Safe and Efficient Performance of Open Tracheostomies in Patients with COVID-19 - The Fenestrated Technique

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Letter to the Editor

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Publication Title

JAMA Otolaryngology-Head and Neck Surgery

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Tracheostomy plays an important role in ventilated patients by improving pulmonary toileting and ventilator weaning while reducing risks of airway stenosis from prolonged intubation. However, it is associated with a considerable aerosolization risk.1,2 Severe acute respiratory syndrome coronavirus 2, which is responsible for coronavirus disease 2019 (COVID-19), concentrates in the upper aerodigestive tract and is transmitted through droplets or aerosols from aerosol-generating procedures (AGPs) performed in this region.3 While these facts have driven recommendations for using negative-pressure rooms and higher-grade personal protective equipment, such as powered air-purifying respirators for AGPs,4,5 there has not been a published study specifically investigating a technique of open tracheostomy that could further reduce aerosolization risks and improve safety. We demonstrate a fenestrated technique of tracheostomy that minimizes aerosolization risks by reducing risk of accidental decannulation and stomal infections while creating a tight seal around the tracheostomy tube.


Surgical Procedures, Operative



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