key: cord-332282-nehpwsqn
authors: Tanaka, L.; Alexandru, M.; Jbyeh, S.; Desbrosses, C.; Bouzit, Z.; Cheisson, G.; Papon, J. F.; Nevoux, J.
title: A hybrid approach to tracheostomy in COVID‐19 patients ensuring staff safety
date: 2020-05-17
journal: Br J Surg
DOI: 10.1002/bjs.11705
sha: 
doc_id: 332282
cord_uid: nehpwsqn

nan

Editor Hogan 1 reported in their correspondence that they 'endeavour, as always, to provide the highest level of patient care within the framework of imposed constraints and to preserve the health of the surgical workforce providing this care' and that 'there is minimal evidence regarding emergency surgical Here, we describe a hybrid surgical tracheostomy using a percutaneous kit under a customized insulated field with the patient in a supine position using a thyroid drape (Fig. 1) . Two surgical arches protected with sterile camera covers were placed and covered by a transparent surgical vertical isolation drape in which a large suction tube was placed to create negative pressure. The goal was to avoid any leakage of viral particles through openings in the drape (made for the operator's hands). A Seldinger technique with a guidewire was used to dilate the tract. Ventilation was suspended prior to each dilator removal, and the open extremity of the in-place dilators was closed with a surgeon's finger to avoid any leak each time ventilation was resumed. The tracheostomy tube, armed with corresponding hardrubber stylet with cone-shaped tips, was inserted when ready.

Recommendations on the timing and location of surgery, and optimal PPE have been published previously 2,4,5 . Adding a customized insulated field and the hybrid technique, which avoids having to perform a fibreoptic bronchoscopy to check the tracheal puncture location or the final position of the

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