Elective open tracheostomy in a patient with covid-19

Abstract

Tracheostomy and linked procedures in COVID-19 patients are regarded as high risk procedures for the transmission of SARS-CoV-2 to the operating team and the supporting staff. The purpose of this article is to present adjustments of the elective open surgical tracheostomy in long-term intubated patients secondary to SARS-CoV-2 infection. The protocol for the elective open surgical tracheostomy procedure in COVID-19 patients was prepared, beginning with a multidisciplinary evaluation of each patient. As opposed to ordinary circumstances, the tracheostomy in COVID-19 patients is performed later, in the intensive care department, and using appropriate personal protective equipment. It is recommended to establish a COVID-19 team of experienced personnel being able to carry out the surgery in a safe, fast and reliable manner. We are describing the open tracheostomy in which harmonized and specific cooperation of the surgical and anaesthesiological team, with steps planed in advance, is of utmost importance. In addition, the procedures should be executed without generating aerosolised particles. Similar precautions should also be implemented for all the subsequent procedures, such as taking care of the tracheal stoma and solving potential complications. It is essential that the cuff of the tracheal cannula is kept inflated all the time, and that the cannula replacement is postponed and done as rarely as possible.