TY - JOUR
T1 - Multidisciplinary Safety Recommendations After Tracheostomy During COVID-19 Pandemic
T2 - State of the Art Review
AU - Meister, Kara D.
AU - Pandian, Vinciya
AU - Hillel, Alexander T.
AU - Walsh, Brian K.
AU - Brodsky, Martin B.
AU - Balakrishnan, Karthik
AU - Best, Simon R.
AU - Chinn, Steven B.
AU - Cramer, John D.
AU - Graboyes, Evan M.
AU - McGrath, Brendan A.
AU - Rassekh, Christopher H.
AU - Bedwell, Joshua R.
AU - Brenner, Michael J.
N1 - Publisher Copyright:
© American Academy of Otolaryngology–Head and Neck Surgery Foundation 2020.
PY - 2021/5
Y1 - 2021/5
N2 - Objective: In the chronic phase of the COVID-19 pandemic, questions have arisen regarding the care of patients with a tracheostomy and downstream management. This review addresses gaps in the literature regarding posttracheostomy care, emphasizing safety of multidisciplinary teams, coordinating complex care needs, and identifying and managing late complications of prolonged intubation and tracheostomy. Data Sources: PubMed, Cochrane Library, Scopus, Google Scholar, institutional guidance documents. Review Methods: Literature through June 2020 on the care of patients with a tracheostomy was reviewed, including consensus statements, clinical practice guidelines, institutional guidance, and scientific literature on COVID-19 and SARS-CoV-2 virology and immunology. Where data were lacking, expert opinions were aggregated and adjudicated to arrive at consensus recommendations. Conclusions: Best practices in caring for patients after a tracheostomy during the COVID-19 pandemic are multifaceted, encompassing precautions during aerosol-generating procedures; minimizing exposure risks to health care workers, caregivers, and patients; ensuring safe, timely tracheostomy care; and identifying and managing laryngotracheal injury, such as vocal fold injury, posterior glottic stenosis, and subglottic stenosis that may affect speech, swallowing, and airway protection. We present recommended approaches to tracheostomy care, outlining modifications to conventional algorithms, raising vigilance for heightened risks of bleeding or other complications, and offering recommendations for personal protective equipment, equipment, care protocols, and personnel. Implications for Practice: Treatment of patients with a tracheostomy in the COVID-19 pandemic requires foresight and may rival procedural considerations in tracheostomy in their complexity. By considering patient-specific factors, mitigating transmission risks, optimizing the clinical environment, and detecting late manifestations of severe COVID-19, clinicians can ensure due vigilance and quality care.
AB - Objective: In the chronic phase of the COVID-19 pandemic, questions have arisen regarding the care of patients with a tracheostomy and downstream management. This review addresses gaps in the literature regarding posttracheostomy care, emphasizing safety of multidisciplinary teams, coordinating complex care needs, and identifying and managing late complications of prolonged intubation and tracheostomy. Data Sources: PubMed, Cochrane Library, Scopus, Google Scholar, institutional guidance documents. Review Methods: Literature through June 2020 on the care of patients with a tracheostomy was reviewed, including consensus statements, clinical practice guidelines, institutional guidance, and scientific literature on COVID-19 and SARS-CoV-2 virology and immunology. Where data were lacking, expert opinions were aggregated and adjudicated to arrive at consensus recommendations. Conclusions: Best practices in caring for patients after a tracheostomy during the COVID-19 pandemic are multifaceted, encompassing precautions during aerosol-generating procedures; minimizing exposure risks to health care workers, caregivers, and patients; ensuring safe, timely tracheostomy care; and identifying and managing laryngotracheal injury, such as vocal fold injury, posterior glottic stenosis, and subglottic stenosis that may affect speech, swallowing, and airway protection. We present recommended approaches to tracheostomy care, outlining modifications to conventional algorithms, raising vigilance for heightened risks of bleeding or other complications, and offering recommendations for personal protective equipment, equipment, care protocols, and personnel. Implications for Practice: Treatment of patients with a tracheostomy in the COVID-19 pandemic requires foresight and may rival procedural considerations in tracheostomy in their complexity. By considering patient-specific factors, mitigating transmission risks, optimizing the clinical environment, and detecting late manifestations of severe COVID-19, clinicians can ensure due vigilance and quality care.
KW - COVID-19
KW - DVT
KW - FFP3
KW - N95
KW - PE
KW - SARS
KW - SARS-CoV-2
KW - VTE
KW - aerosol generating procedure
KW - deep venous thrombosis
KW - health care worker safety
KW - laryngectomy
KW - laryngotracheal injury
KW - pandemic
KW - patient safety and quality improvement
KW - pulmonary embolism
KW - respiratory
KW - subglottic stenosis
KW - suction
KW - tracheal stenosis; tracheocutaneous fistula
KW - tracheostomy
KW - tracheotomy
KW - venous thromboembolism
UR - http://www.scopus.com/inward/record.url?scp=85091364719&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85091364719&partnerID=8YFLogxK
U2 - 10.1177/0194599820961990
DO - 10.1177/0194599820961990
M3 - Review article
C2 - 32960148
AN - SCOPUS:85091364719
SN - 0194-5998
VL - 164
SP - 984
EP - 1000
JO - Otolaryngology - Head and Neck Surgery (United States)
JF - Otolaryngology - Head and Neck Surgery (United States)
IS - 5
ER -