Tracheostomy during COVID‐19 pandemic—Novel approach

Abstract

Background: This study describes a novel approach in reducing SARS-CoV-2 transmission during tracheostomy. Methods: Five patients underwent tracheostomy between April 1, 2020 and April 17, 2020. A clear and sterile plastic drape was used as an additional physical barrier against droplets and aerosols. Operative diagnosis; droplet count and distribution on plastic sheet and face shields were documented.Results: Tracheostomy was performed for patients with carcinoma of tonsil (n = 2) and nasopharynx (n = 1), and aspiration pneumonia (n = 2). Droplet contamination was noted on all plastic sheets (n = 5). Droplet contamination was most severe over the central surface at 91.5% (86.7%-100.0%) followed by the left and right lateral surfaces at 5.2% (6.

Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: a scoping review and narrative synthesis

“…6,15,42e44,54 The most common barrier-enclosure types were plastic wraps or tents (25 reports), 5,9,12,15,17,23e29,31,33,34,38,39,41,42,44,46,47,52,54,56 acrylic aerosol boxes (19 reports), 4e6,8,11,15,16,18,19,22,24,35,36,43,45,51,53,57,58 and combinations of aerosol boxes and plastic wraps (eight reports). 6,8,13,15,32,37,43,49 Eleven reports included other types of barrier enclosures (modified incubator hood, 7 carton box, 8 acrylic panels, 50 surgical retractors, frames and anaesthetic poles, 21,42,44,48 external fixators, 14 suspension laryngoscopy support, 41,55 and modified packaging tray 40 ). In 10 cases, a smoke evacuator/aspirator was reported.…”

“…5,6,8e11,13,14,17e21,23,25e27,29e31,33,40,41,46,48,52,53,57,58 Cases of barrier-enclosure use with one mannequin or one human were noted in eight reports, 12,15,16,42,50,54,62,63 five cases in three reports, 22,24,44 and series of 25 or more cases in three reports. 37,45,47 The reported settings were simulations with mannequins in 20 cases, 4e6,11e13, 16,19,21e23,25e28,39,41,45,49,60 simulations with study volunteers in two cases, 9,51 use in adult patients in 11 cases, 7,15,23,27,31,37,42,44,47,50,55 and four in paediatric patients. 41,43,52,56 In 24 reports, there was either no setting described or there was a barrier-enclosure description without demonstration.…”

“…All were published between December 1, 2019 and May 27, 2020. There were 19 correspondences, 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 16 letters to the editor, 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 , 37 , 38 , 39 10 original articles, 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 three research letters, 34 , 50 , 51 one guideline, 52 one short recommendation, 53 one case report, 54 and one quality improvement study. 55 Of these reports, there were only six case reports or small case series.…”

Impact of hospital lockdown secondary to COVID-19 and past pandemics on surgical practice: A living rapid systematic review

“…Other measures included geographically segregating OR complexes to reduce cross-infection, reducing humidity level and temperature of ORs to reduce HCW perspiration, and using plastic drapes around the tracheostomy operative field to create a closed sterile environment. 40,42,43 A summary of protection measures is provided in Table 4. All studies which implemented more than 3 of the listed measures and also reported on HCW outcomes had an infection rate of 0% among HCW.…”

Impact of COVID-19 Pandemic and Pattern of Patient Care in Otorhinolaryngology Practice in a Tertiary Referral Centre

“…Chow et al conducted ve tracheotomies using two horizontal anaesthetic screens and a clear sterile plastic sheet draped over the operative eld.This helped create a closed sterile environment,preventing droplet infection,aerosol contamination and viral transmission.Droplet contamination was most severe over the central surface of the plastic sheet overlying the site of operation.In this way use of face shields may be spared as it gives rise to fogging and also hinders the use of a head light while operating [36].…”