The management of tracheostomised patients with COVID-19, their transfer from ITU to a COVID-19 ward, their weaning from invasive ventilation and eventual decannulation of the tracheostomy should follow a structured approach. To help guide decision making, a guideline (linked below) has been put together which follows three main steps:
Step 1: Assessment
Identification of patients on the critical care unit who might be suitable to start the weaning process and transfer to a COVID-19 ward, including those who have resolution of their multi-organ failure, have tracheostomy in situ and are awake and alert.
Step 2: Weaning
The transfer to a COVID-19 ward and stepwise approach to weaning from mechanical ventilation.
Step 3: Decannulation
The decannulation of a tracheostomy, ongoing rehabilitation and hopeful discharge home.
There may be patients who struggle to progress through the weaning steps, or may not be decannulated, and these patients should have a bespoke plan for their hospital stay.