Tracheostomy and the SARS epidemic
Experience with tracheostomy during the 2003 SARS epidemic offers a
framework for management strategy during the COVID-19 pandemic. In the
context of the current pandemic, Tay et al. conducted a literature
review of tracheostomies performed during the SARS epidemic and
concluded the following: (1) proper PPE (N95 mask, surgical cap, gown,
goggles, and gloves) is of utmost importance; (2) surgical tracheostomy
is preferably performed in a negative pressure ICU room by experienced
providers with meticulous planning and seamless communication; (3)
aerosol generation should be minimized through patient paralysis,
ventilation hold during creation of tracheal window, and utilization of
HEPA-filtered suction systems. This group identified no cases of SARS
transmission to the surgical team in 23
tracheostomies.7 Others have reported on PPE for
tracheostomy during the SARS epidemic, drawing similar conclusions that
use of N95 masks, face shields, fluid resistant gowns, and gloves
(contact and airborne precautions) provides effective protection against
transmission to providers during tracheostomy.8,9 N95
masks filter 99.5% of particles larger than 0.75µm, providing excellent
protection against airborne particles with a mask that is appropriately
fitted.10