French consensus regarding precautions during tracheostomy and post-tracheostomy care in the context of COVID-19 pandemic

Abstract

a b s t r a c tTracheostomy post-tracheostomy care are regarded as at high risk for contamination of health care professionals with the new coronavirus (SARS-CoV-2). Considering the rapid spread of the infection, all patients in France must be considered as potentially infected by the virus. Nevertheless, patients without clinical or radiological (CT scan) markers of COVID-19, and with negative nasopharyngeal sample within 24 h of surgery, are at low risk of being infected. Instructions for personal protection include specific wound dressings and decontamination of all material used. The operating room should be ventilated after each tracheostomy and the pressure of the room should be neutral or negative. Percutaneous tracheostomy is to be preferred over surgical cervicotomy in order to reduce aerosolization and to avoid moving patients from the intensive care unit to the operating room. Ventilation must be optimized during the procedure, to limit patient oxygen desaturation. Drug assisted neuromuscular blockage is advised to reduce coughing during tracheostomy tube insertion. An experienced team is mandatory to secure and accelerate the procedure as well as to reduce risk of contamination.

A Systematic Review on Tracheostomy in COVID-19 Patients: Current Guidelines and Safety Measures

“…Currently both open surgical as well as percutaneous techniques are used for tracheostomy worldwide but clear advantage of one over the other is not proven. There are studies suggesting equal efficacy of both and some suggest open surgical technique is better [30][31][32][33]. In our set up and with the expertise available we prefer open surgical technique for tracheostomy in both emergency and ICU.…”

Emergent tracheostomy during the pandemic of COVID-19: Slovenian National Recommendations

“…In patients with confirmed/suspected COVID-19, some important issues must be addressed. Emergent TS as the first step under local anaesthesia in a sedated patient is, despite extensive experience, discouraged due to the high risk of potentially infectious aerosol production from the unprotected airway [7,[17][18][19]. As such, the risk of surgical procedures for healthcare workers should be always carefully balanced with the potential benefits for the patients [18,20].…”

Chest tubes in COVID-19 times: a safe way to protect the team

“…All Personal Protective Equipment (PPE) available must be used for procedures that may generate aerosols: sterile and liquid-impervious apron, double gloves, Face Shield, Mask N95/PFF2, or higher 11,12 .…”