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Emergency management plan for paediatric patients with tracheostomies during the COVID-19 pandemic
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  • Beckie Petulla,
  • Emma Ho ,
  • Emma Sov,
  • Marlene Soma
Beckie Petulla
Sydney Children's Hospital Randwick
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Emma Ho
Sydney Children's Hospital Randwick
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Emma Sov
Sydney Children's Hospital Randwick
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Marlene Soma
Sydney Children's Hospital Randwick
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Objectives: Paediatric patients living with tracheostomies are a medically vulnerable group. During the COVID-19 pandemic, there may be apprehension about their susceptibility to SARS-CoV-2 infection with unknown consequences. Healthcare workers managing this cohort can be anxious about viral transmission from respiratory secretions and aerosols emerging from the open airway. Our objective is to share a systematic approach to minimise incidental mismanagement, avoid iatrogenic airway injury, reduce aerosolisation and decrease staff exposure when treating these patients. Methods: A COVID-19 emergency management plan was created for paediatric patients with tracheostomies in the event of presentation with unknown, suspected or proven SARS-CoV-2 infection. Three documents were developed: a generic tracheostomy management plan detailing troubleshooting measures to reduce air leak from around the tube; a personalised management plan with customised recommendations; a guide for tracheostomy tube change with emphasis on minimising aerosol production. Results: Our plan was distributed to 31 patients (age range 11 months - 17 years) including 23 (74.2%) with uncuffed tubes and 9 (29%) on long term ventilation. There have been 10 occasions in which the plan was utilised and influenced care, including 4 situations where successful troubleshooting avoided tube manipulation and 6 situations where an uncuffed tube was safely replaced with a pre-selected cuffed tube to reduce air leak. Conclusions: A structured approach to emergency presentations during the COVID-19 pandemic may safeguard paediatric patients from unnecessary manipulation of their tracheostomy tube and airway trauma, as well as provide guidance to minimise viral exposure and allow provision of expeditious care.

Peer review status:IN REVISION

29 Oct 2021Submitted to Pediatric Pulmonology
29 Oct 2021Assigned to Editor
29 Oct 2021Submission Checks Completed
08 Nov 2021Reviewer(s) Assigned
10 Jan 2022Review(s) Completed, Editorial Evaluation Pending
10 Jan 2022Editorial Decision: Revise Major