Standardization of elective tracheostomies at the Central Institute of the Hospital das Clínicas in São Paulo during the COVID-19 pandemic

Abstract

<jats:p>ABSTRACT The COVID-19 Pandemic has resulted in a high number of hospital admissions and some of those patients need ventilatory support in intensive care units. The viral pneumonia secondary to Sars-cov-2 infection may lead to acute respiratory distress syndrome (ARDS) and longer mechanical ventilation needs, resulting in a higher demand for tracheostomies. Due to the high aerosolization potential of such procedure, and the associated risks of staff and envoirenment contamination, it is necesseray to develop a specific standardization of the of the whole process involving tracheostomies. This manuscript aims to demonstrate the main steps of the standardization created by a tracheostomy team in a tertiary hospital dedicated to providing care for patients with COVID-19.</jats:p>

Uso de equipamento de proteção individual pelos profissionais da saúde e a população em geral durante a Pandemia da COVID-19/ Use of personal protection equipment by health professionals and the general population during the COVID-19 novel

“…Portanto, os profissionais da saúde envolvidos nos cuidados diretos de pacientes devem usar batas cirúrgicas, luvas, máscara cirúrgica e proteção dos olhos com óculos de proteção ou máscara facial (ABREU et al, 2020;MOURA-NETO et al, 2020). Se as batas cirúrgicas não forem resistentes a fluidos, deve-se usar também aventais e somente nos casos de PGA, como intubação orotraqueal, ventilação não invasiva, traqueostomia, ressuscitação cardiopulmonar, entre outros, deve-se usar as máscaras N95, PFF2 ou padrão equivalente, junto aos demais EPI (MENEGOZZO et al, 2020;PACCOS et al, 2020;RAMOS et al, 2020). Os óculos de proteção/protetor facial devem ser exclusivos de cada profissional e passar por limpeza e desinfecção imediatamente após o uso.…”

Position statement of the Latin American Dysphagia Society for the management of oropharyngeal and esophageal dysphagia during the COVID-19 pandemic

“…The following recommendations are suggested for surgical procedures: When deciding to intervene surgically in a dysphagic patient, in times of COVID-19, the possible benefits and risks of the surgery must be weighed, including the risk of transmission to the patient, as well as to the HCP, during both the procedure and the postoperative period. The surgical staff should be as small as possible 60 . The use of an electric or ultrasonic scalpel can promote aerosol formation, and therefore, should be avoided.…”

“…Thus, the procedure should be avoided, if possible, due to the potential risk of SARS-CoV-2 spread during rehabilitation 6 . On the other hand, in the dysphagic patient with a clear indication for such a procedure, myotomy may be a better alternative than tracheostomy, which has a higher risk of aerosolization 60 .…”