INTRODUCTION
The novel coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2
virus. SARS-CoV-2 is found in high abundance in the upper aerodigestive
tract mucosa [1]. It is known to be transmitted via close contact,
droplet and aerosols from aerosol generating procedures (AGP) such as
tracheostomy [2].
COVID-19 is associated with acute respiratory distress syndrome that
requires patients to be intubated and may become dependent on mechanical
ventilation. Patients with prolonged ventilation may require
tracheostomy to optimise weaning from ventilatory support. [3] In
Queen Mary Hospital, an experienced head and neck surgeon will be
summoned to perform tracheostomy on such patients.
As head and neck surgeons, we are constantly exposed when resecting
tumours arising from mucosa in the upper aerodigestive tract, in
addition to tracheostomy and laryngectomy. Our patients may be
asymptomatic at the time of presentation, and there is currently no
accurate way of COVID-19 diagnosis. [4-5] Hence, we are at
particular risk of becoming infected when performing tracheostomy during
the COVID-19 pandemic.
World Health Organisation (WHO), Centres for Disease Control and
Prevention (CDC) and Centre for Health Protection (CHP) recommend full
barrier protection when performing AGP for unknown, suspected and
confirmed COVID-19 patients in order to avoid disease transmission to
health care providers. Such personal protective equipment (PPE) includes
gloves, goggles, face shield and gowns, as well as items filtering
facepiece respirators such as N95 or powered air-purifying respirator
(PAPR) hoods and aprons [6-8].
The number of confirmed COVID-19 cases has soared since its first
description in. December 2019 - as of 18 April 2020, there are 2121675
confirmed cases worldwide, of which Hong Kong accounts for 1024.
[9,10] Such an escalation in the number of infected has resulted in
a global shortage of PPE.
This study describes a novel approach which aims to decrease viral
transmission when performing tracheostomy during the COVID-19 pandemic
and at times of PPE shortage.