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Expert Recommendations for Tracheal Intubation in Critically ill Patients with Noval Coronavirus Disease 2019
Ming-Zhang Zuo1, Yu-Guang Huang2, Wu-Hua Ma3
1Department of Anesthesiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730 China.
Insights
Anesthesiologists face high risks during endotracheal intubation for COVID-19 patients. This recommendation guides airway management, emphasizing enhanced PPE and modified rapid sequence induction for safer intubation procedures.
Area of Science:
- Anesthesiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2, is highly contagious and spread globally.
- Aerosol-generating procedures like endotracheal intubation pose significant nosocomial infection risks to healthcare providers, particularly anesthesiologists.
- Reported SARS-CoV-2 infections among anesthesiologists following intubation in Wuhan highlight the urgent need for safety guidelines.
Purpose of the Study:
- To provide expert recommendations for endotracheal intubation procedures during the COVID-19 pandemic.
- To guide anesthesiologists and critical care physicians in managing airways of patients with suspected or confirmed SARS-CoV-2 infection.
- To minimize the risk of nosocomial infections among healthcare professionals performing airway management.
Main Methods:
- Development of recommendations by an expert panel from the Chinese Society of Anaesthesiology.
- Review of transmission routes of SARS-CoV-2, including droplet, contact, and aerosol pathways.
- Emphasis on enhanced personal protective equipment (PPE) for healthcare providers during airway management.
Main Results:
- Airway assessment is critical before any intervention.
- For normal airways, modified rapid sequence induction is recommended over awake intubation.
- Adequate muscle relaxation is crucial before proceeding with intubation.
- For difficult airways, thorough preparation of devices and detailed plans are essential.
Conclusions:
- Adherence to enhanced PPE protocols is vital for protecting healthcare workers.
- Modified rapid sequence induction offers a safer approach for endotracheal intubation in non-difficult airways.
- Comprehensive planning and preparation are key for managing difficult airways during the COVID-19 pandemic to ensure patient and provider safety.
Abstract:
Coronavirus Disease 2019 (COVID-19), caused by a novel coronavirus (SARS-CoV-2), is a highly contagious disease. It firstly appeared in Wuhan, Hubei province of China in December 2019. During the next two months, it moved rapidly throughout China and spread to multiple countries through infected persons travelling by air. Most of the infected patients have mild symptoms including fever, fatigue and cough. But in severe cases, patients can progress rapidly and develop to the acute respiratory distress syndrome, septic shock, metabolic acidosis and coagulopathy. The new coronavirus was reported to spread via droplets, contact and natural aerosols from human-to-human. Therefore, high-risk aerosol-producing procedures such as endotracheal intubation may put the anesthesiologists at high risk of nosocomial infections. In fact, SARS-CoV-2 infection of anesthesiologists after endotracheal intubation for confirmed COVID-19 patients have been reported in hospitals in Wuhan. The expert panel of airway management in Chinese Society of Anaesthesiology has deliberated and drafted this recommendation, by which we hope to guide the performance of endotracheal intubation by frontline anesthesiologists and critical care physicians. During the airway management, enhanced droplet/airborne PPE should be applied to the health care providers. A good airway assessment before airway intervention is of vital importance. For patients with normal airway, awake intubation should be avoided and modified rapid sequence induction is strongly recommended. Sufficient muscle relaxant should be assured before intubation. For patients with difficult airway, good preparation of airway devices and detailed intubation plans should be made.
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