1
|
Wylie NW, Durrant EL, Phillips EC, De Jong A, Schoettker P, Kawagoe I, de Pinho Martins M, Zapatero J, Graham C, McNarry AF. Videolaryngoscopy use before and after the initial phases of the COVID-19 pandemic: The report of the VL-iCUE survey with responses from 96 countries. Eur J Anaesthesiol 2024; 41:296-304. [PMID: 37962353 DOI: 10.1097/eja.0000000000001922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND The potential benefit of videolaryngoscopy use in facilitating tracheal intubation has already been established, however its use was actively encouraged during the COVID-19 pandemic as it was likely to improve intubation success and increase the patient-operator distance. OBJECTIVES We sought to establish videolaryngoscopy use before and after the early phases of the pandemic, whether institutions had acquired new devices during the COVID-19 pandemic, and whether there had been teaching on the devices acquired. DESIGN We designed a survey with 27 questions made available via the Joint Information Scientific Committee JISC online survey platform in English, French, Spanish, Chinese, Japanese and Portuguese. This was distributed through 18 anaesthetic and airway management societies. SETTING The survey was open for 54 to 90 days in various countries. The first responses were logged on the databases on 28 October 2021, with all databases closed on 26 January 2022. Reminders to participate were sent at the discretion of the administering organisations. PARTICIPANTS All anaesthetists and airway managers who received the study were eligible to participate. MAIN OUTCOME MEASURES Videolaryngoscopy use before the COVID-19 pandemic and at the time of the survey. RESULTS We received 4392 responses from 96 countries: 944/4336 (21.7%) were from trainees. Of the 3394 consultants, 70.8% (2402/3394) indicated no change in videolaryngoscopy use, 19.9% (675/3394) increased use and 9.3% (315/3393) reduced use. Among trainees 65.5% (618/943) reported no change in videolaryngoscopy use, 27.7% (261/943) increased use and 6.8% (64/943) reduced use. Overall, videolaryngoscope use increased by 10 absolute percentage points following the pandemic. CONCLUSIONS Videolaryngoscopy use increased following the early phase of the COVID-19 pandemic but this was less than might have been expected.
Collapse
Affiliation(s)
- Nia W Wylie
- From the South East Scotland School of Anaesthesia, NHS Lothian, Edinburgh UK (NWW, ELD, ECP), Department of Anesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, Université de Montpellier, Inserm, CNRS, CHRU de Montpellier, Montpellier, France (ADJ), Department of Anesthesiology, Lausanne University Hospital, Switzerland (PS), Department of Anesthesiology and Pain Medicine, Juntendo University, Faculty of Medicine, Graduate School of Medicine, Japan (IK), Department of Anesthesia, Critical Care and Pain Medicine, Central Hospital of the Military Police of Rio de Janeiro, Rio de Janeiro, Brazil (MP), Hospital Clínic de Barcelona, Spain (JZ), Edinburgh Clinical Research Facility, University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, UK (CG), Western General and St Johns Hospitals, NHS Lothian, Edinburgh UK (AFMN)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Raithel S, Fields KG, Wu Y, Yao D. Adoption of airway management guidelines during COVID-19 pandemic improved endotracheal intubation success. J Clin Anesth 2021; 76:110556. [PMID: 34695749 PMCID: PMC8511686 DOI: 10.1016/j.jclinane.2021.110556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/19/2021] [Accepted: 10/08/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Stephen Raithel
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
| | - Kara G Fields
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
| | - Yiran Wu
- Xuzhou Medical University, 209 Tongshan Lu, Xuzhou, Jiangsu 221004, China
| | - Dongdong Yao
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA; Department of Anesthesiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles St, Boston, MA 02114, USA.
| |
Collapse
|
3
|
Edalatkhah A, Kazemi MR, Samadi Khorshidi F, Akhoundimeybodi Z, Seyedhosseini SM, Rostami S, Hosseini BV, Akhondi Z, Ghelmani Y. Comparison of the effects of etomidate, ketamine, sodium thiopental, and midazolam on the mortality of patients with COVID-19 requiring intubation. Med J Islam Repub Iran 2021; 35:49. [PMID: 34268237 PMCID: PMC8271227 DOI: 10.47176/mjiri.35.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Indexed: 01/10/2023] Open
Abstract
Background: Among the medications administered for the management of COVID-19 patients, the induction drugs used for intubation have received little attention. The aim of this study was to compare the effect of induction drugs on the mortality of patients with COVID-19 requiring intubation. Methods: In this retrospective study, all patients who were admitted to Shahid Sadoughi and Shahid Rahnemoun hospitals in Yazd from February to March 2020 with definitive diagnosis of COVID-19 and needed intubation were enrolled. Patients were divided into 4 groups based on the type of drugs used in intubation, and mortality rate was assessed at the end of the first, second, fourth, and seventh days of the study. Statistical analyses were performed using SPSS 20 and P values <.05 was considered significant. Results: In this study, 76 patients were examined. Patients were divided into 4 groups, of which 21 were in etomidate group, 8 in ketamine group, 21 in sodium thiopental group, and 35 in midazolam group. Mortality rate in these 4 groups was 25%, 12.5%, 14.3%, and 14.3% (p=0.822), respectively at the end of the first day after intubation; it was 83.3%, 12.5%, 28.6%, and 25.7% (p=0.001), respectively, at the end of the second day; it was 83.3%, 12.5%, 42.9%, and 42.9% (p=0.015), respectively, until the end of the fourth day; it was 100%, 25%, 61.9%, and 65.7% (p=0.007), respectively, until the end of the seventh day. Admission to intubation time interval was 0.91±0.99, 3.12±1.95, 4.09±2.44, and 4.74±2.62 days, respectively (p<0.001). Conclusion: The results of this study suggest that the use of etomidate may be associated with higher mortality in COVID-19 patients. Further studies are needed to verify the results of this study.
Collapse
Affiliation(s)
- Abbas Edalatkhah
- Department of Emergency Medicine, Faculty of Medicine, Shahid Sadoghi University of Medical Science, Yazd, Iran
| | - Mohammad Reza Kazemi
- Department of Emergency Medicine, Faculty of Medicine, Shahid Sadoghi University of Medical Science, Yazd, Iran
| | - Fatemeh Samadi Khorshidi
- Department of Emergency Medicine, Faculty of Medicine, Shahid Sadoghi University of Medical Science, Yazd, Iran
| | - Zohreh Akhoundimeybodi
- Department of infectious diseases, Faculty of Medicine, Shahid Sadoghi University of Medical Sciences, Yazd, Iran
| | | | - Soheila Rostami
- Intensive Care Unit, Nursing Faculty, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Bibi Vaghihe Hosseini
- Intensive Care Unit, Nursing Faculty, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zohreh Akhondi
- Intensive Care Unit, Nursing Faculty, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Yaser Ghelmani
- Clinical Research Development Center of Shahid Sadoughi Hospital. Shahid Sadoghi University of Medical Sciences, Yazd, Iran
| |
Collapse
|
4
|
Foley LJ, Urdaneta F, Berkow L, Aziz MF, Baker PA, Jagannathan N, Rosenblatt W, Straker TM, Wong DT, Hagberg CA. Difficult Airway Management in Adult COVID-19 Patients: Statement by the Society of Airway Management. Anesth Analg 2021; 133:876-890. [PMID: 33711004 DOI: 10.1213/ane.0000000000005554] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The COVID-19 disease, caused by Coronavirus 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 management of the difficult airway by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. SAM task force created recommendations for 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 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 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. and difficult airway management often takes longer, may involve multiple procedures with aerosolization potential, strict adherence to personal protective equipment (PPE) protocols is mandatory to reduce risk to providers. When patient's airway risk assessment suggests awake tracheal intubation is an appropriate choice of technique, procedures that may cause increased aerosolization of secretions should be avoided. Optimal preoxygenation before induction with tight seal facemask may be performed to reduce 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 first-line strategy for airway management. If emergent invasive airway access is indicated, 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 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.
Collapse
Affiliation(s)
- Lorraine J Foley
- Department of Anesthesiology, Winchester Hospital of Beth Israel Lahey Health, Tufts School of Medicine, Boston, MA, USA
| | - Felipe Urdaneta
- Department of Anesthesiology, University of Florida NFSGVHS, Gainesville FL, USA
| | - Lauren Berkow
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Michael F Aziz
- Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Paul A Baker
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Narasimhan Jagannathan
- Department of Anesthesiology Ann & Robert H. Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine Chicago, IL
| | - William Rosenblatt
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Tracey M Straker
- Department of Anesthesiology, Montefiore Hospital, Albert Einstein College of Medicine New York, NY, USA
| | - David T Wong
- Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Carin A Hagberg
- Department of Anesthesiology & Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
5
|
Vaccher F, Paolillo C, Di Meo N, Ramanzin M, Ravanelli M, Maroldi R, Farina D. RAPID score in Covid-19 patients: a clinical-radiological index for the safe discharge from the Emergency Department. A preliminary report. EMERGENCY CARE JOURNAL 2020. [DOI: 10.4081/ecj.2020.9192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
To evaluate the performance of a clinical-radiological index (RAPID-Covid score) in achieving Safe Discharge (SD) of patients accessing the Emergency Department (ED) with symptoms suggesting Covid-19. Clinical and radiological data were retrospectively collected from 853 consecutive patients admitted to the ED during the pandemics with symptoms suggesting Covid-19. Illness severity was graded with RAPID-Covid score, composed of chest X-ray findings, clinical symptoms and PaO2/FiO2. Patients with RAPIDCovid score ≥5 were admitted. Primary outcome was SD of patients to home care. SD was defined as survival of the patient, without evidence of second access to ED requiring hospitalization. 212/853 patients were discharged. 27/212 had a score ≥5 but refused admission. 185/212 were discharged with score <5: 147/185 (79,5%) survived and did not re-access ED; 1/185 (0,5%) died at home after first ED-dismissal; 37/185 (20,0%) had a second access. Of these 15/37 (8,1%) were newly dismissed and one of them (1/15) died at home; 22/37 (11,9%) were hospitalized, 1/22 died during hospitalization. SD was obtained in 161/185 patients (87%). Readmissions occurred 5,1±2,6days from first discharge. Follow-up was 16,7±6,0days. RAPID-Covid score proves useful for SD of Covid-19 to home care. 6-10days may further increase confidence.
Collapse
|
6
|
Gandhi A, Sokhi J, Lockie C, Ward PA. Emergency Tracheal Intubation in Patients with COVID-19: Experience from a UK Centre. Anesthesiol Res Pract 2020; 2020:8816729. [PMID: 33376486 PMCID: PMC7729388 DOI: 10.1155/2020/8816729] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/06/2020] [Accepted: 11/23/2020] [Indexed: 12/15/2022] Open
Abstract
This retrospective observational case series describes a single centre's preparations and experience of 53 emergency tracheal intubations in patients with COVID-19 respiratory failure. The findings of a contemporaneous online survey exploring technical and nontechnical aspects of airway management, completed by intubation team members, are also presented. Preparations included developing a COVID-19 intubation standard operating procedure and checklist, dedicated airway trolleys, a consultant-led mobile intubation team, and an airway education programme. Tracheal intubation was successful in all patients. Intubation first-pass success rate was 85%, first-line videolaryngoscopy use 79%, oxygen desaturation 49%, and hypotension 21%. Performance was consistent across all clinical areas. The main factor impeding first-pass success was larger diameter tracheal tubes. The majority of intubations was performed by consultant anaesthetists. Nonconsultant intubations demonstrated higher oxygen desaturation rates (75% vs. 45%, p=0.610) and lower first-pass success (0% vs. 92%, p < 0.001). Survey respondents (n = 29) reported increased anxiety at the start of the pandemic, with statistically significant reduction as the pandemic progressed (median: 4/5 very high vs. 2/5 low anxiety, p < 0.001). Reported procedural/environmental challenges included performing tasks in personal protective equipment (62%), remote-site working (48%), and modification of normal practices (41%)-specifically, the use of larger diameter tracheal tubes (21%). Hypoxaemia was identified by 90% of respondents as the most challenging patient-related factor during intubations. Our findings demonstrate that a consultant-led mobile intubation team can safely perform tracheal intubation in critically ill COVID-19 patients across all clinical areas, aided by thorough preparation and training, despite heightened anxiety levels.
Collapse
Affiliation(s)
- Ajay Gandhi
- Chelsea and Westminster Hospital, London, UK
| | | | | | | |
Collapse
|
7
|
Levin AB, Ball CM, Featherstone PJ. From cholera to COVID-19: How pandemics have shaped the development of anaesthesia and intensive care medicine. Anaesth Intensive Care 2020; 48:28-38. [PMID: 33241712 DOI: 10.1177/0310057x20969701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The infectious pandemics and epidemics of the past 200 years have caused millions of deaths. However, these devastating events have also led to creative thinking, imaginative experimentation and the evolution of medical care. As a result, the history of critical care medicine is entwined with the story of these global disasters. This article will take case studies from recent pandemics and epidemics and examine their impact on the development of anaesthesia and intensive care medicine.
Collapse
Affiliation(s)
- Adam B Levin
- Department of Anaesthesia and Pain Medicine, Western Health, Melbourne, Australia
| | - Christine M Ball
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Australia.,Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia
| | | |
Collapse
|