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Multidisciplinary guidance for safe tracheostomy care during the COVID-19 pandemic: the NHS National Patient Safety Improvement Programme (NatPatSIP) |
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| Authors: | B A McGrath N Ashby M Birchall P Dean C Doherty K Ferguson J Gimblett M Grocott T Jacob C Kerawala P Macnaughton P Magennis R Moonesinghe P Twose S Wallace A Higgs |
| Institution: | 1. Department of Intensive Care Medicine, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, National Tracheostomy Safety Project, Manchester, UK;2. Royal College of Nursing, University of Nottingham, Nottingham, UK;3. British Laryngological Association, University College London, London, UK;4. Intensive Care Society, Royal Blackburn Teaching Hospital, Lancashire, UK;5. Royal Manchester Children’s Hospital, National Tracheostomy Safety Project Paediatric Lead, Manchester University NHS Foundation Trust, Manchester, UK;6. Aberdeen Royal Infirmary, Association of Anaesthetists, Aberdeen, UK;7. Anaesthesia and Critical Care, Royal College of Anaesthetists, University of Southampton, Southampton, UK;8. ENT & Head and Neck surgeon, Lewisham & Greenwich NHS Trust, ENT-UKt, London, UK;9. Maxillofacial & Head and Neck Surgeon, The Royal Marsden Hospital, British Association of Head & Neck Oncologists, London, UK;10. Intensive Care Medicine at Derriford Hospital, Faculty of Intensive Care Medicine, Plymouth, UK;11. Oral and Maxillofacial Surgeon, Aintree University Hospital, NHS Foundation Trust, British Association of Oral and Maxillofacial Surgeons, Liverpool, UK;12. Anaesthetics and Critical Care Medicine, NHS England & NHS Improvement, University College London Hospitals, London, UK;13. Association of Chartered Physiotherapists in Respiratory Care, Cardiff and Vale University Health Board, Cardiff, UK;14. Speech & Language Therapist, Royal College of Speech & Language Therapists, Manchester University NHS Foundation Trust, Manchester, UK;15. Anaesthesia & Intensive Care Medicine, Warrington & Halton Teaching Hospitals NHS Foundation Trust, Difficult Airway Society, Warrington, UK |
| Abstract: | The COVID-19 pandemic is causing a significant increase in the number of patients requiring relatively prolonged invasive mechanical ventilation and an associated surge in patients who need a tracheostomy to facilitate weaning from respiratory support. In parallel, there has been a global increase in guidance from professional bodies representing staff who care for patients with tracheostomies at different points in their acute hospital journey, rehabilitation and recovery. Of concern are the risks to healthcare staff of infection arising from tracheostomy insertion and caring for patients with a tracheostomy. Hospitals are also facing extraordinary demands on critical care services such that many patients who require a tracheostomy will be managed outside established intensive care or head and neck units and cared for by staff with little tracheostomy experience. These concerns led NHS England and NHS Improvement to expedite the National Patient Safety Improvement Programme’s ‘Safe Tracheostomy Care’ workstream as part of the NHS COVID-19 response. Supporting this workstream, UK stakeholder organisations involved in tracheostomy care were invited to develop consensus guidance based on: expert opinion; the best available published literature; and existing multidisciplinary guidelines. Topics with direct relevance for frontline staff were identified. This consensus guidance includes: infectivity of patients with respect to tracheostomy indications and timing; aerosol-generating procedures and risks to staff; insertion procedures; and management following tracheostomy. |
| Keywords: | coronavirus COVID-19 personal protective equipment tracheostomy |