Objectives: Paediatric patients living with tracheostomies are a
medically vulnerable group. During the COVID-19 pandemic, there may be
apprehension about their susceptibility to SARS-CoV-2 infection with
unknown consequences. Healthcare workers managing this cohort can be
anxious about viral transmission from respiratory secretions and
aerosols emerging from the open airway. Our objective is to share a
systematic approach to minimise incidental mismanagement, avoid
iatrogenic airway injury, reduce aerosolisation and decrease staff
exposure when treating these patients. Methods: A COVID-19 emergency
management plan was created for paediatric patients with tracheostomies
in the event of presentation with unknown, suspected or proven
SARS-CoV-2 infection. Three documents were developed: a generic
tracheostomy management plan detailing troubleshooting measures to
reduce air leak from around the tube; a personalised management plan
with customised recommendations; a guide for tracheostomy tube change
with emphasis on minimising aerosol production. Results: Our plan was
distributed to 31 patients (age range 11 months - 17 years) including 23
(74.2%) with uncuffed tubes and 9 (29%) on long term ventilation.
There have been 10 occasions in which the plan was utilised and
influenced care, including 4 situations where successful troubleshooting
avoided tube manipulation and 6 situations where an uncuffed tube was
safely replaced with a pre-selected cuffed tube to reduce air leak.
Conclusions: A structured approach to emergency presentations during the
COVID-19 pandemic may safeguard paediatric patients from unnecessary
manipulation of their tracheostomy tube and airway trauma, as well as
provide guidance to minimise viral exposure and allow provision of
expeditious care.
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