Implementation of a Tracheostomy Protocol During the COVID-19 Pandemic

Brian Temple; Michael Segal; Vijay A Singh; Daniel Galvin; Robert Kerr; Robert Zingale

doi:doi:10.11648/j.ijcts.20200603.11

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Implementation of a Tracheostomy Protocol During the COVID-19 Pandemic

Brian Temple, Michael Segal, Vijay A Singh, Daniel Galvin, Robert Kerr, Robert Zingale

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 6, Issue 3)

Received: 19 June 2020 Accepted: 7 July 2020 Published: 17 July 2020

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Abstract

The coronavirus SARS-CoV-2 (COVID-19) pandemic has offered a unique set of challenges to the medical community often requiring prolonged treatment algorithms. The illness, afflicting more than 7.3 million people worldwide with estimates of 5-20% requiring critical care, has become a burden on the healthcare community. These critically ill patients who acquire the severe form of the disease routinely require prolonged invasive mechanical ventilation. The questions then arise, “when and for whom does tracheostomy become indicated,” and “how to safely perform a tracheostomy in this patient population.” With consideration to aerosolization of the virus, we have derived and instituted a protocol at a community institution with aims of reducing provider risk while safely performing a tracheostomy. An open tracheostomy was performed at bedside, within a negative pressure intensive care unit (ICU) setting, utilizing a closed-circuit technique as described in this text. A total of 17 tracheostomies were performed employing the described technique. Minimal complications were noted throughout the study and no adverse oxygenation events were observed with an average total apneic time of 106 seconds. An acceptable mortality rate of 23% was observed given the lethal nature of this disease in ventilated, critically ill patients. No nosocomial transmission of the virus was documented for all team members. This protocol can be used to determine efficacy and safely execute a tracheostomy in COVID-19 patients. As information about COVID-19 continues to unfold, protocols for high risk procedures will need to fluidly evolve.

Published in	International Journal of Cardiovascular and Thoracic Surgery (Volume 6, Issue 3)
DOI	10.11648/j.ijcts.20200603.11
Page(s)	38-43
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

COVID-19, Tracheostomy, Protocol, Indication

References

[1]	Worldometer. COVID-19 coronavirus pandemic. June 10, 2020. https://www.worldometers.info/coronavirus/ (accessed June 10, 2020).
[2]	Tay JK, Khoo ML, Loh WS. Surgical Considerations for Tracheostomy During the COVID-19 Pandemic: Lessons Learned From the Severe Acute Respiratory Syndrome Outbreak. JAMA Otolaryngol Head Neck Surg. 2020.
[3]	Durbin CG. Tracheostomy: why, when, and how?. Respir Care. 2010; 55 (8): 1056-68.
[4]	Carlos WG, Dela cruz CS, Cao B, Pasnick S, Jamil S. Novel Wuhan (2019-nCoV) Coronavirus. Am J Respir Crit Care Med. 2020; 201 (4): P7-P8.
[5]	Han Y, Yang H. The transmission and diagnosis of 2019 novel coronavirus infection disease (COVID-19): A Chinese perspective. J Med Virol. 2020.
[6]	Tien HC, Chughtai T, Jogeklar A, Cooper AB, Brenneman F. Elective and emergency surgery in patients with severe acute respiratory syndrome (SARS). Can J Surg. 2005; 48 (1): 71-4.
[7]	Ahmed N, Hare GM, Merkley J, Devlin R, Baker A. Open tracheostomy in a suspect severe acute respiratory syndrome (SARS) patient: brief technical communication. Can J Surg. 2005; 48 (1): 68-71.
[8]	Kwan A, Fok WG, Law KI, Lam SH. Tracheostomy in a patient with severe acute respiratory syndrome. Br J Anaesth. 2004; 92 (2): 280-2.
[9]	Chee VW, Khoo ML, Lee SF, Lai YC, Chin NM. Infection control measures for operative procedures in severe acute respiratory syndrome-related patients. Anesthesiology. 2004; 100 (6): 1394-8.
[10]	Jacob T, Walker A, Mantelakis A, Gibbins N, Keane O. A framework for open tracheostomy in COVID-19 patients. Clin Otolaryngol. 2020.
[11]	Expert consensus on preventing nosocomial transmission during respiratory care for critically ill patients infected by 2019 novel coronavirus pneumonia]. Zhonghua Jie He He Hu Xi Za Zhi. 2020; 17: E020.
[12]	Foster P, Cheung T, Craft P, et al. Novel Approach to Reduce Transmission of COVID-19 During Tracheostomy. J Am Coll Surg. 2020.
[13]	Rassekh et al. Tracheostomy in Ventilated Patients with COVID-19. Annals of Surgery. COVID 19 Online resource, 2020.

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APA Style

Brian Temple, Michael Segal, Vijay A Singh, Daniel Galvin, Robert Kerr, et al. (2020). Implementation of a Tracheostomy Protocol During the COVID-19 Pandemic. International Journal of Cardiovascular and Thoracic Surgery, 6(3), 38-43. https://doi.org/10.11648/j.ijcts.20200603.11

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ACS Style

Brian Temple; Michael Segal; Vijay A Singh; Daniel Galvin; Robert Kerr, et al. Implementation of a Tracheostomy Protocol During the COVID-19 Pandemic. Int. J. Cardiovasc. Thorac. Surg. 2020, 6(3), 38-43. doi: 10.11648/j.ijcts.20200603.11

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AMA Style

Brian Temple, Michael Segal, Vijay A Singh, Daniel Galvin, Robert Kerr, et al. Implementation of a Tracheostomy Protocol During the COVID-19 Pandemic. Int J Cardiovasc Thorac Surg. 2020;6(3):38-43. doi: 10.11648/j.ijcts.20200603.11

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@article{10.11648/j.ijcts.20200603.11,
  author = {Brian Temple and Michael Segal and Vijay A Singh and Daniel Galvin and Robert Kerr and Robert Zingale},
  title = {Implementation of a Tracheostomy Protocol During the COVID-19 Pandemic},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {6},
  number = {3},
  pages = {38-43},
  doi = {10.11648/j.ijcts.20200603.11},
  url = {https://doi.org/10.11648/j.ijcts.20200603.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20200603.11},
  abstract = {The coronavirus SARS-CoV-2 (COVID-19) pandemic has offered a unique set of challenges to the medical community often requiring prolonged treatment algorithms. The illness, afflicting more than 7.3 million people worldwide with estimates of 5-20% requiring critical care, has become a burden on the healthcare community. These critically ill patients who acquire the severe form of the disease routinely require prolonged invasive mechanical ventilation. The questions then arise, “when and for whom does tracheostomy become indicated,” and “how to safely perform a tracheostomy in this patient population.” With consideration to aerosolization of the virus, we have derived and instituted a protocol at a community institution with aims of reducing provider risk while safely performing a tracheostomy. An open tracheostomy was performed at bedside, within a negative pressure intensive care unit (ICU) setting, utilizing a closed-circuit technique as described in this text. A total of 17 tracheostomies were performed employing the described technique. Minimal complications were noted throughout the study and no adverse oxygenation events were observed with an average total apneic time of 106 seconds. An acceptable mortality rate of 23% was observed given the lethal nature of this disease in ventilated, critically ill patients. No nosocomial transmission of the virus was documented for all team members. This protocol can be used to determine efficacy and safely execute a tracheostomy in COVID-19 patients. As information about COVID-19 continues to unfold, protocols for high risk procedures will need to fluidly evolve.},
 year = {2020}
}

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TY  - JOUR
T1  - Implementation of a Tracheostomy Protocol During the COVID-19 Pandemic
AU  - Brian Temple
AU  - Michael Segal
AU  - Vijay A Singh
AU  - Daniel Galvin
AU  - Robert Kerr
AU  - Robert Zingale
Y1  - 2020/07/17
PY  - 2020
N1  - https://doi.org/10.11648/j.ijcts.20200603.11
DO  - 10.11648/j.ijcts.20200603.11
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 38
EP  - 43
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20200603.11
AB  - The coronavirus SARS-CoV-2 (COVID-19) pandemic has offered a unique set of challenges to the medical community often requiring prolonged treatment algorithms. The illness, afflicting more than 7.3 million people worldwide with estimates of 5-20% requiring critical care, has become a burden on the healthcare community. These critically ill patients who acquire the severe form of the disease routinely require prolonged invasive mechanical ventilation. The questions then arise, “when and for whom does tracheostomy become indicated,” and “how to safely perform a tracheostomy in this patient population.” With consideration to aerosolization of the virus, we have derived and instituted a protocol at a community institution with aims of reducing provider risk while safely performing a tracheostomy. An open tracheostomy was performed at bedside, within a negative pressure intensive care unit (ICU) setting, utilizing a closed-circuit technique as described in this text. A total of 17 tracheostomies were performed employing the described technique. Minimal complications were noted throughout the study and no adverse oxygenation events were observed with an average total apneic time of 106 seconds. An acceptable mortality rate of 23% was observed given the lethal nature of this disease in ventilated, critically ill patients. No nosocomial transmission of the virus was documented for all team members. This protocol can be used to determine efficacy and safely execute a tracheostomy in COVID-19 patients. As information about COVID-19 continues to unfold, protocols for high risk procedures will need to fluidly evolve.
VL  - 6
IS  - 3
ER  -

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Author Information

Brian Temple

Huntington Hospital – Northwell Health, Huntington, New York, USA
Michael Segal

Huntington Hospital – Northwell Health, Huntington, New York, USA
Vijay A Singh

Huntington Hospital – Northwell Health, Huntington, New York, USA
Daniel Galvin

Huntington Hospital – Northwell Health, Huntington, New York, USA
Robert Kerr

Huntington Hospital – Northwell Health, Huntington, New York, USA
Robert Zingale

Huntington Hospital – Northwell Health, Huntington, New York, USA

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Plain Text BibTeX RIS

APA Style

Brian Temple, Michael Segal, Vijay A Singh, Daniel Galvin, Robert Kerr, et al. (2020). Implementation of a Tracheostomy Protocol During the COVID-19 Pandemic. International Journal of Cardiovascular and Thoracic Surgery, 6(3), 38-43. https://doi.org/10.11648/j.ijcts.20200603.11

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ACS Style

Brian Temple; Michael Segal; Vijay A Singh; Daniel Galvin; Robert Kerr, et al. Implementation of a Tracheostomy Protocol During the COVID-19 Pandemic. Int. J. Cardiovasc. Thorac. Surg. 2020, 6(3), 38-43. doi: 10.11648/j.ijcts.20200603.11

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AMA Style

Brian Temple, Michael Segal, Vijay A Singh, Daniel Galvin, Robert Kerr, et al. Implementation of a Tracheostomy Protocol During the COVID-19 Pandemic. Int J Cardiovasc Thorac Surg. 2020;6(3):38-43. doi: 10.11648/j.ijcts.20200603.11

Copy | Download

@article{10.11648/j.ijcts.20200603.11,
  author = {Brian Temple and Michael Segal and Vijay A Singh and Daniel Galvin and Robert Kerr and Robert Zingale},
  title = {Implementation of a Tracheostomy Protocol During the COVID-19 Pandemic},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {6},
  number = {3},
  pages = {38-43},
  doi = {10.11648/j.ijcts.20200603.11},
  url = {https://doi.org/10.11648/j.ijcts.20200603.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20200603.11},
  abstract = {The coronavirus SARS-CoV-2 (COVID-19) pandemic has offered a unique set of challenges to the medical community often requiring prolonged treatment algorithms. The illness, afflicting more than 7.3 million people worldwide with estimates of 5-20% requiring critical care, has become a burden on the healthcare community. These critically ill patients who acquire the severe form of the disease routinely require prolonged invasive mechanical ventilation. The questions then arise, “when and for whom does tracheostomy become indicated,” and “how to safely perform a tracheostomy in this patient population.” With consideration to aerosolization of the virus, we have derived and instituted a protocol at a community institution with aims of reducing provider risk while safely performing a tracheostomy. An open tracheostomy was performed at bedside, within a negative pressure intensive care unit (ICU) setting, utilizing a closed-circuit technique as described in this text. A total of 17 tracheostomies were performed employing the described technique. Minimal complications were noted throughout the study and no adverse oxygenation events were observed with an average total apneic time of 106 seconds. An acceptable mortality rate of 23% was observed given the lethal nature of this disease in ventilated, critically ill patients. No nosocomial transmission of the virus was documented for all team members. This protocol can be used to determine efficacy and safely execute a tracheostomy in COVID-19 patients. As information about COVID-19 continues to unfold, protocols for high risk procedures will need to fluidly evolve.},
 year = {2020}
}

Copy | Download

TY  - JOUR
T1  - Implementation of a Tracheostomy Protocol During the COVID-19 Pandemic
AU  - Brian Temple
AU  - Michael Segal
AU  - Vijay A Singh
AU  - Daniel Galvin
AU  - Robert Kerr
AU  - Robert Zingale
Y1  - 2020/07/17
PY  - 2020
N1  - https://doi.org/10.11648/j.ijcts.20200603.11
DO  - 10.11648/j.ijcts.20200603.11
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 38
EP  - 43
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20200603.11
AB  - The coronavirus SARS-CoV-2 (COVID-19) pandemic has offered a unique set of challenges to the medical community often requiring prolonged treatment algorithms. The illness, afflicting more than 7.3 million people worldwide with estimates of 5-20% requiring critical care, has become a burden on the healthcare community. These critically ill patients who acquire the severe form of the disease routinely require prolonged invasive mechanical ventilation. The questions then arise, “when and for whom does tracheostomy become indicated,” and “how to safely perform a tracheostomy in this patient population.” With consideration to aerosolization of the virus, we have derived and instituted a protocol at a community institution with aims of reducing provider risk while safely performing a tracheostomy. An open tracheostomy was performed at bedside, within a negative pressure intensive care unit (ICU) setting, utilizing a closed-circuit technique as described in this text. A total of 17 tracheostomies were performed employing the described technique. Minimal complications were noted throughout the study and no adverse oxygenation events were observed with an average total apneic time of 106 seconds. An acceptable mortality rate of 23% was observed given the lethal nature of this disease in ventilated, critically ill patients. No nosocomial transmission of the virus was documented for all team members. This protocol can be used to determine efficacy and safely execute a tracheostomy in COVID-19 patients. As information about COVID-19 continues to unfold, protocols for high risk procedures will need to fluidly evolve.
VL  - 6
IS  - 3
ER  -

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