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An Otolaryngologist Joins a “Trach Team” that Establishes COVID-19 Protocols and Procedures

Milan Amin, MD
American Board of OtolaryngologyHead and Neck Surgery
Specialty: Otolaryngology – Head and Neck Surgery

When the COVID-19 surge hit his hospital, Milan Amin, MD and his otolaryngology colleagues assumed they would be deployed to monitor the day-to-day care of patients in the intensive care unit. It turned out that their unique expertise in managing airways and tracheostomies was needed more by their hospital colleagues.

“Trach Team”
A handful of otolaryngologists, in collaboration with the Interventional Pulmonary and Thoracic Surgery Teams, set up a “trach team” that created a system to manage patients who required long-term mechanical ventilation. When a patient is placed on a ventilator to help them breathe, a tube is inserted through the soft tissue of the voice box. With long-term use, the tube can cause stenosis of the trachea or damage the voice box. A tracheostomy removes the tube from the throat and places it in the neck, lower than the voice box. The patient can eat and move around. One major downside is that the procedure is aerosol-generating, which can place health care professionals at significant risk of infection from the novel coronavirus that causes COVID-19.

“In our field, there was significant controversy over whether early tracheostomy was worth the potential risk of viral transmission to health care professionals,” said Dr. Amin. “Our institution decided to stick with the standard of care, which is ‘early’ tracheostomy, because it is the right thing to do for patients’ well-being and the risk can be managed with proper protective measures.”

During the COVID-19 surge, the team performed nearly 200 tracheostomies for patients expected to require long-term ventilation (greater than 2 weeks) over a several-week period, far more than normal. The team was able to show that patients who underwent early tracheostomy (compared to late tracheostomy–greater than 13 days from intubation), had better outcomes, specifically experiencing less time on the ventilator. Despite doing this high-risk work, no one on the main trach team was diagnosed with COVID-19 and they all tested negative for antibodies.

By creating a consistent protocol and procedure, the trach team improved the quality and efficiency of COVID-19 patient care. They were able to share their knowledge with other specialties who found themselves caring for trach patients with COVID-19, such as general surgeons and oral maxillofacial surgeons In fact, the team hosted webinars to quickly spread the word about what they had learned and their results to help educate their colleagues.

The Future
Dr. Amin is feeling optimistic about the future. “I definitely am worried about another surge because COVID-19 is relentless and awe-inspiring in its unpredictability. However, I am confident that our team has learned how to manage it.”

Early on in his hospital’s COVID-19 surge, Dr. Amin treated a 28-year old man. “It was shocking to see someone so young be so deathly sick—we thought we were going to lose him. But we gave him an ‘early’ trach and he slowly improved and is now home and doing well. This is why we do what we do and why I have hope for the future.”

Certified by the American Board of Otolaryngology – Head and Neck Surgery, Dr. Amin serves as Professor, Department of Otolaryngology—Head and Neck Surgery at NYU Grossman School of Medicine and the Director of the NYU Voice Center.

(Published: July 2, 2020)

Read more stories from the COVID-19 front lines.

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