Journal Information
Vol. 45. Issue 4.
Pages 253-254 (May 2021)
Vol. 45. Issue 4.
Pages 253-254 (May 2021)
Letter to the Editor
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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

Corresponding author.
Servicio de Medicina Intensiva del Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Spain
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To the Editor,

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.


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.


This study received no funding whatsoever.

Conflicts of interest

None reported.

M.C. Martín Delgado, F.X. Avilés-Jurado, J. Álvarez Escudero, C. Aldecoa Álvarez-Santuyano, C. de Haro López, P. Díaz de Cerio Canduela, et al.
Consensus document of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC), the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and the Spanish Society of Anesthesiology and Resuscitation (SEDAR) on tracheotomy in patients with COVID-19 infection.
Med Intensiva, (2020), pp. S0210-S5691
P. Foster, T. Cheung, P. Craft, K. Baran, M. Kryskow, R. Knowles, et al.
Novel approach to reduce transmission of COVID-19 during tracheostomy.
J Am Coll Surg, (2020),
V.B. Shidham, N.K. Frisch, L.J. Layfield.
Severe acute respiratory syndrome coronavirus 2 (the cause of COVID 19) in different types of clinical specimens and implications for cytopathology specimen: an editorial review with recommendations.
M.Z. Zuo, Y.G. Huang, W.H. Ma, Z.G. Xue, J.Q. Zhang, Y.H. Gong, et al.
Expert recommendations for tracheal intubation in critically ill patients with noval coronavirus disease 2019.
Chin Med Sci J, (2020),
R. Canelli, C.W. Connor, M. Gonzalez, A. Nozari, R. Ortega.
Barrier enclosure during endotracheal intubation.
N Engl J Med, 382 (2020), pp. 1957-1958

Please cite this article as: Pérez Acosta G, González Romero D, Santana-Cabrera L. Respuesta a Documento de consenso de la traqueotomía en pacientes con COVID 19. Med Clin (Barc). 2021;45:253–254.

Copyright © 2020. Elsevier España, S.L.U. and SEMICYUC
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