Change in tracheostomy procedure to prepare for COVID-19

Objective: The Japanese society of OtoRhinoLaryngology-Head and Neck Surgery （JORL-HNS） issued guid­ance on tracheostomy for suspected or confirmed cases of severe acute respiratory coronavirus 2 （SARS-CoV-2） infection in April 2020. To avoid the generation of aerosols, it is necessary to change the tracheostomy procedure. Our medical office performs tracheostomies according to the JORL-HNS guidance because we perform tracheostomies smoothly using an unusual procedure. We verified the significance of the change in the procedure. <br>Methods: We performed 48 tracheostomies from April to December 2020. Twenty-three of them, excluding cases of head and neck surgery and local anesthesia, were performed according to the JORL-HNS guidance on tracheostomy. We surveyed 17 staff members at our medical office about the procedure change. Preoperative PCR tests were negative multiple times in all cases. We performed the procedure using standard personal protective equipment under general anesthesia. The surgeons were not always the same. In addition, we compared the average operation time during the study period after the procedure change with that during the previous year. <br>Results: The average operation time was longer and the physical and mental burden on operators increased with the procedure change. Cooperation with other medical workers, such as anesthesiologists and nurses was important, and they all understood the new procedure well. Everyone in our medical office thought the procedure change was meaningful. <br>Conclusion: Since there are likely to be a number of SARS-CoV-2-positive patients requiring tracheostomy in the future, and SARS-CoV-2 PCR tests can give false-negative results, we need to master the tracheostomy procedure recommended by the JORL-HNS guidance. Our survey suggests that the procedure change is meaningful.