Practical workflow recommendations for emergency endotracheal intubation in critically ill patients with COVID-19 based on the experience of Wuhan Union Hospital
•The condition of some patients with COVID-19 progress rapidly and require aggressive treatments and intensive care, such as endotracheal intubation.•Emergency endotracheal intubation in critically ill patients with COVID-19 has posed a huge challenge to the self-protection of anesthesiologists.•Ane...
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| Published in | Journal of clinical anesthesia Vol. 66; p. 109940 |
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| Main Authors | , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
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Elsevier Inc
01.11.2020
Elsevier Limited |
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| Abstract | •The condition of some patients with COVID-19 progress rapidly and require aggressive treatments and intensive care, such as endotracheal intubation.•Emergency endotracheal intubation in critically ill patients with COVID-19 has posed a huge challenge to the self-protection of anesthesiologists.•Anesthesiologists from the frontline of Wuhan, China brought first-hand experience about emergency endotracheal intubation in critically ill patients with COVID-19 to colleagues. |
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| AbstractList | 2)Respiratory and cardiac arrest patients. 2 Patient ward preparations before endotracheal intubation 1)Personnel preparation: the attending doctor or related medical staff familiar with the ventilator and the suction operation should give assistance; 2)Item preparation: i.Sign on consent to the risk of endotracheal intubation; ii.Open venous access (indwelling needle above 20G) and three-way valve, connect with 0.9% physiological saline; iii.Monitor vital signs (ECG, respiratory rate, SpO2 and blood pressure); iv.Well connected threaded tube, oxygen, power supply, and invasive ventilator with properly adjusted ventilator parameters; v.Oxygen pack filled with oxygen; vi.Connect the suction device; vii.Prescribe in advance and prepare related drugs. 3 Precautions for anesthesia staff before endotracheal intubation 1)After receiving the notification, the anesthesiologist re-confirms the indications for endotracheal intubation and checks the patient's basic situation; 2)The anesthesiologist should check the ventilator, make sure the ventilator parameters are set properly and patient's venous access is open, and evaluate the airway condition. 4 Protection during endotracheal intubation (taking Level III protection measures) 1)Personal protection should be done according to the hospital infection prevention and control requirements including hand-washing clothes or working clothes, medical protective masks, disposable work caps, disposable protective clothing, disposable latex gloves, disposable shoe covers, eye-protective medical surgical masks or goggles, medical protective masks, splash-proof screen or a full-face hood [3]; 2)Putting on personal protective equipment or removing personal protective equipment, as shown in Flow chart 1. The protective equipment should be discarded into the double yellow garbage bags and put to the designated area. 5 Procedure of endotracheal intubation 1)Before endotracheal intubation, it is necessary to check the monitoring equipment (ECG, respiratory rate, blood pressure and SpO2), intubation equipment (video laryngoscope, laryngeal mask, endotracheal tube, intubation stylet), auxiliary respiratory equipment (breathing balloon, mask), oxygen supply equipment, sputum suction equipment again, array the various instrument lines, and prepare first-aid drugs; 2)Pre‑oxygenated with 100% FiO2 for 5 min through a mask via a face mask with reservoir bag, or breathing mask, or BIPAP ventilator, etc. Protect cornea with 0.5% erythromycin ointment; 3)Lung protective ventilation strategy: low tidal volume (6–8 mL/kg, ideal body weight) and low inspiration pressure (platform pressure < 30 cmH2O) for mechanical ventilation to reduce ventilator-related lung injury; breathing parameters can be adjusted by the result of arterial blood gas [7]. •The condition of some patients with COVID-19 progress rapidly and require aggressive treatments and intensive care, such as endotracheal intubation.•Emergency endotracheal intubation in critically ill patients with COVID-19 has posed a huge challenge to the self-protection of anesthesiologists.•Anesthesiologists from the frontline of Wuhan, China brought first-hand experience about emergency endotracheal intubation in critically ill patients with COVID-19 to colleagues. • The condition of some patients with COVID-19 progress rapidly and require aggressive treatments and intensive care, such as endotracheal intubation. • Emergency endotracheal intubation in critically ill patients with COVID-19 has posed a huge challenge to the self-protection of anesthesiologists. • Anesthesiologists from the frontline of Wuhan, China brought first-hand experience about emergency endotracheal intubation in critically ill patients with COVID-19 to colleagues. |
| ArticleNumber | 109940 |
| Author | Song, Limin Wang, Li Xiao, Weimin Zhang, Yuhong Nie, Bingqing Xia, Haifa Lin, Yun Hu, Xiaomin Chen, Xueyin Lin, Ken Yao, Shanglong Chen, Xiangdong Lu, Dongshi Huang, Shiqian |
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| Cites_doi | 10.1097/EJA.0000000000000954 10.1164/rccm.201703-0548ST 10.1097/ALN.0000000000003301 10.1016/j.bja.2019.03.020 10.1016/S0140-6736(20)30183-5 10.1016/j.bja.2017.10.021 10.1001/jama.2017.21907 |
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| References | Ahn, Kwon, Lee, Hahm, Jeong (bb0025) 2019; 123 Higgs, McGrath, Goddard, Rangasami, Suntharalingam, Gale (bb0030) 2018; 120 Fan, Del Sorbo, Goligher, Hodgson, Munshi, Walkey (bb0035) 2017; 195 Huang, Wang, Li, Ren, Zhao, Hu (bb0005) 2020; 395 Fan, Brodie, Slutsky (bb0010) 2018; 319 Chen, Liu, Gong, Guo, Zuo, Li (bb0015) 2020; 132 Hanouz, Lhermitte, Gérard, Fischer (bb0020) 2019; 36 Ahn (10.1016/j.jclinane.2020.109940_bb0025) 2019; 123 Huang (10.1016/j.jclinane.2020.109940_bb0005) 2020; 395 Fan (10.1016/j.jclinane.2020.109940_bb0010) 2018; 319 Hanouz (10.1016/j.jclinane.2020.109940_bb0020) 2019; 36 Chen (10.1016/j.jclinane.2020.109940_bb0015) 2020; 132 Fan (10.1016/j.jclinane.2020.109940_bb0035) 2017; 195 Higgs (10.1016/j.jclinane.2020.109940_bb0030) 2018; 120 |
| References_xml | – volume: 395 start-page: 497 year: 2020 end-page: 506 ident: bb0005 article-title: Clinical features of patients infected with 2019 Novel Coronavirus in Wuhan, China publication-title: Lancet contributor: fullname: Hu – volume: 36 start-page: 335 year: 2019 end-page: 341 ident: bb0020 article-title: Comparison of pre-oxygenation using spontaneous breathing through face mask and high-flow nasal oxygen: a randomised controlled crossover study in healthy volunteers publication-title: Eur J Anaesthesiol contributor: fullname: Fischer – volume: 120 start-page: 323 year: 2018 end-page: 352 ident: bb0030 article-title: Guidelines for the management of tracheal intubation in critically ill adults publication-title: Br J Anaesth contributor: fullname: Gale – volume: 319 start-page: 698 year: 2018 end-page: 710 ident: bb0010 article-title: Acute respiratory distress syndrome: advances in diagnosis and treatment publication-title: JAMA contributor: fullname: Slutsky – volume: 132 start-page: 1307 year: 2020 end-page: 1316 ident: bb0015 article-title: Perioperative management of patients infected with the novel coronavirus: recommendation from the Joint Task Force of the Chinese Society of Anesthesiology and the Chinese Association of Anesthesiologists publication-title: Anesthesiology contributor: fullname: Li – volume: 123 start-page: 309 year: 2019 end-page: 315 ident: bb0025 article-title: Ultrasound-guided lung sliding sign to confirm optimal depth of tracheal tube insertion in young children publication-title: Br J Anaesth contributor: fullname: Jeong – volume: 195 start-page: 1253 year: 2017 end-page: 1263 ident: bb0035 article-title: An official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: mechanical ventilation in adult patients with Acute Respiratory Distress Syndrome publication-title: Am J Respir Crit Care Med contributor: fullname: Walkey – volume: 36 start-page: 335 year: 2019 ident: 10.1016/j.jclinane.2020.109940_bb0020 article-title: Comparison of pre-oxygenation using spontaneous breathing through face mask and high-flow nasal oxygen: a randomised controlled crossover study in healthy volunteers publication-title: Eur J Anaesthesiol doi: 10.1097/EJA.0000000000000954 contributor: fullname: Hanouz – volume: 195 start-page: 1253 year: 2017 ident: 10.1016/j.jclinane.2020.109940_bb0035 article-title: An official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: mechanical ventilation in adult patients with Acute Respiratory Distress Syndrome publication-title: Am J Respir Crit Care Med doi: 10.1164/rccm.201703-0548ST contributor: fullname: Fan – volume: 132 start-page: 1307 year: 2020 ident: 10.1016/j.jclinane.2020.109940_bb0015 article-title: Perioperative management of patients infected with the novel coronavirus: recommendation from the Joint Task Force of the Chinese Society of Anesthesiology and the Chinese Association of Anesthesiologists publication-title: Anesthesiology doi: 10.1097/ALN.0000000000003301 contributor: fullname: Chen – volume: 123 start-page: 309 year: 2019 ident: 10.1016/j.jclinane.2020.109940_bb0025 article-title: Ultrasound-guided lung sliding sign to confirm optimal depth of tracheal tube insertion in young children publication-title: Br J Anaesth doi: 10.1016/j.bja.2019.03.020 contributor: fullname: Ahn – volume: 395 start-page: 497 year: 2020 ident: 10.1016/j.jclinane.2020.109940_bb0005 article-title: Clinical features of patients infected with 2019 Novel Coronavirus in Wuhan, China publication-title: Lancet doi: 10.1016/S0140-6736(20)30183-5 contributor: fullname: Huang – volume: 120 start-page: 323 year: 2018 ident: 10.1016/j.jclinane.2020.109940_bb0030 article-title: Guidelines for the management of tracheal intubation in critically ill adults publication-title: Br J Anaesth doi: 10.1016/j.bja.2017.10.021 contributor: fullname: Higgs – volume: 319 start-page: 698 year: 2018 ident: 10.1016/j.jclinane.2020.109940_bb0010 article-title: Acute respiratory distress syndrome: advances in diagnosis and treatment publication-title: JAMA doi: 10.1001/jama.2017.21907 contributor: fullname: Fan |
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| Snippet | •The condition of some patients with COVID-19 progress rapidly and require aggressive treatments and intensive care, such as endotracheal intubation.•Emergency... 2)Respiratory and cardiac arrest patients. 2 Patient ward preparations before endotracheal intubation 1)Personnel preparation: the attending doctor or related... • The condition of some patients with COVID-19 progress rapidly and require aggressive treatments and intensive care, such as endotracheal intubation. •... |
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| SubjectTerms | Airway management Anesthesia Blood pressure China Coronavirus Infections - prevention & control Coronavirus Infections - therapy Coronaviruses Correspondence COVID-19 Critical Illness Editing Emergencies Hospitals Humans Intubation Intubation, Intratracheal - methods Masks Medical supplies Pandemics - prevention & control Patients Personal protective equipment Pneumonia, Viral - prevention & control Pneumonia, Viral - therapy Protective clothing R&D Research & development Severe acute respiratory syndrome coronavirus 2 Suctioning Ventilators Workflow Writing |
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| Title | Practical workflow recommendations for emergency endotracheal intubation in critically ill patients with COVID-19 based on the experience of Wuhan Union Hospital |
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