should become familiar with these guidelines. Keywords Tracheostomy Á Surgical airway Á Aerosol generating procedure Á COVID-19 pandemic Pre Requisites, Risk Statement and Indication • Aim of the protocol is to reduce the risk of viral exposure and also to prevent PPE (Personal Protective Equipment) depletion [1]. • The benefit of performing early tracheostomy in critically ill COVID-19 patients are unclear from available data [1]. • 14–20% patients with COVID-19 may require ET (En- dotracheal) intubation and ventilator support [2–5]. • Indication: For prolonged ventilation and subsequent weaning/airway access when intubation is unsuccessful [5]. • Increased risk of laryngotracheal stenosis not signifi- cantly reduced in patients with early tracheostomy ( \ 10 days) [1, 5, 6]. • Ventilator associated pneumonia and overall mortal- ity—no improvement with early tracheostomy [1, 7–11]. • Prefer open over percutaneous tracheostomy. • Aerosolized viral particles can transmit for unto 3 h or more [1, 12]. • There is no anticipated timing for viral clearance and critically ill patients may have significantly longer positive testing (unto 2–3 weeks) [1, 13]. • Decision should be taken only after discussion with the senior anesthetist and surgical team. Skilled Team • Limit number of personals involved [1]. • Single dedicated team performing all tracheostomies on weekly basis. • An experienced Anesthetist and an experienced surgeon should be doing the procedure. • The operating team should be limited to: one surgeon, one assistant, one anesthetist, one anesthesia technician and one scrub nurse. & Hafees Abdullah Perumbally drhafeesabdullah@gmail.com 1 Department of Otorhinolaryngology and Head and Neck Surgery, Government Medical College, Manjeri, Kerala, India 123 Indian J Otolaryngol Head Neck Surg (July–Sept 2020) 72(3):398–401; https://doi.org/10.1007/s12070-020-01893-y