A simple recommendation to prevent COVID-19 spread by patients with tracheostomy tube
Mohammad Behgam Shadmehr, Fariba Ghorbani, Mojtaba Mokhber Dezfuli
Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
|Date of Submission||23-Jun-2020|
|Date of Decision||13-Jul-2020|
|Date of Acceptance||22-Jul-2020|
|Date of Web Publication||30-Sep-2021|
Prof. Mohammad Behgam Shadmehr
Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shadmehr MB, Ghorbani F, Mokhber Dezfuli M. A simple recommendation to prevent COVID-19 spread by patients with tracheostomy tube. J Res Med Sci 2021;26:78
|How to cite this URL:|
Shadmehr MB, Ghorbani F, Mokhber Dezfuli M. A simple recommendation to prevent COVID-19 spread by patients with tracheostomy tube. J Res Med Sci [serial online] 2021 [cited 2022 May 18];26:78. Available from: https://www.jmsjournal.net/text.asp?2021/26/1/78/327219
In Iran, the COVID-19 outbreak started on February 19, 2020, and then rapidly grew. The patients are usually asymptomatic or presenting mild symptoms such as fever, cough, sore throat, and myalgia. However, about 20% of patients get very sick and require hospital admission, mostly because of pneumonia. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is mostly spread by infected droplets, entering directly to other persons' mouth, nose, or eyes, caused by coughing, sneezing, or even talking (airborne transmission). It may also be transmitted by touching the contaminated items and surfaces (contact transmission). As there is no definite treatment or vaccination, the most important strategy for control of the disease is prevention of virus spread by infected people.
Disease severity is a wide spectrum from asymptomatic patients to patients with fulminant acute respiratory distress syndrome and respiratory failure requiring endotracheal intubation and mechanical ventilation. Some patients may also require tracheostomy procedure, in case of prolonged intubation. Patients with COVID-19 disease, who have been weaned from mechanical ventilation with a tracheostomy tube in place, are in the most threatening situation for spreading the virus in intensive care units as long as they could not be decannulated.
These patients and other patients with a previous permanent tracheostomy tube, who are infected with SARS-COV-2 virus, could spread the virus by respiratory droplets not only through their mouth and nose but also through their tracheostomy tubes. They may also spread the virus by the tracheal secretions through their stoma, particularly when the stoma is larger than the tracheostomy tube.
Therefore, in addition to wearing a facemask, we recommend that an antimicrobial/antiviral ventilator filter is connected to their tracheostomy tube [Figure 1].
|Figure 1: Antimicrobial/antiviral ventilator filter connected to the tracheostomy tube|
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These devices have a filtration efficiency of >99.999% with viruses as small as 0.017 μ during 24 h. They are also very light, create no respiratory resistance, and are tolerated easily by the patients. They are inexpensive and therefore could be changed whenever there is any concern about their contamination or obstruction by secretions.
These patients should also have a watertight dressing all around their stoma to prevent leakage of potentially infected tracheal secretions. That dressing should be changed as soon as it gets wet and before contaminating the patients' neck and subsequently the patients' hand. The peristomal skin should be disinfected during each dressing change by alcohol-based solutions.
On the other hand, patients with permanent tracheostomy should also observe proper protection equipment for prevention against COVID-19. They should follow all general preventive commands such as social distancing and wearing facemasks and also avoid touching their tracheostomy tubes. In addition, because these filters work in both directions, we highly recommend using an antimicrobial/antiviral filter for more protection against airborne transmission in healthy patients who have tracheostomy tube.
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Conflicts of interest
There are no conflicts of interest.
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