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[Tracheal intubation in patients with severe and critical COVID-19: analysis of 18 cases]

Jiafang Wang¹, Fan Lu¹, Mingxing Zhou¹

¹Department of Anesthesiology, Wuhan First Hospital, Wuhan 430022, China.

Nan Fang Yi Ke Da Xue Xue Bao = Journal of Southern Medical University

|May 8, 2020

Insights

Early tracheal intubation for severe COVID-19 patients improves outcomes. Careful anesthesia and high-level staff protection are crucial during intubation to ensure safety and reduce mortality.

Area of Science:

Critical Care Medicine
Anesthesiology
Infectious Diseases

Background:

Severe and critical coronavirus disease 2019 (COVID-19) often necessitates invasive respiratory support.
Tracheal intubation is a critical procedure for managing respiratory failure in these patients.

Purpose of the Study:

To analyze the clinical characteristics of patients with severe or critical COVID-19 undergoing tracheal intubation.
To evaluate the safety and efficacy of tracheal intubation in this patient population.

Main Methods:

Retrospective analysis of 18 patients with severe or critical COVID-19 requiring tracheal intubation.
Collection of demographic data, pre-intubation status, ventilation modes, and intubation conditions.
Monitoring of vital signs before anesthesia induction and post-intubation.

Main Results:

The average age of patients was 70.39 years; 83.33% received non-invasive ventilation prior to intubation.
Tracheal intubation conditions were excellent or good in 94.44% of patients, with a 100% first-attempt success rate.
Significant decreases in blood pressure and heart rate were observed post-anesthesia induction; 5 patients died within 3 weeks.

Conclusions:

Early tracheal intubation with invasive support is recommended for severe/critical COVID-19 patients to enhance treatment efficacy and reduce mortality.
Careful use of anesthetic agents and high-level personal protective equipment for medical staff are essential during intubation procedures.

Read full analysis

Abstract

Objective:

To analyze the clinical characteristics of patients with severe or critical coronavirus disease 2019 (COVID-19) receiving tracheal intubation.

Methods:

We analyzed clinical characteristics of 18 severely or critically ill patients with COVID-19 undergoing tracheal intubation. The general demographic and clinical data of the patients including their age, gender, pre- intubation state of consciousness and the ventilation mode were recorded. The anesthesiologists performing the tracheal intubation procedure evaluated and recorded the tracheal intubation conditions of the patients. The changes in the vital signs of the patients before anesthesia induction and after intubation were recorded.

Results:

The average ages of these patients were 70.39±8.02 years. Fifteen patients (83.33%) received non- invasive ventilation before tracheal intubation, and 13 patients (72.22%) were conscious before tracheal intubation. After induction of anesthesia, the blood pressure and heart rate of the patients decreased significantly (P < 0.05). Most of the patients (94.44%) were in excellent or good conditions for tracheal intubation, and the first-attempt success rate of tracheal intubation was 100%. Five patients died within 3 weeks following the intubation. Tracheotomy was performed in one patient. Twelve patients were still on endotracheal mechanical ventilation in the intensive care unit, and one of them received ECMO treatment due to poor oxygenation. A total of 16 experienced anesthesiologists participated in tracheal intubation, all with third-level protection during the operation, and no medical staff infection has been detected so far.

Conclusions:

For patients with severe and critical COVID-19 and indications of tracheal intubation, we recommend early intubation with invasive respiratory support to improve the treatment efficacy and reduce the mortality. Anesthetic agents should be used carefully during tracheal intubation to ensure patients' safety. The medical staff should have a high-level protection during the intubation to maximally ensure their safety.

Keywords:

COVID-19 tracheal intubation

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