Inpatient Management
As is the case for any laryngectomy patient admitted to the hospital, it
is crucial for the care teams involved to understand the surgically
modified airway anatomy. Namely, it is imperative that all physicians
and ancillary staff be cognizant of the fact that laryngectomy patients
cannot be oxygenated, bag-masked, or intubated through the upper airway.
Ideally, it is best for these patients to be tested for COVID-19,
resource permitting. However, if testing is not feasible, all
precautions should be taken to minimize risk of transmission of
aerosolized particles. Again, strong consideration should be given to
placing a laryngectomy tube or baseplate with an HME, with or without an
integrated viral/bacterial hydroscopic filter, in the stoma. If the
patient has a significant cough or secretions, measures such as
placement of a tracheotomy tube in the stoma with an attached HEPA
filter and closed-line suction on admission, or placing patients in a
negative pressure room to minimize the spread of viral particles into
the hallway, may be considered.9 Placing patients on a
closed-circuit system such as a mechanical ventilator, even if pressure
support is not needed, has been utilized to reduce aerosolization of
viral particles.3,25 However, this may not be feasible
from a resource utilization standpoint, and as such, any efforts that
reduce aerosolized viral spread with a physical barrier over the stoma
as outlined above should be considered.
Laryngectomy patients should also be counseled to self-suction, if
possible, so other care providers may be absent from the room during
suctioning to minimize the risk of aerosolized
transmission.25 As these patients are unable to clear
secretions from the nasal cavities, we strongly recommend against
suctioning nasal secretions and instead suggest patients dab or wipe any
nasal discharge. Use of enhanced PPE during all interactions with these
patients should be considered until they are known to be COVID-19
negative.
For the COVID-19 negative laryngectomy patient admitted to the hospital,
we recommend placing an HME with an integrated viral/bacterial
hydroscopic filter over the stoma at all times, in addition to wearing
mask over their stoma and face.9,28 Patients should
refrain from touching their stoma unnecessarily and should thoroughly
wash their hands before and after performing any tracheostoma care.
Stoma care may also be reduced to a daily event, if safe to do so, to
reduce potential contamination of the peristomal skin. The laryngectomee
must be cognizant of self-contamination while speaking using a TEP, and
consider frequent hand sanitation (washing, hand sanitizer, gloved
hands, etc.). A hands-free device can eliminate this concern.