We recently read the consensus document published on this journal on tracheostomies performed in patients with COVID-19.1

Our own experience tells us that in these patients, lung affectation is associated with a high need for mechanical ventilation (prolonged in most cases). In our series (n=22) duration extended beyond 20 days and 72% of these patients (a high percentage) had to be tracheostomized, which is consistent with the data reported by other studies.2

COVID-19 is the product of respiratory droplet transmission, which is why during these patients’ hospital stay in the Intensive Care Unit, caution should be the rule of thumb here because of the high risk of aerosol production in high-risk circumstances such as during intubation, bronchoscopy, and tracheostomy maneuvers.3,4

Although it is advisable to wait for a negative polymerase chain reaction test result before performing a tracheostomy, on many occasions, it needs to be performed before running this test when the airway cannot be secured. That is why it is of paramount importance to be extra-cautious using personal protection equipment (masks, goggles, scrubs, and gloves) and all those additional prophylactic measures that could act as a barrier.2

One of these measures is the «aerosol box», a methacrylate protection component originally designed to cover the patient’s face. It can be accessed with both hands through 2 circular ports to perform orotracheal intubation maneuvers, thus avoiding most of the aerosolization process generated.5

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, access the trachea for fixation purposes, facilitate tracheal puncture, and the insertion of guidewires and dilators with the other hand (Fig. 1).

Figure 1.

Use of the protective box during a tracheostomy procedure in a patient with COVID-19.

(0.13MB).

We believe that this component is cheap, easy to make, 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.