Tracheostomy and the SARS epidemic
Experience with tracheostomy during the 2003 SARS epidemic offers a framework for management strategy during the COVID-19 pandemic. In the context of the current pandemic, Tay et al. conducted a literature review of tracheostomies performed during the SARS epidemic and concluded the following: (1) proper PPE (N95 mask, surgical cap, gown, goggles, and gloves) is of utmost importance; (2) surgical tracheostomy is preferably performed in a negative pressure ICU room by experienced providers with meticulous planning and seamless communication; (3) aerosol generation should be minimized through patient paralysis, ventilation hold during creation of tracheal window, and utilization of HEPA-filtered suction systems. This group identified no cases of SARS transmission to the surgical team in 23 tracheostomies.7 Others have reported on PPE for tracheostomy during the SARS epidemic, drawing similar conclusions that use of N95 masks, face shields, fluid resistant gowns, and gloves (contact and airborne precautions) provides effective protection against transmission to providers during tracheostomy.8,9 N95 masks filter 99.5% of particles larger than 0.75µm, providing excellent protection against airborne particles with a mask that is appropriately fitted.10