Perioperative considerations during tracheotomy of COVID-19
patients (Table 5)
Tracheotomy is a procedure which generates aerosols and should be
performed in negative-pressure isolation environments. Additionally,
closed airway circuits can prevent aerosol leakage, and should be used
except during controlled suctioning of the trachea. Antiviral/high
efficiency particulate air filters (HEPA) (e.g. Medtronic ventilator
filters) should be used at all times on ventilators during the clinical
care of COVID-19 patients. There should be two filters per ventilatory
circuit, one between the ventilator and its expiratory port as well as
another on the exhalation outlet of ventilator.
Diathermy should be avoided in tracheotomy as much as possible. There is
currently limited literature with regard to diathermy during tracheotomy
but coagulation with diathermy can produce small particles that may act
as a vehicle for the virus. While there are currently no reports of
virus incubating in muscles, the risk of increased viral aerosolization
cannot be completely ruled out. Surgical ties should considered instead,
especially when ligating the thyroid isthmus to expose the trachea.
Tracheotomy tube change should be delayed post-tracheotomy, with the
cuff kept inflated, in-line suction used, and avoidance of circuit
disconnection. This should be performed preferably when the patient is
no longer positive for COVID-19.