Table 4.

Summary of Posttracheostomy Care of Patients With COVID-19

Society	Recommendations
Ear, Nose, and Throat Surgery in the United Kingdom	•Avoid changing the tracheostomy tube until COVID-19 has passed •Cuff to remain inflated and check for leaks •Make every effort not to disconnect the circuit •Only closed in-line suctioning should be used
Government of Canada	•AGPs should be performed on patients suspected or confirmed with infection only if medically necessary •Strategies to reduce aerosol generation should be applied •The number of HCWs present during AGPs should be limited to those essential for patient care and support
American Academy of Otolaryngology-Head and Neck Surgery	•Limit the number of providers participating in tracheotomy procedural and postprocedural management •Avoid circuit disconnections and suction via closed circuit •Place a HME with viral filter or a ventilator filter once the tracheotomy tube is disconnected from mechanical ventilation •Delay routine postoperative tracheotomy tube changes until COVID-19 testing is negative
Canadian Society of Otolaryngology-Head and Neck Surgery	•Avoid open suction and instead use closed, in-line suction whenever possible •Avoid repeated suctioning and disconnection of the ventilator circuit •Use an HME with HEPA-level filter (preferred) to provide humidity, reduce secretions with minimal increase in perceived respiratory resistance in the ventilator circuit or on the ventilator exhaust portion; monitor filter for obstruction risk •Minimize nebulization, instillation of fluids •Avoid all unnecessary examinations or procedures including decannulation until the patient is considered COVID-19 negative •For mature at-home tracheotomy patients, defer all routine tracheotomy changes during pandemic
Speech Language and Audiology Canada	•Identify the minimum number of people required to safely conduct a session •Consider bundling care with other health-care professionals •Carefully consider equipment use and discuss with infection control services to ensure it can be properly decontaminated •Avoid moving equipment between infectious and noninfectious areas •Wherever possible, single patient use, disposable equipment is preferred

AGP = aerosol generating procedure; HEPA = high-efficiency particulate air; HME = heat moisture exchanger. See Table 1 legend for expansion of other abbreviations.