Safe and Efficient Performance of Open Tracheostomies in Patients With COVID-19 | Critical Care Medicine | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

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

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

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.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

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 (oluwafunmilola.okuyemi@unlv.edu).

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.

References
1.
Chee  VW , Khoo  ML , Lee  SF , Lai  YC , Chin  NM .  Infection control measures for operative procedures in severe acute respiratory syndrome-related patients.   Anesthesiology. 2004;100(6):1394-1398. doi:10.1097/00000542-200406000-00010PubMedGoogle ScholarCrossref
2.
Tran  K , Cimon  K , Severn  M , Pessoa-Silva  CL , Conly  J .  Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review.   PLoS One. 2012;7(4):e35797. doi:10.1371/journal.pone.0035797PubMedGoogle Scholar
3.
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
4.
Vukkadala  N , Qian  ZJ , Holsinger  FC , Patel  ZM , Rosenthal  E .  COVID-19 and the otolaryngologist: preliminary evidence-based review.   Laryngoscope. Published online March 26, 2020. doi:10.1002/lary.28770PubMedGoogle Scholar
5.
Parker  NP , Schiff  BA , Fritz  MA ,  et al. Tracheotomy recommendations during the COVID-19 pandemic. American Academy of Otolaryngology–Head and Neck Surgery. March 27, 2020. Updated April 2, 2020. Accessed October 22, 2020. https://www.entnet.org/content/tracheotomy-recommendations-during-covid-19-pandemic
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_Multimedia_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close