Surgical Tracheostomy Protocol In COVID-19 Patients
BLA TRACHEOSTOMY GUIDELINE
Applies to all tracheostomies undertaken (whether known Covid-19 or not due to high-risk nature of the procedure and increasing prevalence in the community). This guideline refers mainly to open surgical tracheostomy, although in some units percutaneous procedures may be preferred. When choosing a technique, it is critical that the operator is highly experienced in whichever route is chosen to reduce time and potential complications.
Preparation
• One tracheostomy per theatre session (to be kept under review)
• Two ITU consultants to make a decision after discussion with the surgical team and senior anaesthetist. The patient should have a good expectation of achieving full recovery and an independent lifestyle.
• Unlikely to be indicated after less than 14 days of ventilation
• Consider trial of extubation – i.e. high threshold to perform tracheostomy
• The patient should be apyrexial with falling inflammatory markers (a surgical procedure undertaken during viraemia risks precipitating a clinical deterioration)
• Two Negative viral swabs (48 hrs apart) preferred, but it is accepted this may not always be possible
• The patient should be requiring PEEP ≤10cmH2O and FiO2 ≤0.4 (to promote tolerance to periods of apnoea and potential derecruitment)
• Haemodynamically stable with minimal pressor requirement
• Review CXR to ascertain starting distance of ETT tip above carina
• Patient fasted for 6 hours
• Consent form 4 completed by ITU.
OT Team
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