key: cord-0871251-47dkhsdg
authors: Jacob, Tony; Walker, Abigail; Mantelakis, Angelos; Gibbins, Nicholas; Keane, Oliver
title: A framework for open tracheostomy in COVID‐19 patients
date: 2020-04-26
journal: Clin Otolaryngol
DOI: 10.1111/coa.13549
sha: cce54d925abc35233f0cd24134ccf584a1c10132
doc_id: 871251
cord_uid: 47dkhsdg

The COVID-19 pandemic is causing untold disruption across the globe and all countries irrespective of the strength and resilience of their health systems are feeling the burden. Intensive care units are facing a surge of patients requiring invasive ventilation.It is likely that requests for a tracheostomy in COVID-19 ventilated patients will soon come our way. It is difficult to predict the burden, but it would be remiss not to be prepared.

The COVID-19 pandemic is causing untold disruption across the globe, and all countries irrespective of the strength and resilience of their health systems are feeling the burden. Intensive care units are facing a surge of patients requiring invasive ventilation.

It is likely that requests for a tracheostomy in COVID-19 ventilated patients will soon come our way. It is difficult to predict the burden, but it would be remiss not to be prepared. Tracheostomy is almost certainly an aerosol generating procedure and represents a risk to surgeons and others in the operating room. In the SARS epidemic, a survey suggested that healthcare workers who performed tracheostomy had a fourfold increased risk of developing disease. 1 Full personal protective equipment must be used, as failure to comply is a risk factor for infection in healthcare workers. 2, 3 We have developed guidance and cognitive aids to help departments prepare for tracheostomies in COVID-19 patients ( Figure We suggest that departments identify a core "COVID-19 Airway team" who can rapidly adapt these guidelines to local factors and take a lead in training their colleagues. It is necessary and advisable to share the burden of these high risk and stressful events amongst all colleagues.

The key message is to prepare and stay safe.

F I G U R E 1 A, Planning steps recommended in the days and weeks prior to predicted tracheostomy. PPE = Personal Protective Equipment, COVID = novel Coronavirus-19 (nCov19), ICU: Intensive Care Unit, B, Proposed checklist for the day of tracheostomy. HME = Heat and Moisture Exchanger, ETT: Endotracheal tube. C, Performance of critical steps in open tracheostomy once the trachea is exposed. PEEP = Positive End-Expiratory Pressure, APL valve = Adjustable Pressure Limiting valve, CO2 = carbon dioxide, D, Care for the tracheostomy patient after procedure in critical care and beyond. SLT = Speech and Language Therapist

Which preventive measures might protect health care workers from SARS?

Severe acute respiratory syndrome (SARS) in intensive care units (ICUs): limiting the risk to healthcare workers

Infection control measures for operative procedures in severe acute respiratory syndrome-related patients

Tracheostomy guidance during the COVID-19-Pandemic

Percutaneous techniques versus surgical techniques for tracheostomy