To the Editor The ongoing coronavirus disease 2019 (COVID-19)-related pandemic has created a challenge with performance of tracheostomy due to the high risk of aerosolization of potentially infectious materials. This creates a significant hazard for operating room staff and surgeons. Dr Bertroche and colleagues1 have described an excellent method for creating an enclosed negative-pressure environment for performance of tracheostomy, with the purpose of minimizing release of aerosol. We present a modification of this description (Figure).
Rather than the laryngoscope holder, our group has used the Bookwalter retractor as the arm for drape placement. This is a commonly used retractor system for abdominal surgery, and is placed after draping the patient. After the ring is positioned, a C-arm drape or radio frequency room scanner wand drape is used, with creation of working arm ports similar to the description provided by Bertroche and colleagues.1 The drape is held stable with towel clamps. For the purposes of tracheostomy, we find several advantages. The ring of the retractor creates a flat view of the operating field, which permits a similar view between surgeon and first assistant clinician. Second, the ring prevents collapse of the drape with application of negative pressure. We find that excessive collapse and folding amplify the glare issues that occur when working through a drape material. The major disadvantage of this setup is the restriction in vertical working room above the surgical field, depending on the placement of the ring on the Bookwalter arm. We overcame this by avoiding elongated instruments, specifically the Yankauer suction.
Given the high-risk aerosolization potential of tracheostomy, we completely agree with the creation of an enclosed working space over the surgical field. We hope this modification can assist with ease of performing the procedure.
Corresponding Author: Bharat Bhushan Yarlagadda, MD, Division of Otolaryngology–Head and Neck Surgery, Lahey Hospital and Medical Center, 41 Mall Rd, Burlington, MA 01805 (bharat.b.yarlagadda@lahey.org).
Published Online: October 8, 2020. doi:10.1001/jamaoto.2020.3589
Conflict of Interest Disclosures: None reported.