Tracheostomies in Patients with SARS COV-2 Safety Protocol of the Head and Neck Equipment

Abstract

Introduction: The SARS-CoV-2 virus appeared in the city of Wuhan, a province of Hubei in China, at the end of December 2019, as an outbreak of viral pneumonia because of a new type of coronavirus B, the was called COVID-19; later, officially, the virus will be declared as SARS-Cov-2. Head and neck surgeons perform tracheostomies in patients with COVID-19, which results in increased aerosolization exposure. The present work aims to describe the surgical technique of open tracheostomy with adequate protection of the head and neck surgery team in patients with SAR-CoV-2.

Methods: This study was carried out at the La Trinidad Teaching Medical Center, in charge of the head and neck service. The multidisciplinary team was made up of head and neck surgeons, intensivists, and specialist nurses in the area. The technique was open tracheostomy in patients admitted to the intensive care unit with a positive result for SARS-CoV-2 infection, in the period between August 2020 to August 2021, after discussion with the multidisciplinary team and with the consent of the patient’s relatives, ideally between the 15th and 21st.

Results: 14 open tracheostomies were performed; the first tracheostomy was performed on 01 / 08/2020 and the last one on 08/28/2021. All tracheostomies were performed in the intensive care unit. The medical staff was the minimum possible and consisted of: Head and neck surgeon, first and second assistant, scrub nurse, intensivist, intensive care resident and intensive care nurse. In all cases, proper hand hygiene and placement of personal protective equipment was carried out.

Conclusions: Keeping patients relaxed during the procedure, deflating the endotracheal tube cuff, and closing the circuit prior to the incision and quickly after the incision in the trachea and inserting the tracheostoma, connecting the closed-circuit system, seems to be a technique that preserves the safety of the surgical team.