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.