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Negative-Pressure Aerosol Cover for COVID-19 Tracheostomy

Educational Objective
To understand how negative-pressure aerosol cover can decrease risk of spreading COVID-19 during tracheostomy
1 Credit CME

Because of the high virulence of the novel coronavirus responsible for causing COVID-19, many patients infected with the virus become critically ill, requiring prolonged intubation, and may ultimately require tracheostomy. Mucosal surfaces have been shown to be reservoirs for high concentrations of the virus, which can become aerosolized for up to 3 hours following manipulation.1,2 Surgeons performing tracheostomies are at high risk for exposure, and recently published guidelines recommend against elective, non–time-sensitive procedures.3 In the event that a tracheostomy is indicated in a patient with confirmed or suspected COVID-19, interventions that limit the spread of aerosols are critical to reducing exposure.4,5 Here we present the creation of a novel negative-pressure aerosol cover made out of readily available operating room materials as an additional barrier to limit the spread of aerosols during tracheostomy.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: April 14, 2020.

Published Online: April 28, 2020. doi:10.1001/jamaoto.2020.1081

Correction: This article was corrected on June 11, 2020, to add missing funding information.

Corresponding Author: J. Tyler Bertroche, MD, Department of Otolaryngology–Head & Neck Surgery, Washington University in St Louis School of Medicine, 1 Barnes-Jewish Plaza, St Louis, MO 63108 (jtbertroche@wustl.edu).

Author Contributions: Drs Bertroche, Pipkorn, and Zevallos had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Bertroche, Buchman, Zevallos.

Acquisition, analysis, or interpretation of data: Bertroche, Pipkorn, Zolkind, Zevallos.

Drafting of the manuscript: Bertroche, Buchman.

Critical revision of the manuscript for important intellectual content: All authors.

Administrative, technical, or material support: Zolkind, Zevallos.

Study supervision: Pipkorn, Buchman, Zevallos.

Conflict of Interest Disclosures: Dr Buchman reported receiving grants from the US Department of Defense and consulting fees from Cochlear Limited, Advanced Bionics, Envoy, and IotaMotion outside the submitted work; in addition, Dr Buchman had a patent to US9,072,468B2 licensed. No other disclosures were reported.

Funding/Support: Research reported in this publication was supported by the Foundation for Barnes-Jewish Hospital Otolaryngology Surgical Outcomes and Quality Improvement Unit (SOQIU) at Barnes-Jewish Hospital (grant 4090).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Zou  L , Ruan  F , Huang  M ,  et al.  SARS-CoV-2 viral load in upper respiratory specimens of infected patients.   N Engl J Med. 2020;382(12):1177-1179. doi:10.1056/NEJMc2001737PubMedGoogle ScholarCrossref
2.
van Doremalen  N , Bushmaker  T , Morris  DH ,  et al.  Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1.   N Engl J Med. 2020;382(16):1564-1567. doi:10.1056/NEJMc2004973PubMedGoogle ScholarCrossref
3.
Givi  B , Schiff  BA , Chinn  SB ,  et al.  Safety recommendations for evaluation and surgery of the head and neck during the COVID-19 pandemic  [published online March 31, 2020].  JAMA Otolaryngol Head Neck Surg. 2020. doi:10.1001/jamaoto.2020.0780PubMedGoogle Scholar
4.
Parker  N , Schiff  B , Fritz  M ,  et al; Airway and Swallowing Committee of the American Academy of Otolaryngology–Head and Neck Surgery. Tracheotomy recommendations during the COVID-19 pandemic. Accessed April 20, 2020. https://www.entnet.org/content/tracheotomy-recommendations-during-covid-19-pandemic
5.
Tay  JK , Khoo  ML , Loh  WS .  Surgical considerations for tracheostomy during the COVID-19 pandemic: lessons learned from the severe acute respiratory syndrome outbreak  [published online March 31, 2020].  JAMA Otolaryngol Head Neck Surg. 2020. doi:10.1001/jamaoto.2020.0764PubMedGoogle Scholar
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