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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.
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Accepted for Publication: September 27, 2020.
Published Online: January 21, 2021. doi:10.1001/jamaoto.2020.4432
Corresponding Author: Oluwafunmilola T. Okuyemi, MD, MSCI, Department of Otolaryngology–Head & Neck Surgery, University of Nevada, Las Vegas School of Medicine, 1701 W Charleston Blvd, Ste 490, Las Vegas, NV 89102 (firstname.lastname@example.org).
Author Contributions: Drs Okuyemi and Wang had full access to all of the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis.
Concept and design: Okuyemi, Elkins, Wang.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Okuyemi.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Okuyemi.
Administrative, technical, or material support: Spinner, Elkins, Bigcas, Ng, Wang.
Supervision: Okuyemi, Wang.
Conflict of Interest Disclosures: Dr Wang reports holding stock in Johnson & Johnson and Abbott Laboratories outside of the submitted work. No other disclosures were reported.
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