Key points:
- Covid-19 patients are often intubated for a long time, with indication
to tracheotomy, at high risk for transmitting the disease.
- Open surgical sub-isthmic tracheotomy above the ETT cuff should always
be performed on fully paralyzed patients, to minimize the airflow and
aerosolisation from alveolar space.
- Other technical refinements described in the paper are finalized to
reduce the “no seal” time from ETT cuff deflation and cannula cuff
inflation, which can become shorter than 2 seconds.
- Risks connected to tracheotomy in Covid-19, a conceptually extremely
hazardous procedure, can be significantly reduced by rational measures
and teamwork.
Dear Editor,
Tracheotomy, more than any other procedure, increases the risk of
transmission from Covid-19 patients to operators because of
aerosolisation1: a cough with an opened trachea and no
seal from a cuff is the worst exposure situation.
We describe our experience with tracheotomy in Covid-19, analyzing steps
at risk and describing technical refinements to minimize such risk.