Successful Tracheotomy during SARS
There are multiple
reports3,4of safely performing tracheotomy on SARS patients without infecting
healthcare workers. Standard processes included strict infection control
measures, seamless and regulated surgical intervention, and if possible
delayed (> 30 days from diagnosis) tracheotomy in patients
who had been SARS positive. Infection control measures (in addition to
standard airborne and contact precautions) taken during these procedures
included: double gowning, PAPR suits, double gloving, a changing room
after the procedure (ante room), performing the procedure in a negative
pressure room. The surgical personnel were the most experienced
available to minimize operating/exposure time. Patients were completely
paralyzed to minimize air movement and coughing and thus viral
dissemination via aerosolization. Prior to the procedure a trial run was
completed to ensure maximum efficiency of the procedure. Just prior to
airway entry, the patients were pre-oxygenated, ventilation was held,
and the cuff on the endotracheal tube was dropped in order to minimize
air movement over the respiratory mucosa. While the patient was apneic,
the tracheotomy incision was performed. Open suctioning of the trachea
was avoided. Instead, a closed suctioning system with a viral filter was
used3
4.