Authors: Dr Laura Flood, Dr Maurice Le Guen, Dr Tim Leong, and A/Prof Chris Nickson
Patients with COVID-19 who require tracheostomies pose management challenges in the intensive care unit. A recent article in The Lancet comprehensively discusses the management of this group of patients.
McGrath BA, Brenner MJ, Warrillow SJ, et al. Tracheostomy in the COVID-19 era: global and multidisciplinary guidance [published online ahead of print, 2020 May 15]. Lancet Respir Med. 2020;S2213-2600(20)30230-7. doi:10.1016/S2213-2600(20)30230-7
In order to safely and effectively perform this procedure in patients with COVID-19 we have trained a small group of intensivists to form an intact team providing this service in the ICU. We have developed a checklist and a cognitive aid for use during the procedure.
These were developed using a translational simulation approach, involving a dozen simulations that included pluralistic walkthroughs and systems-focussed debriefs to iteratively refine the checklist and cognitive aid. They have subsequently been used effectively in the clinical setting for actual procedures.
Importantly, the checklist and cognitive aid are no substitute for training. Our approach has been to develop intact teams that train together and to perform a walkthrough or simulation with the bedside nurse who will be involved in the actual procedure the day before.
COVID-19 percutaneous tracheostomy checklist:
COVID-19 cognitive aid: