Open AccessCritical Care Guidance for Tracheostomy Care During the COVID-19 Pandemic: A Global, Multidisciplinary Approach
Author(s) -
Vinciya Pandian,
Linda Morris,
Martin B. Brodsky,
James C. Lynch,
Brian Walsh,
Cynda Hylton Rushton,
Jane Phillips,
Alphonsa Rahman,
Troy Derose,
Leah D Lambe,
Lionel Lami,
Sarah Pui Man Wu,
Francisco Paredes Garza,
Simona Maiani,
Andrea Zavalis,
Kafilat Ajoke Okusanya,
Patrick A. Palmieri,
Brendan A. McGrath,
Paolo Pelosi,
Mary Lou Sole,
Patricia M. Davidson,
Michael Brenner
Publication year - 2020
Publication title -
american journal of critical care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.592
H-Index - 81
eISSN - 1937-710X
pISSN - 1062-3264
DOI - 10.4037/ajcc2020561
Subject(s) - medicine , personal protective equipment , pandemic , health care , intensive care medicine , multidisciplinary approach , infection control , covid-19 , medical emergency , transmission (telecommunications) , medline , safeguarding , nursing , infectious disease (medical specialty) , disease , pathology , social science , engineering , sociology , political science , law , electrical engineering , economics , economic growth
Purpose Critical care nurses caring for patients with a tracheostomy are at high risk because of the predilection of SARS-CoV-2 for respiratory and mucosal surfaces. This review identifies patient-centered practices that ensure safety and reduce risk of infection transmission to health care workers during the coronavirus disease 2019 (COVID-19) pandemic. Methods Consensus statements, guidelines, institutional recommendations, and scientific literature on COVID-19 and previous outbreaks were reviewed. A global interdisciplinary team analyzed and prioritized findings via electronic communications and video conferences to develop consensus recommendations. Results Aerosol-generating procedures are commonly performed by nurses and other health care workers, most notably during suctioning, tracheostomy tube changes, and stoma care. Patient repositioning, readjusting circuits, administering nebulized medications, and patient transport also present risks. Standard personal protective equipment includes an N95/FFP3 mask with or without surgical masks, gloves, goggles, and gown when performing aerosol-generating procedures for patients with known or suspected COVID-19. Viral testing of bronchial aspirate via tracheostomy may inform care providers when determining the protective equipment required. The need for protocols to reduce risk of transmission of infection to nurses and other health care workers is evident. Conclusion Critical care nurses and multidisciplinary teams often care for patients with a tracheostomy who are known or suspected to have COVID-19. Appropriate care of these patients relies on safeguarding the health care team. The practices described in this review may greatly reduce risk of infectious transmission.