Phase of Care Considerations and Mitigation Strategies
Preoperative
Decrease in viral shedding: Testing available – De-isolation after two negative PCR tests in 24 hours Testing unavailable – Consider delaying tracheostomy until 21 days post-intubation
Perioperative
Location: ICU preferable- minimizes transport Negative pressure room Surgical Team: Minimize number of staff members during the procedure Use of appropriate PPE (airborne and contact precautions) Technical Considerations: Patient paralysis to prevent coughing Holding ventilation during tracheotomy until cuff inflated and circuit reconnected
Postoperative
Droplet precautions during tracheostomy care Use of closed, inline suctioning Closed circuit with HEPA filter if on mechanical ventilatory support HME when off ventilatory support Delaying the first tracheostomy change to one month or after de-isolation occurs for COVID-19 positive patients