French consensus regarding precautions during tracheostomy and post-tracheostomy care in the context of COVID-19 pandemic
Identifieur interne : 000B64 ( Pmc/Corpus ); précédent : 000B63; suivant : 000B65French consensus regarding precautions during tracheostomy and post-tracheostomy care in the context of COVID-19 pandemic
Auteurs : P. Schultz ; J.-B. Morvan ; N. Fakhry ; S. Morinière ; S. Vergez ; C. Lacroix ; S. Bartier ; B. Barry ; E. Babin ; V. Couloigner ; I. AtallahSource :
- European Annals of Otorhinolaryngology, Head and Neck Diseases [ 1879-7296 ] ; 2020.
Abstract
Tracheostomy post-tracheostomy care are regarded as at high risk for contamination of health care professionals with the new coronavirus (SARS-CoV-2). Considering the rapid spread of the infection, all patients in France must be considered as potentially infected by the virus. Nevertheless, patients without clinical or radiological (CT scan) markers of COVID-19, and with negative nasopharyngeal sample within 24 h of surgery, are at low risk of being infected. Instructions for personal protection include specific wound dressings and decontamination of all material used. The operating room should be ventilated after each tracheostomy and the pressure of the room should be neutral or negative. Percutaneous tracheostomy is to be preferred over surgical cervicotomy in order to reduce aerosolization and to avoid moving patients from the intensive care unit to the operating room. Ventilation must be optimized during the procedure, to limit patient oxygen desaturation. Drug assisted neuromuscular blockage is advised to reduce coughing during tracheostomy tube insertion. An experienced team is mandatory to secure and accelerate the procedure as well as to reduce risk of contamination.
Url:
DOI: 10.1016/j.anorl.2020.04.006
PubMed: NONE
PubMed Central: 7144608
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PMC:7144608Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">French consensus regarding precautions during tracheostomy and post-tracheostomy care in the context of COVID-19 pandemic</title><author><name sortKey="Schultz, P" sort="Schultz, P" uniqKey="Schultz P" first="P." last="Schultz">P. Schultz</name><affiliation><nlm:aff id="aff0005">Service d’ORL et de chirurgie cervico-faciale, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg, France</nlm:aff></affiliation></author><author><name sortKey="Morvan, J B" sort="Morvan, J B" uniqKey="Morvan J" first="J.-B." last="Morvan">J.-B. Morvan</name><affiliation><nlm:aff id="aff0010">Service d’ORL et de chirurgie cervico-faciale, hôpital d’instruction des armées Saint-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France</nlm:aff></affiliation></author><author><name sortKey="Fakhry, N" sort="Fakhry, N" uniqKey="Fakhry N" first="N." last="Fakhry">N. Fakhry</name><affiliation><nlm:aff id="aff0015">Service d’ORL et de chirurgie cervico-faciale, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France</nlm:aff></affiliation></author><author><name sortKey="Moriniere, S" sort="Moriniere, S" uniqKey="Moriniere S" first="S." last="Morinière">S. Morinière</name><affiliation><nlm:aff id="aff0020">Service d’ORL et de chirurgie cervico-faciale, CHRU Bretonneau-Tours, 2, boulevard Tonnellé, 37044 Tours, France</nlm:aff></affiliation></author><author><name sortKey="Vergez, S" sort="Vergez, S" uniqKey="Vergez S" first="S." last="Vergez">S. Vergez</name><affiliation><nlm:aff id="aff0025">Service d’ORL et de chirurgie cervico-faciale, CHU Rangueil-Larrey, 24, chemin de Pourvourville, 31400 Toulouse, France</nlm:aff></affiliation><affiliation><nlm:aff id="aff0030">Service de chirurgie, Institut universitaire du cancer de Toulouse, 1, avenue Irène Joliot-Curie, 31100 Toulouse, France</nlm:aff></affiliation></author><author><name sortKey="Lacroix, C" sort="Lacroix, C" uniqKey="Lacroix C" first="C." last="Lacroix">C. Lacroix</name><affiliation><nlm:aff id="aff0035">Service d’ORL et de chirurgie cervico-faciale, hôpital européen Georges-Pompidou, Assistance publique–Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France</nlm:aff></affiliation></author><author><name sortKey="Bartier, S" sort="Bartier, S" uniqKey="Bartier S" first="S." last="Bartier">S. Bartier</name><affiliation><nlm:aff id="aff0040">Service d’ORL et de chirurgie cervico-faciale, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil, France</nlm:aff></affiliation></author><author><name sortKey="Barry, B" sort="Barry, B" uniqKey="Barry B" first="B." last="Barry">B. Barry</name><affiliation><nlm:aff id="aff0045">Service d’ORL et de chirurgie cervico-faciale, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France</nlm:aff></affiliation></author><author><name sortKey="Babin, E" sort="Babin, E" uniqKey="Babin E" first="E." last="Babin">E. Babin</name><affiliation><nlm:aff id="aff0050">Service d’ORL et de chirurgie cervico-faciale, CHU Caen Normandie, avenue Côte de Nacre, 14000 Caen, France</nlm:aff></affiliation></author><author><name sortKey="Couloigner, V" sort="Couloigner, V" uniqKey="Couloigner V" first="V." last="Couloigner">V. Couloigner</name><affiliation><nlm:aff id="aff0055">Service d’ORL et de chirurgie cervico-faciale pédiatriques, hôpital Necker-Enfants–Malades, Assistance publique–Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris, France</nlm:aff></affiliation></author><author><name sortKey="Atallah, I" sort="Atallah, I" uniqKey="Atallah I" first="I." last="Atallah">I. Atallah</name><affiliation><nlm:aff id="aff0060">Service d’ORL et de chirurgie cervico-faciale, CHU Grenoble Alpes, boulevard de la Chantourne, 38700 La Tronche, France</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmc">7144608</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144608</idno><idno type="RBID">PMC:7144608</idno><idno type="doi">10.1016/j.anorl.2020.04.006</idno><idno type="pmid">NONE</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000B64</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000B64</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">French consensus regarding precautions during tracheostomy and post-tracheostomy care in the context of COVID-19 pandemic</title><author><name sortKey="Schultz, P" sort="Schultz, P" uniqKey="Schultz P" first="P." last="Schultz">P. Schultz</name><affiliation><nlm:aff id="aff0005">Service d’ORL et de chirurgie cervico-faciale, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg, France</nlm:aff></affiliation></author><author><name sortKey="Morvan, J B" sort="Morvan, J B" uniqKey="Morvan J" first="J.-B." last="Morvan">J.-B. Morvan</name><affiliation><nlm:aff id="aff0010">Service d’ORL et de chirurgie cervico-faciale, hôpital d’instruction des armées Saint-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France</nlm:aff></affiliation></author><author><name sortKey="Fakhry, N" sort="Fakhry, N" uniqKey="Fakhry N" first="N." last="Fakhry">N. Fakhry</name><affiliation><nlm:aff id="aff0015">Service d’ORL et de chirurgie cervico-faciale, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France</nlm:aff></affiliation></author><author><name sortKey="Moriniere, S" sort="Moriniere, S" uniqKey="Moriniere S" first="S." last="Morinière">S. Morinière</name><affiliation><nlm:aff id="aff0020">Service d’ORL et de chirurgie cervico-faciale, CHRU Bretonneau-Tours, 2, boulevard Tonnellé, 37044 Tours, France</nlm:aff></affiliation></author><author><name sortKey="Vergez, S" sort="Vergez, S" uniqKey="Vergez S" first="S." last="Vergez">S. Vergez</name><affiliation><nlm:aff id="aff0025">Service d’ORL et de chirurgie cervico-faciale, CHU Rangueil-Larrey, 24, chemin de Pourvourville, 31400 Toulouse, France</nlm:aff></affiliation><affiliation><nlm:aff id="aff0030">Service de chirurgie, Institut universitaire du cancer de Toulouse, 1, avenue Irène Joliot-Curie, 31100 Toulouse, France</nlm:aff></affiliation></author><author><name sortKey="Lacroix, C" sort="Lacroix, C" uniqKey="Lacroix C" first="C." last="Lacroix">C. Lacroix</name><affiliation><nlm:aff id="aff0035">Service d’ORL et de chirurgie cervico-faciale, hôpital européen Georges-Pompidou, Assistance publique–Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France</nlm:aff></affiliation></author><author><name sortKey="Bartier, S" sort="Bartier, S" uniqKey="Bartier S" first="S." last="Bartier">S. Bartier</name><affiliation><nlm:aff id="aff0040">Service d’ORL et de chirurgie cervico-faciale, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil, France</nlm:aff></affiliation></author><author><name sortKey="Barry, B" sort="Barry, B" uniqKey="Barry B" first="B." last="Barry">B. Barry</name><affiliation><nlm:aff id="aff0045">Service d’ORL et de chirurgie cervico-faciale, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France</nlm:aff></affiliation></author><author><name sortKey="Babin, E" sort="Babin, E" uniqKey="Babin E" first="E." last="Babin">E. Babin</name><affiliation><nlm:aff id="aff0050">Service d’ORL et de chirurgie cervico-faciale, CHU Caen Normandie, avenue Côte de Nacre, 14000 Caen, France</nlm:aff></affiliation></author><author><name sortKey="Couloigner, V" sort="Couloigner, V" uniqKey="Couloigner V" first="V." last="Couloigner">V. Couloigner</name><affiliation><nlm:aff id="aff0055">Service d’ORL et de chirurgie cervico-faciale pédiatriques, hôpital Necker-Enfants–Malades, Assistance publique–Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris, France</nlm:aff></affiliation></author><author><name sortKey="Atallah, I" sort="Atallah, I" uniqKey="Atallah I" first="I." last="Atallah">I. Atallah</name><affiliation><nlm:aff id="aff0060">Service d’ORL et de chirurgie cervico-faciale, CHU Grenoble Alpes, boulevard de la Chantourne, 38700 La Tronche, France</nlm:aff></affiliation></author></analytic><series><title level="j">European Annals of Otorhinolaryngology, Head and Neck Diseases</title><idno type="ISSN">1879-7296</idno><idno type="eISSN">1879-730X</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Tracheostomy post-tracheostomy care are regarded as at high risk for contamination of health care professionals with the new coronavirus (SARS-CoV-2). Considering the rapid spread of the infection, all patients in France must be considered as potentially infected by the virus. Nevertheless, patients without clinical or radiological (CT scan) markers of COVID-19, and with negative nasopharyngeal sample within 24 h of surgery, are at low risk of being infected. Instructions for personal protection include specific wound dressings and decontamination of all material used. The operating room should be ventilated after each tracheostomy and the pressure of the room should be neutral or negative. Percutaneous tracheostomy is to be preferred over surgical cervicotomy in order to reduce aerosolization and to avoid moving patients from the intensive care unit to the operating room. Ventilation must be optimized during the procedure, to limit patient oxygen desaturation. Drug assisted neuromuscular blockage is advised to reduce coughing during tracheostomy tube insertion. An experienced team is mandatory to secure and accelerate the procedure as well as to reduce risk of contamination.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Wei, W I" uniqKey="Wei W">W.I. Wei</name></author><author><name sortKey="Tuen, H H" uniqKey="Tuen H">H.H. Tuen</name></author><author><name sortKey="Ng, R W" uniqKey="Ng R">R.W. Ng</name></author><author><name sortKey="Lam, L K" uniqKey="Lam L">L.K. Lam</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="To, K K W" uniqKey="To K">K.K.-W. To</name></author><author><name sortKey="Tsang, O T Y" uniqKey="Tsang O">O.T.-Y. Tsang</name></author><author><name sortKey="Leung, W S" uniqKey="Leung W">W.-S. Leung</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Abe, T" uniqKey="Abe T">T. Abe</name></author><author><name sortKey="Madotto, T" uniqKey="Madotto T">T. Madotto</name></author><author><name sortKey="Pham, T" uniqKey="Pham T">T. Pham</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Phua, G C" uniqKey="Phua G">G.C. Phua</name></author><author><name sortKey="Govert, J" uniqKey="Govert J">J. Govert</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Morvan, J B" uniqKey="Morvan J">J.B. Morvan</name></author><author><name sortKey="Pasquier, Y" uniqKey="Pasquier Y">Y. Pasquier</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="other"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Eur Ann Otorhinolaryngol Head Neck Dis</journal-id><journal-id journal-id-type="iso-abbrev">Eur Ann Otorhinolaryngol Head Neck Dis</journal-id><journal-title-group><journal-title>European Annals of Otorhinolaryngology, Head and Neck Diseases</journal-title></journal-title-group><issn pub-type="ppub">1879-7296</issn><issn pub-type="epub">1879-730X</issn><publisher><publisher-name>Published by Elsevier Masson SAS.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmc">7144608</article-id><article-id pub-id-type="publisher-id">S1879-7296(20)30096-X</article-id><article-id pub-id-type="doi">10.1016/j.anorl.2020.04.006</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>French consensus regarding precautions during tracheostomy and post-tracheostomy care in the context of COVID-19 pandemic</article-title></title-group><contrib-group><contrib contrib-type="author" id="aut0005"><name><surname>Schultz</surname><given-names>P.</given-names></name><email>philippe.schultz@chru-strasbourg.fr</email><xref rid="aff0005" ref-type="aff">a</xref><xref rid="cor0005" ref-type="corresp">*</xref></contrib><contrib contrib-type="author" id="aut0010"><name><surname>Morvan</surname><given-names>J.-B.</given-names></name><xref rid="aff0010" ref-type="aff">b</xref></contrib><contrib contrib-type="author" id="aut0015"><name><surname>Fakhry</surname><given-names>N.</given-names></name><xref rid="aff0015" ref-type="aff">c</xref></contrib><contrib contrib-type="author" id="aut0020"><name><surname>Morinière</surname><given-names>S.</given-names></name><xref rid="aff0020" ref-type="aff">d</xref></contrib><contrib contrib-type="author" id="aut0025"><name><surname>Vergez</surname><given-names>S.</given-names></name><xref rid="aff0025" ref-type="aff">e</xref><xref rid="aff0030" ref-type="aff">f</xref></contrib><contrib contrib-type="author" id="aut0030"><name><surname>Lacroix</surname><given-names>C.</given-names></name><xref rid="aff0035" ref-type="aff">g</xref></contrib><contrib contrib-type="author" id="aut0035"><name><surname>Bartier</surname><given-names>S.</given-names></name><xref rid="aff0040" ref-type="aff">h</xref></contrib><contrib contrib-type="author" id="aut0040"><name><surname>Barry</surname><given-names>B.</given-names></name><xref rid="aff0045" ref-type="aff">i</xref></contrib><contrib contrib-type="author" id="aut0045"><name><surname>Babin</surname><given-names>E.</given-names></name><xref rid="aff0050" ref-type="aff">j</xref></contrib><contrib contrib-type="author" id="aut0050"><name><surname>Couloigner</surname><given-names>V.</given-names></name><xref rid="aff0055" ref-type="aff">k</xref></contrib><contrib contrib-type="author" id="aut0055"><name><surname>Atallah</surname><given-names>I.</given-names></name><xref rid="aff0060" ref-type="aff">l</xref></contrib><contrib contrib-type="author"><collab>French Society of Otorhinolaryngology, Head, Neck Surgery (SFORL)</collab></contrib><contrib contrib-type="author"><collab>French Society of Head, Neck Carcinology (SFCCF)</collab></contrib></contrib-group><aff id="aff0005"><label>a</label>Service d’ORL et de chirurgie cervico-faciale, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg, France</aff><aff id="aff0010"><label>b</label>Service d’ORL et de chirurgie cervico-faciale, hôpital d’instruction des armées Saint-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France</aff><aff id="aff0015"><label>c</label>Service d’ORL et de chirurgie cervico-faciale, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France</aff><aff id="aff0020"><label>d</label>Service d’ORL et de chirurgie cervico-faciale, CHRU Bretonneau-Tours, 2, boulevard Tonnellé, 37044 Tours, France</aff><aff id="aff0025"><label>e</label>Service d’ORL et de chirurgie cervico-faciale, CHU Rangueil-Larrey, 24, chemin de Pourvourville, 31400 Toulouse, France</aff><aff id="aff0030"><label>f</label>Service de chirurgie, Institut universitaire du cancer de Toulouse, 1, avenue Irène Joliot-Curie, 31100 Toulouse, France</aff><aff id="aff0035"><label>g</label>Service d’ORL et de chirurgie cervico-faciale, hôpital européen Georges-Pompidou, Assistance publique–Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France</aff><aff id="aff0040"><label>h</label>Service d’ORL et de chirurgie cervico-faciale, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94010 Créteil, France</aff><aff id="aff0045"><label>i</label>Service d’ORL et de chirurgie cervico-faciale, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France</aff><aff id="aff0050"><label>j</label>Service d’ORL et de chirurgie cervico-faciale, CHU Caen Normandie, avenue Côte de Nacre, 14000 Caen, France</aff><aff id="aff0055"><label>k</label>Service d’ORL et de chirurgie cervico-faciale pédiatriques, hôpital Necker-Enfants–Malades, Assistance publique–Hôpitaux de Paris, 149, rue de Sèvres, 75743 Paris, France</aff><aff id="aff0060"><label>l</label>Service d’ORL et de chirurgie cervico-faciale, CHU Grenoble Alpes, boulevard de la Chantourne, 38700 La Tronche, France</aff><author-notes><corresp id="cor0005"><label>⁎</label>Corresponding author. <email>philippe.schultz@chru-strasbourg.fr</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>9</day><month>4</month><year>2020</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>9</day><month>4</month><year>2020</year></pub-date><permissions><copyright-statement>© 2020 Published by Elsevier Masson SAS.</copyright-statement><copyright-year>2020</copyright-year><copyright-holder></copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract id="abs0005"><p>Tracheostomy post-tracheostomy care are regarded as at high risk for contamination of health care professionals with the new coronavirus (SARS-CoV-2). Considering the rapid spread of the infection, all patients in France must be considered as potentially infected by the virus. Nevertheless, patients without clinical or radiological (CT scan) markers of COVID-19, and with negative nasopharyngeal sample within 24 h of surgery, are at low risk of being infected. Instructions for personal protection include specific wound dressings and decontamination of all material used. The operating room should be ventilated after each tracheostomy and the pressure of the room should be neutral or negative. Percutaneous tracheostomy is to be preferred over surgical cervicotomy in order to reduce aerosolization and to avoid moving patients from the intensive care unit to the operating room. Ventilation must be optimized during the procedure, to limit patient oxygen desaturation. Drug assisted neuromuscular blockage is advised to reduce coughing during tracheostomy tube insertion. An experienced team is mandatory to secure and accelerate the procedure as well as to reduce risk of contamination.</p></abstract><kwd-group id="kwd0005"><title>Keywords</title><kwd>COVID-19</kwd><kwd>SARS-Cov-2</kwd><kwd>Pandemic</kwd><kwd>Tracheostomy</kwd><kwd>Care</kwd><kwd>Percutaneous</kwd></kwd-group></article-meta></front><body><sec id="sec0005"><label>1</label><title>Introduction</title><p id="par0005">The objective of this paper was to present information and advice to health care professionals concerning post-tracheostomy care in the COVID-19 pandemic context <xref rid="bib0045" ref-type="bibr">[1]</xref>, <xref rid="bib0050" ref-type="bibr">[2]</xref>. Procedures are susceptible to change on a day-to-day basis, as the epidemic evolves and according to the technical and human resources available and scientific evidence concerning SARS-Cov-2.</p></sec><sec id="sec0010"><label>2</label><title>Precautions to be taken when performing post-tracheostomy care</title><p id="par0010">Definition of patient COVID 19 positive and COVID 19 negative status before tracheostomy care.</p><p id="par0015">Confinement having been pronounced for the entire French territory, we can no longer, regarding the rapidity of the spread of this pandemic, consider any region or patient as not being at risk of excreting the SARS-Cov-2 virus. If the patient cannot, in the absence of clinical signs, have a chest CT-scan and a nasopharyngeal viral sample systematically before tracheostomy care, he/she should be considered as COVID-19 positive and the measures mentioned below should be applied in wherever possible:<list list-type="simple" id="lis0005"><list-item id="lsti0005"><label>•</label><p id="par0020">surgical hand scrub and/or friction with hydro-alcoholic solution before and after each treatment;</p></list-item><list-item id="lsti0010"><label>•</label><p id="par0025">wear surgical gown and an overall that you change with your clothes at the end of the day;</p></list-item><list-item id="lsti0015"><label>•</label><p id="par0030">dressing and undressing must be done within the room. This dressing consists of:</p></list-item></list><list list-type="simple" id="lis0010"><list-item id="lsti0020"><label>∘</label><p id="par0035">an apron or a gown,</p></list-item><list-item id="lsti0025"><label>∘</label><p id="par0040">head protection with a hood cap rather than with a simple cap in order to better prevent any skin exposure,</p></list-item><list-item id="lsti0030"><label>∘</label><p id="par0045">FFP2 (N95) mask, protective glasses (possibly a dive mask), non-sterile gloves.</p></list-item></list></p><p id="par0050">Care givers must ensure that all the equipment, in particular the suction probe, is ready.</p><p id="par0055">For tracheostomy change, abundant spraying of 5% lidocaine into the tracheostomy tube, followed by an aspiration a few minutes later, is useful.</p><p id="par0060">If the patient is ventilated on the tracheostomy cannula, the anesthesiologist is asked to sedate the patient and perform a neuromuscular block to reduce any risk of coughing during the change of the cannula.</p><p id="par0065">All disposable material that has been in contact with the cannula or trachea (filters, suction probes) during the post-tracheostomy care must be eliminated through the infectious waste circuit.</p><p id="par0070">It is possible to use a room without air treatment provided that <xref rid="bib0055" ref-type="bibr">[3]</xref>:<list list-type="simple" id="lis0015"><list-item id="lsti0035"><label>•</label><p id="par0075">the bedroom door is kept closed;</p></list-item><list-item id="lsti0040"><label>•</label><p id="par0080">the patient's room is regularly ventilated;</p></list-item><list-item id="lsti0045"><label>•</label><p id="par0085">the air pressure in the room is maintained at zero.</p></list-item></list></p><p id="par0090">The duration of contagiousness is still uncertain but is probably more than 25 days <xref rid="bib0060" ref-type="bibr">[4]</xref>. These instructions are therefore valid throughout the management of the tracheotomized patient in the absence of validated data on virus excretion.</p><p id="par0095">When the post-tracheostomy care is performed at home or in a health care facility different from a hospital or a clinic, there has usually been no recent diagnostic assessment and the caregiver does not know whether his or her patient is infected with SARS-Cov2 or not. Hence, the following precautions are justified: FFP2 (N95) mask, protective glasses (possibly a dive mask), gown, cap or hood cap. All disposable material that has been in contact with the cannula or trachea (filters, suction probes) must be eliminated through the infectious waste circuit.</p><p id="par0100">In order to limit the risks of contamination of the patient's environment, the cannula should ideally be connected to an HME filter and covered by a surgical mask.</p></sec><sec id="sec0015"><label>3</label><title>Scheduled tracheostomy for a COVID-19 positive patient ventilated through an oro- or naso-tracheal tube</title><p id="par0105">It is critical to properly define when patients should be regarded as COVID-19 positive and COVID-19 negative in order to adapt the level of precautions when performing a tracheostomy. Confinement having been pronounced for the entire French territory, we can no longer currently or in view of the rapidity of the spread of this pandemic consider regions and patients without risk of infection with COVID 19.</p><p id="par0110">A patient can nevertheless be considered COVID-19 negative if, less than 24 hours before the procedure, there are no clinical manifestations of COVID-19, the Nasopharyngeal viral swab is negative and a chest-CT scan does not show bilateral peripheral alveolo-interstitial pneumonitis characteristic of COVID-19 infection.</p><sec id="sec0020"><label>3.1</label><title>Indications</title><p id="par0115">The indication for tracheostomy and the choice of the technique is a multidisciplinary medical decision made by the anesthesiologist in charge of the patient, in discussion with the ENT surgeon. In the context of the COVID-19 epidemic, the strategy adopted by more and more intensive care units consists in early tracheostomy to wean off intubation in selective patients with severe ARDS and transfer them to a ventilatory weaning unit thus creating room for new patients in ICU <xref rid="bib0065" ref-type="bibr">[5]</xref>, <xref rid="bib0070" ref-type="bibr">[6]</xref>, <xref rid="bib0075" ref-type="bibr">[7]</xref>.</p><p id="par0120">As far as possible (except absolute vital emergency) the tracheostomy must be done in an intubated patient.</p></sec><sec id="sec0025"><label>3.2</label><title>Techniques</title><p id="par0125">Two techniques are possible, the percutaneous technique and the cervicotomy technique. In accordance with the recommendations of French Anesthesiology and ENT Societies (SFAR and SFORL), in the COVID-19 context <xref rid="bib0050" ref-type="bibr">[2]</xref>, the percutaneous technique is to be preferred to reduce aerosolization and the risk of viral contamination for the nursing staff and to avoid having to move the patient to an operating room. The surgical technique is recommended in the event of anatomical contraindications, failure of the percutaneous technique or exhaustion of the percutaneous kits. Some technical points are recommended <xref rid="bib0080" ref-type="bibr">[8]</xref>:</p><p id="par0130">For the percutaneous technique, it requires:<list list-type="simple" id="lis0020"><list-item id="lsti0050"><label>•</label><p id="par0135">a remote fibroscope and video screen;</p></list-item><list-item id="lsti0055"><label>•</label><p id="par0140">optimizing oxygenation with 100% FiO<sub>2</sub> and adapting resistance levels with the fibroscope in the intubation probe due to a high risk of rapid desaturation and hypoxic cardiac arrest;</p></list-item><list-item id="lsti0060"><label>•</label><p id="par0145">a valve filter to insert the fibroscope in a closed circuit;</p></list-item><list-item id="lsti0065"><label>•</label><p id="par0150">patient apnea should be available on demand during stages which are at risk of aerosolization (at risk of spreading of the virus);</p></list-item><list-item id="lsti0070"><label>•</label><p id="par0155">if possible: a drug assisted neuromuscular block to reduce any risk of coughing.</p></list-item></list></p><p id="par0160">For the cervicotomy technique:<list list-type="simple" id="lis0030"><list-item id="lsti0080"><label>•</label><p id="par0165">minimize the use of electrocoagulation which can generate aerosolization of the virus when the trachea is open;</p></list-item><list-item id="lsti0085"><label>•</label><p id="par0170">when possible, use a sterile transparent interface between the patient and the surgeon, in order to limit the risk of contamination;</p></list-item><list-item id="lsti0090"><label>•</label><p id="par0175">if possible: carry out a drug assisted neuromuscular block to reduce any risk of coughing when opening the trachea;</p></list-item><list-item id="lsti0095"><label>•</label><p id="par0180">stop ventilation just before the trachea is incised;</p></list-item><list-item id="lsti0100"><label>•</label><p id="par0185">once the trachea is open and a cannula or endotracheal tube is inserted, connect the ventilation circuit to the cannula or the inserted endotracheal tube to resume ventilation of the patient;</p></list-item><list-item id="lsti0105"><label>•</label><p id="par0190">a reinforced endotracheal tube should be privileged in the tracheostomy if the patient requires ventilation in a prone position, and the cannula fixed to the skin;</p></list-item><list-item id="lsti0110"><label>•</label><p id="par0195">suture the cannula particularly if a prone position of the patient is planned.</p></list-item></list></p><p id="par0200">Tracheostomy under local anesthesia is not recommended. However, if it is necessary, it is recommended to inject 5 cc of Lidocaine 5% intratracheally through the tracheal wall, before the incision of the trachea is performed in order to reduce the cough reflex.</p><p id="par0205">Whichever the procedure, an experienced team must be in charge, especially when opening the trachea because patient desaturation is may be rapid.</p><p id="par0210">Health security tips encompass the drastic limitation f the number of caregivers present in the operating room, performing the tracheostomy procedure in the intensive care unit, if possible, in order to avoid contamination during transport of the patient to the operating room, and an appropriate surgical dressing which should consist of:<list list-type="simple" id="lis0025"><list-item id="lsti0115"><label>•</label><p id="par0215">head protection with a hood cap rather than with a simple cap in order to better prevent any skin exposure;</p></list-item><list-item id="lsti0120"><label>•</label><p id="par0220">full face shield/visor or airtight protective glasses (possibly dive masks);</p></list-item><list-item id="lsti0125"><label>•</label><p id="par0225">FFP2 (N95) or FFP3 mask;</p></list-item><list-item id="lsti0130"><label>•</label><p id="par0230">headlight covered by a head cap;</p></list-item><list-item id="lsti0135"><label>•</label><p id="par0235">an impermeable protective apron or an overcoat that must be worn under the surgical gown as it is not sterile.</p></list-item></list></p><p id="par0240">The team must ensure that all the necessary equipment (suction catheters, cannula…) is ready before starting the procedure.</p></sec></sec><sec id="sec0030"><title>Disclosure of interest</title><p id="par0245">The authors declare that they have no competing interest.</p></sec></body><back><ref-list id="bibl0005"><title>References</title><ref id="bib0045"><label>1</label><element-citation publication-type="journal" id="sbref0045"><person-group 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Protocole « Trachéotomie » EMR SSA-Mulhouse, Service de santé des armées</chapter-title><year>2020</year></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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