The COVID TIDE Approach: A Protocol for Safe Tracheostomy Practice in COVID Patients

Abstract

We all are aware of COVID 19 pandemic. As the numbers are increasing, the critical care demand is also increasing. Tracheostomy is one of the commonest procedures which has been performed on COVID positive ventilated patients. It is important to understand and follow the utmost safe practices for the patient and the health care workers for such aerosol generating procedures. The aim of this study is to identify the lacunae in tracheostomy practices during this COVID times and suggest a systematic approach for the safe practices. An online questionnaire survey-based study was performed in September 2020. The target population was practicing otolaryngologists of India with various years of experience. The aim of the study was to evaluate the lacunae in tracheostomy safe practices and to create a systematic approach for the safety of health care workers. Data compilation and analysis was done by using Microsoft Excel. A systematic COVID TIDE tracheostomy safe practices approach was designed after reviewing various tracheostomy guidelines and recommendations. Total 114 otolaryngologists responded with a complete survey report. 72.2% responders were not up to date with their knowledge of tracheostomy safe practices. 79.8% were not performing this procedure in a negative pressure room. 15.8% were not aware of the personal protective equipment level they are using. Only 56.1% survey responders were holding the ventilation before tracheal incision. Overall, 94.7% responders were keen to know about the safe approach of tracheostomy in COVID positive patients. Tracheostomy is an aerosol generating procedure, lacunae in the knowledge can cause major risk to health care professionals. Finally, in such crises, consideration should be taken for simulation exercises, dedicated airway teams and a systematic COVID TIDE approach to improve the safety of the staff and patients.

Coronavirus disease tracheostomy complications: a scoping review

“…Over the course of the pandemic, various consensus guidelines have been released for the provision of safe surgical tracheostomy in Covid-19. 15,32,33 Such protocols have all shared the recommendation to pause ventilation during the creation of the tracheal window, to minimise aerosolisation during this high-risk step of the procedure. This may explain the difference found in this review, reflecting a higher risk of hypoxia during open surgical tracheostomies than during percutaneous tracheostomies.…”