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Letter to the Editor
Reply to Consensus document on tracheotomy in patients with COVID 19
Respuesta a Documento de consenso de la traqueotomía en pacientes con COVID 19
G. Pérez Acosta, D. González Romero, L. Santana-Cabrera
Corresponding author
lsancabx@gobiernodecanarias.org

Corresponding author.
Servicio de Medicina Intensiva del Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We recently read the consensus document published on this journal on tracheostomies performed in patients with COVID-19&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Our own experience tells us that in these patients&#44; lung affectation is associated with a high need for mechanical ventilation &#40;prolonged in most cases&#41;&#46; In our series &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>22&#41; duration extended beyond 20 days and 72&#37; of these patients &#40;a high percentage&#41; had to be tracheostomized&#44; which is consistent with the data reported by other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">COVID-19 is the product of respiratory droplet transmission&#44; which is why during these patients&#8217; hospital stay in the Intensive Care Unit&#44; caution should be the rule of thumb here because of the high risk of aerosol production in high-risk circumstances such as during intubation&#44; bronchoscopy&#44; and tracheostomy maneuvers&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although it is advisable to wait for a negative polymerase chain reaction test result before performing a tracheostomy&#44; on many occasions&#44; it needs to be performed before running this test when the airway cannot be secured&#46; That is why it is of paramount importance to be extra-cautious using personal protection equipment &#40;masks&#44; goggles&#44; scrubs&#44; and gloves&#41; and all those additional prophylactic measures that could act as a barrier&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">One of these measures is the &#171;aerosol box&#187;&#44; a methacrylate protection component originally designed to cover the patient&#8217;s face&#46; It can be accessed with both hands through 2 circular ports to perform orotracheal intubation maneuvers&#44; thus avoiding most of the aerosolization process generated&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">To perform tracheostomies we changed the structure of the box by adding an extra lateral port so we could have a direct and complete field of vision during the entire procedure&#44; access the trachea for fixation purposes&#44; facilitate tracheal puncture&#44; and the insertion of guidewires and dilators with the other hand &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">We believe that this component is cheap&#44; easy to make&#44; and should be considered an additional barrier while performing risky procedures with high production of aerosols like tracheostomies in patients with pneumonia due to COVID-19&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">This study received no funding whatsoever&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">None reported&#46;</p></span></span>"
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ISSN: 21735727
Original language: English
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