Airway Management Of COVID-19 Patients Research Articles

Croatian national audit on videolaryngoscopes and alternative intubation devices in the era of COVID-19 pandemic.

Videolaryngoscopy (VL) is the recommended strategy for airway management in COVID-19 patients and guidelines recommends that all anesthesiologists should be trained to use and have immediate access to the device. However, the availability of VL in hospitals and its use may vary, as well as the choice of the device and necessary training. Our primary aim was to investigate data on availability of VL in Croatia, its use, the choice of the device and its implementation, with special consideration of COVID-19 management. An electronic survey was sent to all Croatian hospitals that have anesthesiology service available. The survey was designed to examine data on availability and use of VL with special consideration of COVID-19 wards. The survey was conducted between 1.03.2021 and 30.08.2021. Response rate was 83%. VL was available in 86% of hospitals and the best supplied areas were intensive care units, general surgery and gynecology/obstetrics. The most common VL devices were Bonfils, C-MAC and C-MAC D-blade. The choice of VL was mainly based on centralized hospital procurement and informal introduction was found to be the most frequent training method. The VL was mainly used in Croatian hospitals in cases of difficult airway or as a backup method after failed intubation. Only 16% of hospitals reported regular use in everyday practice. Even though, VL was available in 64% of COVID-19 wards, only 21% of hospitals reported routine use. Although VL is available in the majority of Croatian hospitals, its use is still mainly restricted to difficult airway scenarios. Use of VL in COVID-19 management is also low and education on the method is still mainly informal. Based upon our results better implementation in practice should be targeted, as well as formal skill trainings especially regarding COVID-19 care.

A multicentric prospective study on clear plastic drape versus acrylic box during airway management of COVID-19 patients.

A multicentric prospective study on clear plastic drape versus acrylic box during airway management of COVID-19 patients.

Human Factors and Airway Management in COVID-19 Patients: The Perfect Storm?

The SARS-CoV-2 pandemic heavily impacted healthcare workers, increasing their physical and psychological workload. Specifically, COVID-19 patients’ airway management is definitely a challenging task regarding both severe and acute respiratory failure and the risk of contagion while performing aerosol-generating procedures. The category of anesthesiologists and intensivists, the main actors of airway management, showed a poor psychological well-being and a high stress and burnout risk. Identifying and better defining the specific main SARS-CoV-2-related stressors can help them deal with and effectively plan a strategy to manage these patients in a more confident and safer way. In this review, we therefore try to analyze the relevance of human factors and non-technical skills when approaching COVID-19 patients. Lessons from the past, such as National Audit Project 4 recommendations, have taught us that safe airway management should be based on preoperative assessment, the planning of an adequate strategy, the optimization of setting and resources and the rigorous evaluation of the scenario. Despite, or thanks to, the critical issues and difficulties, the “take home lesson” that we can translate from SARS-CoV-2 to every airway management is that there can be no more room for improvisation and that creating teamwork must become a priority.

Emergency airway management in COVID-19 patients and risk to healthcare workers: A low-middle income country data from the intubate COVID registry.

Emergency airway management in COVID-19 patients and risk to healthcare workers: A low-middle income country data from the intubate COVID registry.

Airway management of COVID-19 patients: A survey on the experience of 1125 physicians in Spain.

BackgroundWe explored the experience of clinicians from the Spanish Society of Anesthesiology (SEDAR) in airway management of COVID-19 patients.MethodsAn 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.Results1125 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.ConclusionsMost physicians preferred using a video-laryngoscope with remote monitor and disposable Macintosh blade, using the Frova guide.

Tracheal intubation in the critically ill patient.

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.

Effectiveness of a Simulation-Based Training Program in Improving the Preparedness of Health Care Workers Involved in the Airway Management of COVID-19 Patients.

BackgroundCoronavirus disease 2019 (COVID-19) has currently emerged as a global threat and a significant public health issue. The role of simulation-based training (SBT) during such a pandemic becomes more relevant for teaching a team approach and building capacity especially when there is a threat to health care workers due to aerosol generation and there is a huge demand for manpower during the pandemic.ObjectiveTo assess the effectiveness of a simulation-based training program in improving knowledge and concept of teamwork of health care workers involved in airway management of suspected or confirmed COVID-19 patients.MethodsAfter institutional review committee approval, a prospective analytical study was conducted in the department of medical education on participants from various specialties undergoing COVID-19 airway training. The purpose of the study was to assess team dynamics during simulation scenarios and compare test scores at baseline, immediately post-training, and seven days post-training (using online forms). Scores were compared using the Friedman test followed by post-hoc testing. Sub-group comparison was done using an unpaired t-test.ResultsMedian scores were significantly higher in the immediate post-training test and seven days post-training test (online) compared to baseline pretest scores in the overall participant group and in individual sub-groups. There was no significant difference in immediate versus seven-day post-training test scores overall and in all subgroups. In the sub-group comparisons, median improvement in score was significantly better in the non-anesthesia group and in the resident group. It was observed that team performance in terms of role clarity, closed-loop communication, and idea acceptance improved substantially during the subsequent scenarios.ConclusionSimulation-based training was effective in improving knowledge and team dynamics amongst health care workers regarding airway management in COVID-19 patients, with retention of up to one week. Similar future research can be planned for the affective and psychomotor domains.

Preparation for airway management in Australia and New Zealand ICUs during the COVID -19 pandemic.

BackgroundThis paper aimed to describe the airway practices of intensive care units (ICUs) in Australia and New Zealand specific to patients presenting with COVID-19 and to inform whether consistent clinical practice was achieved. Specific clinical airway guidelines were endorsed in March 2020 by the Australian and New Zealand Intensive Care Society (ANZICS) and College of Intensive Care Medicine (CICM).Methods and findingsProspective, structured questionnaire for all ICU directors in Australia and New Zealand was completed by 69 ICU directors after email invitation from ANZICS. The online questionnaire was accessible for three weeks during September 2020 and analysed by cloud-based software. Basic ICU demographics (private or public, metropolitan or rural) and location, purchasing, airway management practices, guideline uptake, checklist and cognitive aid use and staff training relevant to airway management during the COVID-19 pandemic were the main outcome measures. The 69 ICU directors reported significant simulation-based inter-professional airway training of staff (97%), and use of video laryngoscopy (94%), intubation checklists (94%), cognitive aids (83%) and PPE “spotters” (89%) during the airway management of patients with COVID-19. Tracheal intubation was almost always performed by a Specialist (97% of ICUs), who was more likely to be an intensivist than an anaesthetist (61% vs 36%). There was a more frequent adoption of specific airway guidelines for the management of COVID-19 patients in public ICUs (94% vs 71%) and reliance on specialist intensivists to perform intubations in private ICUs (92% vs 53%).ConclusionThere was a high uptake of a standardised approach to airway management in COVID-19 patients in ICUs in Australia and New Zealand, likely due to endorsement of national guidelines.

The barrier techniques for airway management in covid-19 patients - review of literature.

The coronavirus disease 2019 (COVID-19) has emerged as a pandemic and shall prevail for some time around the globe. The disease can manifest from asymptomatic to severe respiratory compromise requiring airway intervention. Transmission of COVID-19 has been reported to be by droplets, fomites, and aerosols, and airway management is an aerosol-generating procedure. The high viral load in the patient's airway puts the clinician performing intubation at a very high risk of viral load exposure. So, the need for barrier devices was considered and led to reporting of various such devices. All these devices have been reported individually and have not been compared. We present a review of all the information on these devices based on the reported literature.

Manejo de vía aérea en pacientes COVID-19: una encuesta sobre la experiencia de 1125 médicos en España

BackgroundWe explored the experience of clinicians from the Spanish Society of Anesthesiology in airway management of COVID-19 patients. MethodsAn 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. Results1125 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 physicians. 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. ConclusionsMost physicians preferred using a video-laryngoscope with remote monitor and disposable Macintosh blade, using the Frova guide.

Rocuronium vs Succinylcholine: Emergency Airway Management of the COVID-19 Patient

Tracheal Intubation is routinely performed in many settings. Anesthesia providers are experts in this procedure. Determination for the best possible approach for tracheal intubation include patient and provider specific considerations. Severe acute respiratory syndrome-coronavirus-2 (SARS CoV-2) infection has led to the COVID-19 pandemic. SARS CoV-2 is a highly contagious RNA virus that has caused widespread infections, severe respiratory disease, and deaths. The purpose of this article is to describe the airway management currently recommended in Germany as well as the United States, the multi-systems pathophysiologic complications of these patients, and review the need for minimum airway manipulation prior to intubation of the trachea. Further, this article discusses the pharmacologic options that are available for muscle relaxation during rapid sequence induction. A review of the literature was performed. Further, some authors of this article have actively participated in airway management of COVID-19 patients. Available literature and guidelines suggest that rapid sequence induction with minimal airway manipulation is superior to standard induction. The article suggests that appropriate doses of rocuronium with an option of sugammadex reversal is a safer and superior choice to succinylcholine.

What are the best methods of airway management in COVID-19 patients?

What are the best methods of airway management in COVID-19 patients?

Reply to: video laryngoscopy during airway management in COVID-19 patients.

Editor, We thank Hilbert1 for his interest in our previous work2 and appreciate the opportunity to respond. We absolutely agree that using a video laryngoscope, preferably with an external monitor, during intubation should be urgently included in the general recommendations for airway management in the care of patients with COVID-19. As we mentioned in our article in the last year's Christmas issue of the European Journal of Anaesthesiology, the use of video laryngoscope increases the distance between the face of the intubating person and the mouth of the patient, which is likely to reduce the risk of cross-infection of respiratory infectious diseases between patient and healthcare personnel. In our study, we also cultivated the patients’ exhaled gas colonies during intubation. However, these data were not reported in our article2 as we did not cultivate exhaled gas colonies before induction. Still, it is reasonable to conclude that the risk of cross-infection decreases with the increase of this spatial distance, which is also the reason why Dr Hilbert proposed separating the screen from the laryngoscope handle and using an external screen. Compared with the GlideScope, the handle of which is separated from the screen, our colleagues are more willing to use a video laryngoscope with a screen mounted on the handle, because it is lighter and more convenient in daily clinical practice. However, if we can make the split-screen video laryngoscope lighter and more convenient, our colleagues’ habits are likely to change radically. Although many countermeasures have been taken, the global spread of COVID-19 is strikingly fast3 and its contagion power is stronger than SARS-CoV and MERS-CoV.4 We agree that in addition to the consequent use of the personal protective equipment, we should reduce all procedures that are associated with the intense formation of aerosols to prevent further airborne spread of the virus as best as possible. All the intubation operators have been encouraged to use video laryngoscopy rather than direct laryngoscopy for intubation amid the COVID-19 outbreak in China.5 In addition, we also developed a new way to reduce the risk of cross-infection between anaesthesiologists and patients by using a uniquely designed protective sleeve (Fig. 1).6 This enable us to avoid self-contamination since that routine use of personal protective equipment is associated with frequent self-contamination, which is highest during removal of the equipment.7Fig. 1: Difference in intubation with or without the novel protective sleeve.In short, fighting with respiratory infection microorganism is a long process. With the advancement of technology, coupled with our continuous innovation, there will be more and more ways to deal with it, and the comprehensive use of these methods will allow us to increase the chance of defeating the disease. Hand in hand with peers around the world, we could finally conquer COVID-19 together. Acknowledgements relating to this article Assistance with the letter: none. Financial support and sponsorship: this work was supported by Postdoctoral Science Foundation of China (Grant No. 2019M663260 and No. 2020T130148ZX) and the Fundamental Research Funds for the Central Universities, China (Grant No. 20ykpy20). Conflicts of interest: none.

Video laryngoscopy during airway management in COVID-19 patients: practical relevance of a recent EJA Christmas issue article.

Video laryngoscopy during airway management in COVID-19 patients: practical relevance of a recent EJA Christmas issue article.

Airway management of COVID-19 patients with severe pneumonia

重症及危重症新型冠状病毒肺炎患者会在短时间内进展为急性呼吸窘迫综合征，无创或有创正压通气支持将是重症和危重症治疗的重要手段，有助于提高新型冠状病毒肺炎的临床救治率，降低重症患者的病死率。良好的气道治疗管理对提高呼吸支持效率，减少并发症，促进康复具有重要意义。.

Airway management of COVID-19 patients with severe pneumonia

Patients with severe and critical COVID-19 will develop into acute respiratory distress syndrome in a short time. Noninvasive or invasive positive pressure ventilation will be important means for those patients, which will help to improve the clinical cure rate and reduce the mortality. Effective airway management has a great significance to improve respiratory support, reduce complications, and promote rehabilitation.

Anestezi Teknisyenlerinin/Teknikerlerinin Koronavirüs (COVID-19) Pozitif ya da Şüpheli Hastalarda Entübasyon ile İlgili Bilgi Düzeyleri

Objective: Airway management is very important in COVID-19 infection, which was declared as a pandemic in March 2020 and is among the intensive contact procedures. Our aim in this study is to determine the knowledge levels and attitudes of anesthesia technicians about COVID-19 positive patients or endotracheal intubation using questionnaire questions we prepared. Methods: Anesthesia technicians who accepted to participate in the study were asked to fill in an online questionnaire that measures the level of knowledge about airway management in COVID-19 patients. Results: Statistical analysis was performed on the data of 341 participants. The mean age of the participants was 33.07±8.43 years. Those with a working experience of 0-5 years (27.3%) and those working in a public hospital (43.1%) constituted the majority of the participants. It was seen that the majority of the participants correctly answered the questions related to intubation and extubation. The proportion of participants whose awareness increased due to the survey was 58.1%. Participants reported that they were most concerned about the risk of contamination. Conclusion: We found that in COVID-19 positive or suspicious cases, the points to be considered in endotracheal intubation are well known by the majority of the participants and their awareness on this issue is high.