Critical Care Guidance for Tracheostomy Care During the COVID-19 Pandemic: A Global, Multidisciplinary Approach

Vinciya Pandian¹, Linda L Morris², Martin B Brodsky³, James Lynch⁴, Brian Walsh⁵, Cynda Rushton⁶, Jane Phillips⁷, Alphonsa Rahman⁸, Troy DeRose⁹, Leah Lambe¹⁰, Lionel Lami¹¹, Sarah Pui Man Wu¹², Francisco Paredes Garza¹³, Simona Maiani¹⁴, Andrea Zavalis¹⁵, Kafilat Ajoke Okusanya¹⁶, Patrick A Palmieri¹⁷, Brendan A McGrath¹⁸, Paolo Pelosi¹⁹, Mary Lou Sole²⁰, Patricia Davidson²¹, Michael J Brenner²²

Affiliations

¹ Vinciya Pandian is associate professor, Department of Nursing Faculty, and Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland.
² Linda L. Morris is associate professor, Northwestern University Feinberg School of Medicine; Shirley Ryan AbilityLab, Chicago, Illinois.
³ Martin B. Brodsky is associate professor, Department of Physical and Rehabilitation, Division of Critical Care and Pulmonary and OACIS Research Group, Johns Hopkins University.
⁴ James Lynch is advanced critical care practitioner, Acute Intensive Care Unit, Manchester University National Health Services Foundation Trust, and National Tracheostomy Safety Project, Manchester, United Kingdom.
⁵ Brian Walsh is professor, Department of Health Sciences, Liberty University, Lynchburg, Virginia.
⁶ Cynda Rushton is professor, Johns Hopkins University Anne and George L. Bunting Berman Institute of Bioethics, Department of Nursing Faculty, Johns Hopkins School of Nursing, and Department of Pediatrics, Johns Hopkins School of Medicine; and adjunct professor, University of Technology of Sydney, Sydney, New South Wales, Australia.
⁷ Jane Phillips is professor of Palliative Nursing, and director IMPACCT, University of Technology Sydney.
⁸ Alphonsa Rahman is critical care clinical nurse specialist, The Johns Hopkins Hospital, Baltimore, Maryland.
⁹ Troy DeRose is nurse practitioner, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
¹⁰ Leah Lambe is nursing clinical coordinator, Rapid Response Team, Hospital of the University of Pennsylvania, Phila-delphia, Pennsylvania.
¹¹ Lionel Lami, University of Hospital of Toulouse, and University Cancer Institute of Toulouse Oncopole, Toulouse, France.
¹² Sarah Pui Man Wu, advance practice nurse, Department of Otolaryngology, Head and Neck Surgery, Chinese University of Hong Kong, Hong Kong.
¹³ Francisco Paredes Garza is critical care nurse, Hospital Universitario La Paz, Madrid, Spain.
¹⁴ Simona Maiani is head nurse, Anesthesiology and Intensive Care, San Martino Policlinico Hospital, and IRCCS for Oncology and Neurosciences, Genoa, Italy.
¹⁵ Andrea Zavalis is critical care nurse, Enfermeira Intensivista, Manaus, Brazil.
¹⁶ Kafilat Ajoke Okusanya is critical care nurse, Lagos University Teaching Hospital, Lagos, Nigeria.
¹⁷ Patrick A. Palmieri is vice chancellor for research, Universidad Norbert Wiener; and director of Centro de Salud Basada en Evidencia de Sudamérica: A Joanna Briggs Affiliated Group, Lima, Perú.
¹⁸ Brendan A. McGrath is anesthesiology consultant, University of Manchester, National Health Service Foundation Trust, National Tracheostomy Safety Project, Manchester, United Kingdom.
¹⁹ Paolo Pelosi is with Anesthesiology and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, University of Genoa, Genoa, Italy.
²⁰ Mary Lou Sole is dean of College of Nursing, Orlando Health Endowed Chair in Nursing, and University of Central Florida Pegasus Professor, University of Central Florida, Orlando, Florida.
²¹ Patricia Davidson is professor and dean, Department of Nursing Faculty, Johns Hopkins University.
²² Michael J. Brenner is associate professor, Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan; president, Global Tracheostomy Collaborative, Raleigh, North Carolina.

PMID: 32929453
DOI: 10.4037/ajcc2020561

Review

Critical Care Guidance for Tracheostomy Care During the COVID-19 Pandemic: A Global, Multidisciplinary Approach

Vinciya Pandian et al. Am J Crit Care. 2020.

. 2020 Nov 1;29(6):e116-e127.

doi: 10.4037/ajcc2020561.

Authors

Affiliations

¹ Vinciya Pandian is associate professor, Department of Nursing Faculty, and Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland.
² Linda L. Morris is associate professor, Northwestern University Feinberg School of Medicine; Shirley Ryan AbilityLab, Chicago, Illinois.
³ Martin B. Brodsky is associate professor, Department of Physical and Rehabilitation, Division of Critical Care and Pulmonary and OACIS Research Group, Johns Hopkins University.
⁴ James Lynch is advanced critical care practitioner, Acute Intensive Care Unit, Manchester University National Health Services Foundation Trust, and National Tracheostomy Safety Project, Manchester, United Kingdom.
⁵ Brian Walsh is professor, Department of Health Sciences, Liberty University, Lynchburg, Virginia.
⁶ Cynda Rushton is professor, Johns Hopkins University Anne and George L. Bunting Berman Institute of Bioethics, Department of Nursing Faculty, Johns Hopkins School of Nursing, and Department of Pediatrics, Johns Hopkins School of Medicine; and adjunct professor, University of Technology of Sydney, Sydney, New South Wales, Australia.
⁷ Jane Phillips is professor of Palliative Nursing, and director IMPACCT, University of Technology Sydney.
⁸ Alphonsa Rahman is critical care clinical nurse specialist, The Johns Hopkins Hospital, Baltimore, Maryland.
⁹ Troy DeRose is nurse practitioner, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
¹⁰ Leah Lambe is nursing clinical coordinator, Rapid Response Team, Hospital of the University of Pennsylvania, Phila-delphia, Pennsylvania.
¹¹ Lionel Lami, University of Hospital of Toulouse, and University Cancer Institute of Toulouse Oncopole, Toulouse, France.
¹² Sarah Pui Man Wu, advance practice nurse, Department of Otolaryngology, Head and Neck Surgery, Chinese University of Hong Kong, Hong Kong.
¹³ Francisco Paredes Garza is critical care nurse, Hospital Universitario La Paz, Madrid, Spain.
¹⁴ Simona Maiani is head nurse, Anesthesiology and Intensive Care, San Martino Policlinico Hospital, and IRCCS for Oncology and Neurosciences, Genoa, Italy.
¹⁵ Andrea Zavalis is critical care nurse, Enfermeira Intensivista, Manaus, Brazil.
¹⁶ Kafilat Ajoke Okusanya is critical care nurse, Lagos University Teaching Hospital, Lagos, Nigeria.
¹⁷ Patrick A. Palmieri is vice chancellor for research, Universidad Norbert Wiener; and director of Centro de Salud Basada en Evidencia de Sudamérica: A Joanna Briggs Affiliated Group, Lima, Perú.
¹⁸ Brendan A. McGrath is anesthesiology consultant, University of Manchester, National Health Service Foundation Trust, National Tracheostomy Safety Project, Manchester, United Kingdom.
¹⁹ Paolo Pelosi is with Anesthesiology and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, University of Genoa, Genoa, Italy.
²⁰ Mary Lou Sole is dean of College of Nursing, Orlando Health Endowed Chair in Nursing, and University of Central Florida Pegasus Professor, University of Central Florida, Orlando, Florida.
²¹ Patricia Davidson is professor and dean, Department of Nursing Faculty, Johns Hopkins University.
²² Michael J. Brenner is associate professor, Department of Otolaryngology - Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan; president, Global Tracheostomy Collaborative, Raleigh, North Carolina.

PMID: 32929453
DOI: 10.4037/ajcc2020561

Abstract

Purpose: Critical care nurses caring for patients with a tracheostomy are at high risk because of the predilection of SARS-CoV-2 for respiratory and mucosal surfaces. This review identifies patient-centered practices that ensure safety and reduce risk of infection transmission to health care workers during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: Consensus statements, guidelines, institutional recommendations, and scientific literature on COVID-19 and previous outbreaks were reviewed. A global interdisciplinary team analyzed and prioritized findings via electronic communications and video conferences to develop consensus recommendations.

Results: Aerosol-generating procedures are commonly performed by nurses and other health care workers, most notably during suctioning, tracheostomy tube changes, and stoma care. Patient repositioning, readjusting circuits, administering nebulized medications, and patient transport also present risks. Standard personal protective equipment includes an N95/FFP3 mask with or without surgical masks, gloves, goggles, and gown when performing aerosol-generating procedures for patients with known or suspected COVID-19. Viral testing of bronchial aspirate via tracheostomy may inform care providers when determining the protective equipment required. The need for protocols to reduce risk of transmission of infection to nurses and other health care workers is evident.

Conclusion: Critical care nurses and multidisciplinary teams often care for patients with a tracheostomy who are known or suspected to have COVID-19. Appropriate care of these patients relies on safeguarding the health care team. The practices described in this review may greatly reduce risk of infectious transmission.

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Critical Care Guidance for Tracheostomy Care During the COVID-19 Pandemic: A Global, Multidisciplinary Approach

Affiliations

Critical Care Guidance for Tracheostomy Care During the COVID-19 Pandemic: A Global, Multidisciplinary Approach

Authors

Affiliations

Abstract

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous