Post-operative use of HME filter‑protected open tracheostomy circuit during the COVID-19 pandemic

In the era of the COVID-19 pandemic, the avoidance of aerosol generating procedures (AGPs) is paramount to reduce the risk of viral transmission to staff and other patients. Perioperative management of a new tracheostomy is challenging as routine care, such as suctioning, frequently involves AGPs. We developed and implemented an apparatus called the heat and moisture exchanger (HME) filter-protected open circuit. This enabled closed suctioning to be performed and allowed spontaneously breathing patients to be managed with an open circuit in a shared environment while reducing the risk of viral aerosolisation. We performed a prospective observational study of 20 cases, recording the incidence of desaturation (<90%), apparatus disconnection, apparatus dislodgement and apparatus replacement. The ease of use of the apparatus for recovery nursing staff and patient comfort were measured on a Likert scale. There were no incidents of desaturation. There were two circuit disconnections. Apparatus replacement with an alternate circuit was not required for any patient. Most recovery nursing staff agreed or strongly agreed that the apparatus was easy to use and that the apparatus bulk or weight did not interfere with patient care activities. Ninety-five per cent of patients reported that their breathing was comfortable prior to discharge from the Post Anaesthesia Care Unit. In conclusion, the HME filter-protected open circuit is a relatively safe, acceptable and practical device to use for spontaneously breathing patients with newly created tracheostomies in the perioperative environment.