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1.
Eur J Anaesthesiol ; 39(5): 463-472, 2022 May 01.
Article in English | MEDLINE | ID: covidwho-1806662

ABSTRACT

Tracheal intubation is among the most commonly performed and high-risk procedures in critical care. Indeed, 45% of patients undergoing intubation experience at least one major peri-intubation adverse event, with cardiovascular instability being the most common event reported in 43%, followed by severe hypoxemia in 9% and cardiac arrest in 3% of cases. These peri-intubation adverse events may expose patients to a higher risk of 28-day mortality, and they are more frequently observed with an increasing number of attempts to secure the airway. The higher risk of peri-intubation complications in critically ill patients, compared with the anaesthesia setting, is the consequence of their deranged physiology (e.g. underlying respiratory failure, shock and/or acidosis) and, in this regard, airway management in critical care has been defined as "physiologically difficult". In recent years, several randomised studies have investigated the most effective preoxy-genation strategies, and evidence for the use of positive pressure ventilation in moderate-to-severe hypoxemic patients is established. On the other hand, evidence on interventions to mitigate haemodynamic collapse after intubation has been elusive. Airway management in COVID-19 patients is even more challenging because of the additional risk of infection for healthcare workers, which has influenced clinical choices in this patient group. The aim of this review is to provide an update of the evidence for intubation in critically ill patients with a focus on understanding peri-intubation risks and evaluating interventions to prevent or mitigate adverse events.


Subject(s)
COVID-19 , Respiratory Insufficiency , Airway Management/adverse effects , Critical Illness/therapy , Humans , Intubation, Intratracheal/adverse effects , Intubation, Intratracheal/methods
2.
Minerva Anestesiol ; 88(4): 293-299, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1786554

ABSTRACT

INTRODUCTION: The aim of this study was to revise the etiologic features about Tapia's Syndrome (TS), a condition to particularly consider in the era of the COVID-19 pandemic. EVIDENCE ACQUISITION: A systematic review was performed according to the PRISMA criteria. The Medline and Embase databases were searched from January 1, 1990, to December 31, 2020. Initially the search yielded 399 manuscripts, which were reduced to 50, upon the application of inclusion criteria. EVIDENCE SYNTHESIS: A total of 65 patients were included in the present review. Mean age was 44±17.5 (DS) years (15-95); M:F ratio was 2.3:1. TS involved mainly the left side (3:2) and was rarely bilateral. Only 2 TS reported cases were due to central causes. Peripheral causes were mainly due to postintubation edema (77%), extrinsic compression (15%), vascular disease (3%), other/not defined (5%). CONCLUSIONS: TS is a rare syndrome that has been related to a combined cranial nerve palsy; while TS due to central causes is very rare, it is mainly related to peripheral causes. A particular attention to TS should be given during the SARS-CoV-2 pandemic, either since the correlation between Tapia's syndrome, airway management and anesthetic procedures, since the possible implication of the viral infection itself.


Subject(s)
COVID-19 , Hypoglossal Nerve Diseases , Adult , Airway Management/adverse effects , Humans , Hypoglossal Nerve Diseases/etiology , Middle Aged , Pandemics , SARS-CoV-2
3.
BMJ Case Rep ; 15(4)2022 Apr 08.
Article in English | MEDLINE | ID: covidwho-1784785

ABSTRACT

We present three cases who presented to the emergency department with severe complications of dental infections: Ludwig's angina, necrotising fasciitis and peritonsillar abscess. All of our cases presented at the beginning of COVID-19 pandemic, with complications of dental infections. They delayed their dental treatment due to the pandemic. The airway management was difficult in our cases. Their mortality risk increased due to complications. We aimed to draw attention to complicated odontogenic infections which are rarely seen in emergency department in the past, however started to show up increasingly particularly at the beginning of the COVID-19 pandemic.


Subject(s)
COVID-19 , Ludwig's Angina , Airway Management/adverse effects , Delayed Diagnosis/adverse effects , Humans , Ludwig's Angina/diagnosis , Pandemics
5.
Curr Opin Anaesthesiol ; 35(2): 137-143, 2022 Apr 01.
Article in English | MEDLINE | ID: covidwho-1662134

ABSTRACT

PURPOSE OF REVIEW: Critically ill Coronavirus disease 2019 (COVID-19) patients needing endotracheal intubation are on the verge of rapid decompensation. The aims of this review were to assess the risks, the preoxygenation, the device and the hemodynamic management of a patient with COVID-19. RECENT FINDINGS: The proceduralist performing endotracheal intubation with the entire team are at an increased risk for exposure to COVID-19. Appropriate personal protective equipment and other measures remain essential. For preoxygenation, noninvasive ventilation allows higher oxygen saturation during intubation in severely hypoxemic patients and can be associated with apneic oxygenation and mask ventilation during apnea in selected cases. The COVID-19 pandemic has further highlighted the place of videolaryngoscopy during intubation in intensive care unit (ICU). Hemodynamic optimization is mandatory to limit hypotension and cardiac arrest associated with airway management. SUMMARY: Future trials will better define the role of videolaryngoscopy, apneic oxygenation and mask ventilation during apnea for intubation of COVID-19 patients in ICU. The use of fluid loading and vasopressors remains to be investigated in large randomized controlled studies. Choosing the right time for intubation remains uncertain in clinical practice, and future works will probably help to identify earlier the patients who will need intubation.


Subject(s)
COVID-19 , Airway Management , Critical Illness/therapy , Humans , Intubation, Intratracheal/adverse effects , Pandemics , SARS-CoV-2
6.
Can J Anaesth ; 69(2): 205-215, 2022 02.
Article in English | MEDLINE | ID: covidwho-1641021

ABSTRACT

PURPOSE: To determine the performance and impact of an airway management team (AMT) assembled during the COVID-19 pandemic. METHODS: We conducted a retrospective cohort review of all adult patients who had received airway management services from the AMT (n = 269) and administered a survey questionnaire targeting physicians who had the option to activate the AMT (n = 77). The retrospective review determined the performance of the AMT, and the physicians' survey evaluated the impact of the AMT. The study was conducted at a large Canadian health centre (1,133 beds) from 28 March to 30 June 2020. We included patients in the cohort review who were ≥18 yr of age, whose chart showed that the AMT was activated, and whose airway was managed outside the operating room. We reviewed both electronic medical records and paper chart documentation. Outcomes included intubation success, number of intubation attempts, intubation time, team response time, patient contact time, intubation complications, and breaches of personal protective equipment (PPE) protocol. The physicians' survey evaluated the relevance, performance, reasonableness, and clinical utility of the AMT. RESULTS: The AMT intubated 231 patients. Charts showed that 91% of intubations were accomplished on first attempt. The mean (standard deviation) intubation time was 2.1 (0.2) min. The complication rate was minimal. The incidence of breaching PPE protocol items was less than 6%. No AMT members reported COVID-19 symptoms. The response rate for the physician's survey was 36%. The consensus among the participants was that the AMT had considerable clinical utility during the COVID-19 pandemic. CONCLUSION: An AMT assembled during the COVID-19 pandemic showed high competency and effectiveness, and had favourable impact on the main responsible physicians who activated the team.


RéSUMé: OBJECTIF: Déterminer la performance et l'impact d'une équipe de prise en charge des voies aériennes (AMT - Airway Management Team) assemblée pendant la pandémie de COVID-19. MéTHODE: Nous avons réalisé une revue de cohorte rétrospective de tous les patients adultes qui avaient bénéficié des services de prise en charge des voies aériennes par l'AMT (n = 269) et avons soumis un questionnaire aux médecins qui avaient eu la possibilité de faire appel à l'AMT (n = 77). La revue rétrospective a permis de déterminer la performance de l'AMT, et le sondage auprès des médecins a évalué l'impact de cette équipe dédiée. L'étude a été réalisée dans un grand centre de santé canadien (1133 lits) du 28 mars au 30 juin 2020. Dans la revue de cohorte, nous avons inclus des patients âgés de ≥18 ans, dans le dossier médical desquels il était fait mention de l'activation de l'AMT et dont les voies aériennes avaient été prises en charge à l'extérieur de la salle d'opération. Nous avons passé en revue à la fois la documentation des dossiers médicaux informatisés et des dossiers papier. Les résultats mesurés comprenaient le succès de l'intubation, le nombre de tentatives d'intubation, le temps pour intubation, le temps de réponse de l'équipe, le temps de contact avec le patient, les complications de l'intubation et les violations du protocole relatif aux équipements de protection individuelle (EPI). Le sondage auprès des médecins a évalué la pertinence, la performance, le caractère raisonnable et l'utilité clinique de l'AMT. RéSULTATS: L'AMT a intubé 231 patients. Les dossiers ont montré que 91 % des intubations ont réussi à la première tentative. Le temps moyen (écart type) d'intubation était de 2,1 (0,2) min. Le taux de complications était minime. L'incidence d'infractions aux articles du protocole pour les EPI était inférieure à 6 %. Aucun membre de l'AMT n'a rapporté de symptômes de COVID-19. Le taux de réponse au sondage auprès des médecins était de 36 %. Le consensus parmi les participants était que l'AMT était d'une utilité clinique considérable pendant la pandémie de COVID-19. CONCLUSION: Une équipe de prise en charge des voies aériennes assemblée pendant la pandémie de COVID-19 a démontré une compétence et une efficacité élevées et a eu un impact favorable sur les principaux médecins en charge qui ont fait appel à l'équipe.


Subject(s)
COVID-19 , Adult , Airway Management , Canada , Humans , Intubation, Intratracheal , Pandemics , Retrospective Studies , SARS-CoV-2
7.
Rev Esp Anestesiol Reanim (Engl Ed) ; 69(1): 12-24, 2022 01.
Article in English | MEDLINE | ID: covidwho-1632803

ABSTRACT

BACKGROUND: We explored the experience of clinicians from the Spanish Society of Anesthesiology (SEDAR) in airway management of COVID-19 patients. METHODS: An software-based survey including a 32-item questionnaire was conducted from April 18 to May 17, 2020. Participants who have been involved in tracheal intubations in patients with suspected or confirmed COVID-19 infection were included anonymously after obtaining their informed consent. The primary outcome was the preferred airway device for tracheal intubation. Secondary outcomes included the variations in clinical practice including the preferred video laryngoscope, plans for difficult airway management, and personal protective equipment. RESULTS: 1125 physicians completed the questionnaire with a response rate of 40,9%. Most participants worked in public hospitals and were anesthesiologists. The preferred device for intubation was the video laryngoscope (5.1/6), with the type of device in decreasing order as follows: Glidescope, C-MAC, Airtraq, McGrath and King Vision. The most frequently used device for intubation was the video laryngoscope (70,5%), using them in descending order as follow: the Airtraq, C-MAC, Glidescope, McGrath and King Vision. Discomfort of intubating wearing personal protective equipment and the frequency of breaching a security step was statistically significant, increasing the risk of cross infection between patients and healthcare workers. The opinion of senior doctors differed from younger physicians in the type of video-laryngoscope used, the number of experts involved in tracheal intubation and the reason that caused more stress during the airway management. CONCLUSIONS: Most physicians preferred using a video-laryngoscope with remote monitor and disposable Macintosh blade, using the Frova guide.


Subject(s)
COVID-19 , Laryngoscopes , Physicians , Airway Management , Humans , Intubation, Intratracheal , Laryngoscopy , SARS-CoV-2 , Spain , Surveys and Questionnaires
8.
Am J Emerg Med ; 53: 122-126, 2022 03.
Article in English | MEDLINE | ID: covidwho-1638161

ABSTRACT

BACKGROUND: Endotracheal intubation (ETI) is still the gold standard of airway management, but in cases of sudden cardiac arrest in patients with suspected SARS-CoV-2 infection, ETI is associated with risks for both the patient and the medical personnel. We hypothesized that the Vie Scope® is more useful for endotracheal intubation of suspected or confirmed COVID-19 cardiac arrest patients than the conventional laryngoscope with Macintosh blade when operators are wearing personal protective equipment (PPE). METHODS: Study was designed as a prospective, multicenter, randomized clinical trial performed by Emergency Medical Services in Poland. Patients with suspected or confirmed COVID-19 diagnosis who needed cardiopulmonary resuscitation in prehospital setting were included. Patients under 18 years old or with criteria predictive of impossible intubation under direct laryngoscopy, were excluded. Patients were randomly allocated 1:1 to Vie Scope® versus direct laryngoscopy with a Macintosh blade. Study groups were compared on success of intubation attempts, time to intubation, glottis visualization and number of optimization maneuvers. RESULTS: We enrolled 90 out-of-hospital cardiac arrest (OHCA) patients, aged 43-92 years. Compared to the VieScope® laryngoscope, use of the Macintosh laryngoscope required longer times for tracheal intubation with an estimated mean difference of -48 s (95%CI confidence interval [CI], -60.23, -35.77; p < 0.001). Moreover VieScope® improved first attempt success rate, 93.3% vs. 51.1% respectively (odds ratio [OR] = 13.39; 95%CI: 3.62, 49.58; p < 0.001). CONCLUSIONS: The use of the Vie Scope® laryngoscope in OHCA patients improved the first attempt success rate, and reduced intubation time compared to Macintosh laryngoscope in paramedics wearing PPE for against aerosol generating procedures. TRIAL REGISTRATION: ClinicalTrials registration number NCT04365608.


Subject(s)
Allied Health Personnel/statistics & numerical data , Intubation, Intratracheal/instrumentation , Laryngoscopes/standards , Adult , Aged , Aged, 80 and over , Airway Management/instrumentation , Airway Management/methods , Airway Management/statistics & numerical data , Allied Health Personnel/standards , Female , Humans , Intubation, Intratracheal/methods , Intubation, Intratracheal/statistics & numerical data , Laryngoscopes/statistics & numerical data , Male , Middle Aged , Personal Protective Equipment/adverse effects , Personal Protective Equipment/standards , Personal Protective Equipment/statistics & numerical data , Prospective Studies , Resuscitation/instrumentation , Resuscitation/methods , Resuscitation/statistics & numerical data
9.
Arch Cardiol Mex ; 91(Suplemento COVID): 095-101, 2021 Dec 20.
Article in Spanish | MEDLINE | ID: covidwho-1609000

ABSTRACT

The new coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), detected in Wuhan, China, causes coronavirus disease 2019 (COVID-19), which was declared pandemic, and has caused more than 19 million confirmed cases and more than 700 thousand deaths worldwide. When our institution was converted to COVID's hospital since early April 2020, specific care protocols were developed, with the aim of improving the quality of care and safety of patients and the staff involved in their management. Airway management represents one of the highest risks of direct contact infection with aerosol generation (orotracheal intubation, secretion aspiration, extubation, cardiopulmonary resuscitation, high flow oxygen therapy, noninvasive ventilation, and invasive ventilation). We present the current recommendations for airway management as well as a step-by-step airway management protocol to carry out a more secure procedure based on the literature reported so far.


El nuevo coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), detectado en Wuhan (China), causante de la enfermedad por coronavirus 2019 (COVID-19), que se declaró como pandemia, ha causado más de 19 millones de casos confirmados y más de 700 mil muertes en el mundo. Nuestra institución se reconvirtió a hospital COVID desde principios de abril del 2020, con lo que se desarrollaron protocolos de atención específicos, con el objetivo de mejorar la calidad de atención y seguridad de los pacientes y el personal involucrado en su manejo. El manejo de la vía aérea representa uno de los riesgos más altos de contagio por contacto directo en la generación de aerosoles (intubación orotraqueal, aspiración de secreciones, extubación, resucitación cardiopulmonar, terapia de oxígeno de alto flujo, ventilación no invasiva y ventilación invasiva). Presentamos las recomendaciones actuales para el manejo de la vía aérea, así como un protocolo de manejo paso a paso para llevar a cabo un procedimiento con mayor seguridad basados en la literatura reportada hasta el momento.


Subject(s)
Airway Management/methods , COVID-19 , Cardiology , Airway Management/standards , COVID-19/therapy , Cardiology/methods , Cardiology/standards , Humans
10.
Can J Anaesth ; 69(3): 333-342, 2022 03.
Article in English | MEDLINE | ID: covidwho-1561138

ABSTRACT

BACKGROUND: In the COVID-19 pandemic, an unprecedented number of individuals required endotracheal intubation. To safely face these challenges, expert intubation teams were formed in some institutions. Here, we report on the experience of emergency rapid intubation teams (ERITs) in two Canadian hospitals. METHODS: We retrospectively collected data on all airway management procedures in confirmed or suspected COVID-19 patients performed by ERITs at two academic hospitals between 3 April and 17 June 2020. The co-primary outcomes were incidence of periprocedural adverse events (hypoxemia, hypotension, and cardiac arrest within 15 min of intubation) and first-attempt intubation success rate. Secondary outcomes included number of intubation attempts, device used to achieve successful airway management, and adherence to personal protective equipment (PPE) protocols. RESULTS: During the study period, 123 patients were assessed for airway management, with 117 patients receiving airway interventions performed by the ERIT. The first-attempt success rate for intubation was 92%, and a videolaryngoscope was the final successful device in 93% of procedures. Hypoxemia (peripheral oxygen saturation [SpO2] < 90%) occurred in 28 patients (24%) and severe hypoxemia (SpO2 < 70%) occurred in ten patients (9%). Hypotension (systolic blood pressure [SBP] < 90 mm Hg) occurred in 37 patients (32%) and severe hypotension (SBP < 65 mm Hg) in 11 patients (9%). Adherence to recommended PPE use among providers was high. CONCLUSION: In this cohort of critically ill patients with respiratory failure requiring time-sensitive airway management, specialized ERIT teams showed high rates of successful airway management with high adherence to PPE use. Hypoxemia and hemodynamic instability were common and should be anticipated within the first 15 min following intubation. STUDY REGISTRATION: www.ClinicalTrials.gov (NCT04689724); registered 30 December 2020.


RéSUMé: CONTEXTE: Pendant la pandémie de COVID-19, un nombre sans précédent de patients ont dû bénéficier d'une intubation endotrachéale. Pour faire face en toute sécurité à ces défis, des équipes d'experts en intubation ont été formées dans certains établissements. Nous rendons compte ici de l'expérience d'équipes d'intubation rapide d'urgence (ou ERIT, pour Emergency Rapid Intubation Team) dans deux hôpitaux canadiens. MéTHODE: Nous avons colligé rétrospectivement les données concernant toutes les interventions de prise en charge des voies aériennes chez les patients COVID-19 confirmés ou suspectés réalisées par les ERIT dans deux hôpitaux universitaires entre le 3 avril et le 17 juin 2020. Les deux critères d'évaluation principaux étaient l'incidence d'événements indésirables péri-procédure (hypoxémie, hypotension et arrêt cardiaque dans les 15 minutes suivant l'intubation) et le taux de réussite de l'intubation à la première tentative. Les critères d'évaluation secondaires comprenaient le nombre de tentatives d'intubation, le dispositif utilisé pour parvenir au succès de la prise en charge des voies aériennes et le respect des protocoles concernant les équipements de protection individuelle (EPI). RéSULTATS: Au cours de la période à l'étude, 123 patients ont été évalués pour une prise en charge des voies aériennes, et 117 patients ont bénéficié d'interventions au niveau des voies aériennes réalisées par l'ERIT. Le taux de réussite de la première tentative d'intubation était de 92 %, et un vidéolaryngoscope a été le dispositif menant à une intubation réussie dans 93 % des interventions. Des épisodes d'hypoxémie (saturation périphérique en oxygène [SpO2] < 90 %) sont survenus chez 28 patients (24 %) et dix patients (9 %) ont souffert d'hypoxémie sévère (SpO2 < 70 %). Des épisodes d'hypotension (tension artérielle systolique [TAS] < 90 mmHg) sont survenus chez 37 patients (32 %) et 11 patients (9 %) ont souffert d'hypotension sévère (TAS < 65 mmHg). Le respect de l'utilisation recommandée des EPI chez les soignants était élevé. CONCLUSION: Dans cette cohorte de patients gravement malades atteints d'insuffisance respiratoire et nécessitant une prise en charge des voies aériennes urgente, les équipes spécialisées de l'ERIT ont montré des taux élevés de succès de prise en charge des voies aériennes, avec une adhésion élevée aux protocoles d'utilisation des EPI. L'hypoxémie et l'instabilité hémodynamique étaient fréquentes et devaient être anticipées dans les 15 premières minutes suivant l'intubation. ENREGISTREMENT DE L'éTUDE: www.ClinicalTrials.gov  (NCT04689724); enregistrée le 30 décembre 2020.


Subject(s)
COVID-19 , Airway Management/methods , Canada , Hospitals , Humans , Intubation, Intratracheal , Pandemics , Prospective Studies , Retrospective Studies , SARS-CoV-2
11.
Intensive Crit Care Nurs ; 69: 103189, 2022 04.
Article in English | MEDLINE | ID: covidwho-1560560
12.
BMC Anesthesiol ; 21(1): 288, 2021 11 22.
Article in English | MEDLINE | ID: covidwho-1528675

ABSTRACT

BACKGROUND: VieScope is a new type of laryngoscope, with a straight, transparent and illuminated blade, allowing for direct line of sight towards the larynx. In addition, VieScope is disposed of after single patient use, which can avoid cross-contaminations of contagious material. This has gained importance especially when treating patients with highly contagious infectious diseases, such as during the SARS-CoV2 pandemic. In this context, VieScope has not been evaluated yet in a clinical study. MATERIAL AND METHODS: This study compared intubation with VieScope to video-laryngoscopy (GlideScope) in normal and difficult airway in a standardized airway manikin in a randomized controlled simulation trial. Thirty-five medical specialists were asked to perform endotracheal intubation in full personal protective equipment (PPE). Primary endpoint was correct tube position. First-pass rate (i.e., success rate at the first attempt), time until intubation and time until first correct ventilation were registered as secondary endpoints. RESULTS: For correct tracheal tube placement, there was no significant difference between VieScope and GlideScope in normal and difficult airway conditions. VieScope had over 91% fist-pass success rate in normal airway setting. VieScope had a comparable success rate to GlideScope in difficult airway, but had a significantly longer time until intubation and time until ventilation. CONCLUSION: VieScope and GlideScope had high success rates in normal as well as in difficult airway. There was no unrecognized esophageal intubation in either group. Overall time for intubation was longer in the VieScope group, though in an acceptable range given in literature. Results from this simulation study suggest that VieScope may be an acceptable alternative for tracheal intubation in full PPE. TRIAL REGISTRATION: The study was registered at the German Clinical Trials Register www.drks.de (Registration date: 09/11/2020; TrialID: DRKS00023406 ).


Subject(s)
Airway Management/methods , Intubation, Intratracheal/methods , Laryngoscopy/methods , Personal Protective Equipment , Adult , Airway Management/instrumentation , Disposable Equipment , Equipment Design , Female , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intubation, Intratracheal/instrumentation , Laryngoscopy/instrumentation , Male , Manikins , Middle Aged , Time Factors , Video Recording
14.
Anesthesiology ; 136(2): 395-396, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1511037
15.
Anesthesiology ; 136(2): 394-395, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1511036
18.
Anesth Analg ; 133(4): 876-890, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1412364

ABSTRACT

The coronavirus disease 2019 (COVID-19) disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), often results in severe hypoxemia requiring airway management. Because SARS-CoV-2 virus is spread via respiratory droplets, bag-mask ventilation, intubation, and extubation may place health care workers (HCW) at risk. While existing recommendations address airway management in patients with COVID-19, no guidance exists specifically for difficult airway management. Some strategies normally recommended for difficult airway management may not be ideal in the setting of COVID-19 infection. To address this issue, the Society for Airway Management (SAM) created a task force to review existing literature and current practice guidelines for difficult airway management by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. The SAM task force created recommendations for the management of known or suspected difficult airway in the setting of known or suspected COVID-19 infection. The goal of the task force was to optimize successful airway management while minimizing exposure risk. Each member conducted a literature review on specific clinical practice section utilizing standard search engines (PubMed, Ovid, Google Scholar). Existing recommendations and evidence for difficult airway management in the COVID-19 context were developed. Each specific recommendation was discussed among task force members and modified until unanimously approved by all task force members. Elements of Appraisal of Guidelines Research and Evaluation (AGREE) Reporting Checklist for dissemination of clinical practice guidelines were utilized to develop this statement. Airway management in the COVID-19 patient increases HCW exposure risk. Difficult airway management often takes longer and may involve multiple procedures with aerosolization potential, and strict adherence to personal protective equipment (PPE) protocols is mandatory to reduce risk to providers. When a patient's airway risk assessment suggests that awake tracheal intubation is an appropriate choice of technique, and procedures that may cause increased aerosolization of secretions should be avoided. Optimal preoxygenation before induction with a tight seal facemask may be performed to reduce the risk of hypoxemia. Unless the patient is experiencing oxygen desaturation, positive pressure bag-mask ventilation after induction may be avoided to reduce aerosolization. For optimal intubating conditions, patients should be anesthetized with full muscle relaxation. Videolaryngoscopy is recommended as a first-line strategy for airway management. If emergent invasive airway access is indicated, then we recommend a surgical technique such as scalpel-bougie-tube, rather than an aerosolizing generating procedure, such as transtracheal jet ventilation. This statement represents recommendations by the SAM task force for the difficult airway management of adults with COVID-19 with the goal to optimize successful airway management while minimizing the risk of clinician exposure.


Subject(s)
Airway Management/standards , COVID-19/prevention & control , Health Personnel/standards , Infection Control/standards , Personal Protective Equipment/standards , Societies, Medical/standards , Adult , Advisory Committees/standards , Airway Extubation/methods , Airway Extubation/standards , Airway Management/methods , COVID-19/epidemiology , Humans , Infection Control/methods , Intubation, Intratracheal/methods , Intubation, Intratracheal/standards , Practice Guidelines as Topic/standards
19.
Can J Anaesth ; 68(9): 1313-1316, 2021 09.
Article in English | MEDLINE | ID: covidwho-1392020
20.
BMC Anesthesiol ; 21(1): 28, 2021 01 25.
Article in English | MEDLINE | ID: covidwho-1388729

ABSTRACT

BACKGROUND: Routine preoperative methods to assess airway such as the interincisor distance (IID), Mallampati classification, and upper lip bite test (ULBT) have a certain risk of upper respiratory tract exposure and virus spread. Condyle-tragus maximal distance(C-TMD) can be used to assess the airway, and does not require the patient to expose the upper respiratory tract, but its value in predicting difficult laryngoscopy compared to other indicators (Mallampati classification, IID, and ULBT) remains unknown. The purpose of this study was to observe the value of C-TMD to predict difficult laryngoscopy and the influence on intubation time and intubation attempts, and provide a new idea for preoperative airway assessment during epidemic. METHODS: Adult patients undergoing general anesthesia and tracheal intubation were enrolled. IID, Mallampati classification, ULBT, and C-TMD of each patient were evaluated before the initiation of anesthesia. The primary outcome was intubation time. The secondary outcomes were difficult laryngoscopy defined as the Cormack-Lehane Level > grade 2 and the number of intubation attempts. RESULTS: Three hundred four patients were successfully enrolled and completed the study, 39 patients were identified as difficult laryngoscopy. The intubation time was shorter with the C-TMD>1 finger group 46.8 ± 7.3 s, compared with the C-TMD<1 finger group 50.8 ± 8.6 s (p<0.01). First attempt success rate was higher in the C-TMD>1 finger group 98.9% than in the C-TMD<1 finger group 87.1% (P<0.01). The correlation between the C-TMD and Cormack-Lehane Level was 0.317 (Spearman correlation coefficient, P<0.001), and the area under the ROC curve was 0.699 (P<0.01). The C-TMD < 1 finger width was the most consistent with difficult laryngoscopy (κ = 0.485;95%CI:0.286-0.612) and its OR value was 10.09 (95%CI: 4.19-24.28), sensitivity was 0.469 (95%CI: 0.325-0.617), specificity was 0.929 (95%CI: 0.877-0.964), positive predictive value was 0.676 (95%CI: 0.484-0.745), negative predictive value was 0.847 (95%CI: 0.825-0.865). CONCLUSION: Compared with the IID, Mallampati classification and ULBT, C-TMD has higher value in predicting difficult laryngoscopy and does not require the exposure of upper respiratory tract. TRIAL REGISTRATION: The study was registered on October 21, 2019 in the Chinese Clinical Trial Registry ( ChiCTR1900026775 ).


Subject(s)
Airway Management/methods , Anesthesia, General/methods , Intubation, Intratracheal/methods , Laryngoscopy/methods , Adult , Aged , COVID-19 , Female , Humans , Male , Middle Aged , Pilot Projects , Predictive Value of Tests , Preoperative Care , Prospective Studies , Respiratory System/anatomy & histology , Sensitivity and Specificity
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