Discussion
Local and national guidance have helped in creating best practice models
for teams to adhere to across the UK, reassuring teams of their personal
safety when performing aerosol generating procedures in COVID -19
patients.
The recent emergence of this disease in the UK has meant that robust
outcome data is yet to be established. Although there has been a recent
series of 51 patients undergoing percutaneous tracheostomy [8],
there have been no published series of solely surgical tracheostomy
outcomes in COVID-19.
There was good adherence to our local and national guidance for both
timing and level of ventilatory support prior to tracheostomy suggesting
robust processes locally to ensure tracheostomies are being performed
appropriately [1].
We believe modifications to the standard surgical tracheostomy technique
represents a safe technique for patients and staff alike. Although there
is no definite evidence to guide which of percutaneous or surgical
techniques are less aerosol generating, no staff members involved in our
series or that of Takhar et al have tested positive for COVID-19 in the
post-operative period [9].
Whilst this initial study is limited in terms of numbers and follow up
duration, there are many positive aspects which support the continued
use of the national guidance. Complication rates were low (15%) and
comparable to the published literature [10]. This early data on
surgical tracheostomy outcomes, demonstrates that it is a safe technique
in this cohort of patients and should help to give hospitals around the
country confidence to continue to perform this procedure, via the
technique they are most comfortable with, whilst further evidence is
collected.
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