Recommendations:
1. Monitor endotracheal and tracheostomy tube cuff pressures Q4 hours.
In patients who are intubated, especially in prolonged intubations >72 hours the risk of tracheal stenosis increases over time. Teams managing these patients should stress that all intubated patients have Q4 hour cuff pressure check with goal of approximately 30mm Hg if feasible given the vent parameter requirements, as pressures higher than 30mmg Hg may result in pressure necrosis. Certainly, adequate pressure to avoid cuff leakage and aerosolization is critical when managing SARS-CoV-2 patients, but it should be recognized that unnecessarily high cuff pressures are also problematic. The minimum cuff pressure required to create an adequate seal should be individualized for each patient and verified frequently by care providers. This is a dynamic process and frequent adjustments may be indicated depending on ventilation parameters. Prevention of tracheal mucosal pressure necrosis, resulting tracheal and cricoid chondritis, and subsequent stenosis is critical in the SARS-CoV-2 population.[25] [26]
SARS-CoV-2 testing via RT-PCE detection platform for SARS-CoV-2 and pan- sarbecovirus detection is recommended for all patients who are under consideration for tracheostomy. Keeping in mind that that data surrounding accuracy of the test during the pandemic is forthcoming, and false negatives are a real possibility.[27] The test may be performed a second time if clinical suspicions or institutional policy warrants repeat testing prior to high risk procedures.