Technique
Our unit has opted to undertake all tracheostomies surgically for two reasons. The group believed that control of aerosol generation could be more effective, with minor modifications to surgical and anaesthetic techniques. Secondly, the anticipated increase in workload for critical care staff during the COVID-19 pandemic led to the group opting for a surgical approach that would share the burden of managing these patients across different teams.
Usual practice when placing a surgical tracheostomy is that there are minimal interruptions to mechanical ventilation. Aerosolisation of respiratory secretions into the area surrounding the operating field is likely during endotracheal tube repositioning, tracheal window formation and exchange of endotracheal tube for tracheostomy tube. To limit the exposure of healthcare workers involved in the procedure to unnecessary risk ventilation is stopped entirely during these steps. The endotracheal tube is clamped when the ventilator circuit is broken. Suctioning of the trachea is performed using closed in-line suctioning apparatus.