Initial steps
A multidisciplinary steering group, initiated by consultants from the
Adult Critical Care Unit (ACCU), maxillofacial surgery and anaesthesia,
and joined by ENT, created a standard operating procedure (SOP) for all
tracheostomies proceeding during the pandemic period (Figure 1). Senior
nursing staff were also consulted. The group considered risks to staff
and patients inherent in both percutaneous and surgical techniques and
how techniques might be modified to mitigate risks. Deviations from
usual institutional practice were set out. An early version of our local
SOP was subsequently adopted by the British Laryngological Association
[1] and we have subsequently developed our local SOP further, based
on our evolving experience (Figure 1).