YO-IFOS Guidelines for Pediatric ENT Surgery during COVID-19: An Overview of Recommendations.

Objective To review the literature on pediatric ENT COVID-19 guidelines worldwide, in particular, surgical practice during the pandemic, and to establish a comprehensive set of recommendations. Methods A comprehensive literature review through an independent electronic search of the COVID-19 pandemic in PubMed, Medline, Google, and Google Scholar was performed on April 26-30, 2020. Resources identified comprised of published papers, national and international pediatric ENT society guidelines. Results Fourteen guidelines fit the inclusion criteria. Key statements were formulated and graded: a) Strong recommendation (reported by 9 or more/14), b) Fair recommendation (7-8/14) c) Weak recommendation (5-6/14) d) Expert opinion (2-4/14). Any single source suggestion was included as a comment. Highly scored recommendations included definition of urgent/emergent cases that required surgery; surgery for acute airway obstruction; prompt diagnosis of suspected cancer and surgical intervention for sepsis following initial first-line medical management. Other well scored recommendations included senior faculty to perform the surgery; the use of open approaches rather than endoscopic ones; and avoidance of powered instruments that would aerosolise virus-loaded tissue. A tracheostomy should be performed on a case by case basis where key technical modifications become necessary. Conclusion The COVID-19 pandemic will have a profound short and long-term impact on pediatric ENT practice. During this rapidly evolving climate, guidelines have been based on local practice and expert opinion. Until evidence-based practice in the COVID era is established, a comprehensive set of recommendations for pediatric ENT surgical practice based on a review of currently available literature and guidelines, is therefore appropriate. This article is protected by copyright. All rights reserved.