Tracheostomy management in COVID-19 positive patients
GENERAL PRECAUTIONS
- Patients should be managed as patients with COVID-19 who require
oxygenation/hospitalization (7).
- Encourage the patient to perform as much of the cleaning and care as
they are comfortable (7).
- Staff caring for this patient set should be properly educated on
COVID-19 airway management (such as using closed suctioning, cannula
care), as these are high-risk (to staff) scenario (7, 12).
- PPE and airborne/droplet precautions should be followed according to
institutional protocol (6-17).
- Tracheostomy change procedures should be delayed until patient no
longer tests positive, if possible (6, 7, 12).
VENTILATED PATIENTS
- Avoid disconnecting patient circuit from ventilator. If necessary,
clamp tubing distal to HME filter prior to disconnecting (8-12, 14,
15).
- Use inner cannula if thick secretions or on open system. If used,
limit inspection/cleaning of inner cannula (7).
- Cuff deflation when weaning from ventilator will result in aerosol
generation. Ensure patients are in isolation or in a cohort room with
other COVID-19 patients (7).
NON-VENTILATED PATIENTS
- Cuffed, non-fenestrated tracheostomy tubes should be used and remain
inflated to limit aerosol generation (7-9, 11, 12, 17).
- Humidification with a simple HME device, along with a viral filter
should be placed on the tracheostomy tube (6-17).
- A simple facemask should be placed on the patient (7, 13-15).
- Any suctioning should be done using a closed system (7-12, 14-17).
- Should supplemental oxygenation be needed, a trach collar is preferred
due to its protection against droplet spread (7).