Successful Tracheotomy during SARS
There are multiple reports3,4of safely performing tracheotomy on SARS patients without infecting healthcare workers. Standard processes included strict infection control measures, seamless and regulated surgical intervention, and if possible delayed (> 30 days from diagnosis) tracheotomy in patients who had been SARS positive. Infection control measures (in addition to standard airborne and contact precautions) taken during these procedures included: double gowning, PAPR suits, double gloving, a changing room after the procedure (ante room), performing the procedure in a negative pressure room. The surgical personnel were the most experienced available to minimize operating/exposure time. Patients were completely paralyzed to minimize air movement and coughing and thus viral dissemination via aerosolization. Prior to the procedure a trial run was completed to ensure maximum efficiency of the procedure. Just prior to airway entry, the patients were pre-oxygenated, ventilation was held, and the cuff on the endotracheal tube was dropped in order to minimize air movement over the respiratory mucosa. While the patient was apneic, the tracheotomy incision was performed. Open suctioning of the trachea was avoided. Instead, a closed suctioning system with a viral filter was used3 4.