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Deschamps FJ, Deschamps PSDS, da Silva LC, Blos EK, Savoldi ES, Garcia MJC, Staub GJ, da Rocha FR, Laporta GZ. Hospital cohort study on survival predictors for intubated coronavirus disease 2019 patients. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231464. [PMID: 38775534 PMCID: PMC11101181 DOI: 10.1590/1806-9282.20231464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/16/2023] [Indexed: 05/25/2024]
Abstract
OBJECTIVE The objective of this study was to assess the predictors of survival among patients with coronavirus disease 2019 who underwent tracheal intubation, as part of a hospital cohort study. METHODS This retrospective cohort study in the Rio do Sul County Hospital, Santa Catarina, Brazil, from April 2020 to May 2021, focused on patients aged 18 years or older intubated for coronavirus disease 2019. We assessed the 90-day survival of intubated patients by estimating the hazard ratio using a Cox proportional hazards regression model. RESULTS The study included 132 participants, with an average age of approximately 60 years. Tracheal intubation was successfully accomplished in 97% of cases within two attempts. The overall mortality rate was 62.9%. Notably, mortality rates were significantly higher in patients aged over 60 years (hazard ratio=2.57; 95%CI 1.54-4.29; p<0.001), those with blood oxygen saturation below 85% (hazard ratio=1.92; 95%CI 1.03-3.57; p=0.04), instances where tracheal intubation was carried out using a conventional laryngoscope (hazard ratio=2.59; 95%CI 1.22-5.48; p=0.013), and when performed by emergency physicians (hazard ratio=3.96; 95%CI 1.51-10.4; p=0.005). CONCLUSION Our analysis unveiled that the risk of death in intubated coronavirus disease 2019 patients is four times higher when an emergency physician, as opposed to an anesthesiologist, leads the tracheal intubation team.
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Affiliation(s)
- Fabiola Jahn Deschamps
- Centro Universitário Faculdade de Medicina do ABC, Graduate Program in Health Sciences – Santo Andre (SP), Brazil
- Universidade para o Desenvolvimento do Alto Vale do Rio Itajaí, School of Medicine – Rio do Sul (SC), Brazil
| | - Paulo Sergio da Silva Deschamps
- Centro Universitário Faculdade de Medicina do ABC, Graduate Program in Health Sciences – Santo Andre (SP), Brazil
- Universidade para o Desenvolvimento do Alto Vale do Rio Itajaí, School of Medicine – Rio do Sul (SC), Brazil
- Hospital of the High Itajai River Valley – Rio do Sul (SC), Brazil
| | - Laura Correa da Silva
- Universidade para o Desenvolvimento do Alto Vale do Rio Itajaí, School of Medicine – Rio do Sul (SC), Brazil
| | | | | | | | | | | | - Gabriel Zorello Laporta
- Centro Universitário Faculdade de Medicina do ABC, Graduate Program in Health Sciences – Santo Andre (SP), Brazil
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Gibson J, Leckie T, Hayward J, Hodgson L. Non-theatre emergency airway management: a multicentre prospective observational study. Anaesthesia 2023; 78:1338-1346. [PMID: 37549371 DOI: 10.1111/anae.16107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/09/2023]
Abstract
Emergency airway management events are common, unpredictable and associated with high complication rates. This multicentre prospective observational study across eight acute NHS hospitals in southeast England reports the incidence and nature of non-theatre emergency airway management events. Data were collected from non-theatre emergency airway management, including adverse events, over a continuous 28-day window, and recorded on an electronic case report form. Events were classified according to type (advanced airway; simple airway; and cardiac arrest). A total of 166 events were recorded, with 111 advanced airway events involving tracheal intubation or tracheostomy management. Senior personnel with three or more years of airway management experience were present for 105/111 (95%) advanced airway management episodes. There was a significant reduction in consultant or equivalent presence out-of-hours (21/64, 33%) vs. in-hours (34/47, 72%) (p < 0.001). We found high utilisation of videolaryngoscopy (95/106, 90%) and universal use of capnography for all advanced airway management events. This was lower during cardiac arrest when videolaryngoscopy was used in 11/16 (69%) of tracheal intubations and capnography in 21/32 (66%) of all cardiac arrest episodes. Adverse outcomes during advanced airway management (excluding during cardiac arrest) occurred in 53/111 (48%) episodes, including hypoxia (desaturation to Sp O2 < 80% in 14/111, 13%) and hypotension (systolic blood pressure < 80 mmHg in 27/111, 25%). Adverse outcomes were not associated with time of day or experience level of airway practitioners. We conclude that there is a disparity between consultant presence for advanced airway interventions in- and out-of-hours; high utilisation of videolaryngoscopy and capnography, especially for advanced airway interventions; and a high incidence of hypotension and hypoxaemia, including critical values, during non-theatre airway management.
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Affiliation(s)
- J Gibson
- Department of Anaesthetics and Intensive Care Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill, Surrey, UK
| | - T Leckie
- Department of Anaesthetics and Intensive Care Medicine, University Hospitals Sussex NHS Foundation Trust, Worthing, Sussex, UK
- Department of Anaesthetics and Intensive Care Medicine, University Hospitals Sussex NHS Foundation Trust, Worthing, Sussex, UK
| | - J Hayward
- Department of Anaesthetics and Intensive Care Medicine, University Hospitals Sussex NHS Foundation Trust, Worthing, Sussex, UK
| | - L Hodgson
- Department of Anaesthetics and Intensive Care Medicine, University Hospitals Sussex NHS Foundation Trust, Worthing, Sussex, UK
- Brighton and Sussex Medical School, Brighton, UK
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3
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Hickey AJ, Cummings MJ, Short B, Brodie D, Panzer O, Madahar P, O'Donnell MR. Approach to the Physiologically Challenging Endotracheal Intubation in the Intensive Care Unit. Respir Care 2023; 68:1438-1448. [PMID: 37221087 PMCID: PMC10506638 DOI: 10.4187/respcare.10821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Endotracheal intubation for airway management is a common procedure in the ICU. Intubation may be difficult due to anatomic airway abnormalities but also due to physiologic derangements that predispose patients to cardiovascular collapse during the procedure. Results of studies demonstrate a high incidence of morbidity and mortality associated with airway management in the ICU. To reduce the likelihood of complications, medical teams must be well versed in the general principles of intubation and be prepared to manage physiologic derangements while securing the airway. In this review, we present relevant literature on the approach to endotracheal intubation in the ICU and provide pragmatic recommendations relevant to medical teams performing intubations in patients who are physiologically unstable.
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Affiliation(s)
- Andrew J Hickey
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York
| | - Matthew J Cummings
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York
| | - Briana Short
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York
| | - Daniel Brodie
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Oliver Panzer
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York
| | - Purnema Madahar
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York
| | - Max R O'Donnell
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York, New York.
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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4
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Russotto V, Lascarrou JB, Tassistro E, Parotto M, Antolini L, Bauer P, Szułdrzyński K, Camporota L, Putensen C, Pelosi P, Sorbello M, Higgs A, Greif R, Grasselli G, Valsecchi MG, Fumagalli R, Foti G, Caironi P, Bellani G, Laffey JG, Myatra SN. Efficacy and adverse events profile of videolaryngoscopy in critically ill patients: subanalysis of the INTUBE study. Br J Anaesth 2023; 131:607-616. [PMID: 37208282 DOI: 10.1016/j.bja.2023.04.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/23/2023] [Accepted: 04/14/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Tracheal intubation is a high-risk procedure in the critically ill, with increased intubation failure rates and a high risk of other adverse events. Videolaryngoscopy might improve intubation outcomes in this population, but evidence remains conflicting, and its impact on adverse event rates is debated. METHODS This is a subanalysis of a large international prospective cohort of critically ill patients (INTUBE Study) performed from 1 October 2018 to 31 July 2019 and involving 197 sites from 29 countries across five continents. Our primary aim was to determine the first-pass intubation success rates of videolaryngoscopy. Secondary aims were characterising (a) videolaryngoscopy use in the critically ill patient population and (b) the incidence of severe adverse effects compared with direct laryngoscopy. RESULTS Of 2916 patients, videolaryngoscopy was used in 500 patients (17.2%) and direct laryngoscopy in 2416 (82.8%). First-pass intubation success was higher with videolaryngoscopy compared with direct laryngoscopy (84% vs 79%, P=0.02). Patients undergoing videolaryngoscopy had a higher frequency of difficult airway predictors (60% vs 40%, P<0.001). In adjusted analyses, videolaryngoscopy increased the probability of first-pass intubation success, with an OR of 1.40 (95% confidence interval [CI] 1.05-1.87). Videolaryngoscopy was not significantly associated with risk of major adverse events (odds ratio 1.24, 95% CI 0.95-1.62) or cardiovascular events (odds ratio 0.78, 95% CI 0.60-1.02). CONCLUSIONS In critically ill patients, videolaryngoscopy was associated with higher first-pass intubation success rates, despite being used in a population at higher risk of difficult airway management. Videolaryngoscopy was not associated with overall risk of major adverse events. CLINICAL TRIAL REGISTRATION NCT03616054.
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Affiliation(s)
- Vincenzo Russotto
- Department of Anesthesia and Critical Care, University Hospital San Luigi Gonzaga, University of Turin, Italy
| | | | - Elena Tassistro
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 Center), University of Milano-Bicocca, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Matteo Parotto
- Department of Anesthesiology and Pain Medicine, Interdepartmental Division of Critical Care Medicine, University of Toronto, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Laura Antolini
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 Center), University of Milano-Bicocca, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Philippe Bauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Konstanty Szułdrzyński
- Department of Anesthesiology and Intensive Care, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland; Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Luigi Camporota
- Health Centre for Human and Applied Physiological Sciences, Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christian Putensen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Massimiliano Sorbello
- Anesthesia and Intensive Care, Policlinico Vittorio Emanuele San Marco University Hospital, Catania, Italy
| | - Andy Higgs
- Anaesthesia and Intensive Care Medicine, Warrington Teaching Hospitals NHS Foundation Trust, Warrington, UK
| | - Robert Greif
- Department of Anaesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Giacomo Grasselli
- Dipartimento di Anestesia, Rianimazione ed Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria G Valsecchi
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 Center), University of Milano-Bicocca, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Roberto Fumagalli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Anesthesiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppe Foti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Emergency and Intensive Care, University Hospital San Gerardo, Monza, Italy
| | - Pietro Caironi
- Department of Anesthesia and Critical Care, University Hospital San Luigi Gonzaga, University of Turin, Italy
| | - Giacomo Bellani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Emergency and Intensive Care, University Hospital San Gerardo, Monza, Italy
| | - John G Laffey
- Regenerative Medicine Institute at CURAM Centre for Medical Devices, School of Medicine, University of Galway, Galway, Ireland; Anesthesia and Intensive Care Medicine, University Hospital Galway, Galway, Ireland.
| | - Sheila N Myatra
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Saul SA, Ward PA, McNarry AF. Airway Management: The Current Role of Videolaryngoscopy. J Pers Med 2023; 13:1327. [PMID: 37763095 PMCID: PMC10532647 DOI: 10.3390/jpm13091327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Airway management is usually an uncomplicated and safe intervention; however, when problems arise with the primary airway technique, the clinical situation can rapidly deteriorate, resulting in significant patient harm. Videolaryngoscopy has been shown to improve patient outcomes when compared with direct laryngoscopy, including improved first-pass success at tracheal intubation, reduced difficult laryngeal views, reduced oxygen desaturation, reduced airway trauma, and improved recognition of oesophageal intubation. The shared view that videolaryngoscopy affords may also facilitate superior teaching, training, and multidisciplinary team performance. As such, its recommended role in airway management has evolved from occasional use as a rescue device (when direct laryngoscopy fails) to a first-intention technique that should be incorporated into routine clinical practice, and this is reflected in recently updated guidelines from a number of international airway societies. However, currently, overall videolaryngoscopy usage is not commensurate with its now widespread availability. A number of factors exist that may be preventing its full adoption, including perceived financial costs, inadequacy of education and training, challenges in achieving deliverable decontamination processes, concerns over sustainability, fears over "de-skilling" at direct laryngoscopy, and perceived limitations of videolaryngoscopes. This article reviews the most up-to-date evidence supporting videolaryngoscopy, explores its current scope of utilisation (including specialist techniques), the potential barriers preventing its full adoption, and areas for future advancement and research.
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Affiliation(s)
- Sophie A. Saul
- St. John’s Hospital, Howden West Road, NHS Lothian, Livingston EH54 6PP, UK; (S.A.S.); (A.F.M.)
| | - Patrick A. Ward
- St. John’s Hospital, Howden West Road, NHS Lothian, Livingston EH54 6PP, UK; (S.A.S.); (A.F.M.)
| | - Alistair F. McNarry
- St. John’s Hospital, Howden West Road, NHS Lothian, Livingston EH54 6PP, UK; (S.A.S.); (A.F.M.)
- Western General Hospital, Crewe Road South, NHS Lothian, Edinburgh EH4 2XU, UK
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6
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Mazzeffi M, Shelton K. Preparing Cardiothoracic Intensive Care Unit Leaders for Success. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00249-5. [PMID: 37147208 DOI: 10.1053/j.jvca.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/07/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Michael Mazzeffi
- University of Virginia Health, Department of Anesthesiology, Charlottesville, VA
| | - Kenneth Shelton
- Massachusetts General Hospital, Department of Anesthesia, Harvard Medical School, Boston, MA
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7
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Mohr NM, Santos Leon E, Carlson JN, Driver B, Krishnadasan A, Harland KK, Ten Eyck P, Mower WR, Foley TM, Wallace K, McDonald LC, Kutty PK, Santibanez S, Talan DA. Endotracheal Intubation Strategy, Success, and Adverse Events Among Emergency Department Patients During the COVID-19 Pandemic. Ann Emerg Med 2023; 81:145-157. [PMID: 36336542 PMCID: PMC9633323 DOI: 10.1016/j.annemergmed.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/09/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022]
Abstract
STUDY OBJECTIVE To describe endotracheal intubation practices in emergency departments by staff intubating patients early in the coronavirus disease 2019 (COVID-19) pandemic. METHODS Multicenter prospective cohort study of endotracheal intubations conducted at 20 US academic emergency departments from May to December 2020, stratified by known or suspected COVID-19 status. We used multivariable regression to measure the association between intubation strategy, COVID-19 known or suspected status, first-pass success, and adverse events. RESULTS There were 3,435 unique emergency department endotracheal intubations by 586 participating physicians or advanced practice providers; 565 (18%) patients were known or suspected of having COVID-19 at the time of endotracheal intubation. Compared with patients not known or suspected of COVID-19, endotracheal intubations of patients with known or suspected COVID-19 were more often performed using video laryngoscopy (88% versus 82%, difference 6.3%; 95% confidence interval [CI], 3.0% to 9.6%) and passive nasal oxygenation (44% versus 39%, difference 5.1%; 95% CI, 0.9% to 9.3%). First-pass success was not different between those who were and were not known or suspected of COVID-19 (87% versus 86%, difference 0.6%; 95% CI, -2.4% to 3.6%). Adjusting for patient characteristics and procedure factors in those with low anticipated airway difficulty (n=2,374), adverse events (most commonly hypoxia) occurred more frequently in patients with known or suspected COVID-19 (35% versus 19%, adjusted odds ratio 2.4; 95% CI, 1.7 to 3.3). CONCLUSION Compared with patients not known or suspected of COVID-19, endotracheal intubation of those confirmed or suspected to have COVID-19 was associated with a similar first-pass intubation success rate but higher risk-adjusted adverse events.
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Affiliation(s)
- Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa College of Public Health, Iowa City, IA; Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA.
| | - Eliezer Santos Leon
- Department of Emergency Medicine, University of Iowa College of Public Health, Iowa City, IA
| | - Jestin N Carlson
- Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA
| | - Brian Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Anusha Krishnadasan
- Olive View-University of California Los Angeles Education and Research Institute, Los Angeles, CA
| | - Karisa K Harland
- Department of Emergency Medicine, University of Iowa College of Public Health, Iowa City, IA; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Sciences, University of Iowa, Iowa City, IA
| | - William R Mower
- University of California Los Angeles, Ronald Reagan Medical Center, Los Angeles, CA
| | - Tyler M Foley
- Department of Internal Medicine, University of Virginia, Charlottesville, VA
| | - Kelli Wallace
- Department of Emergency Medicine, University of Iowa College of Public Health, Iowa City, IA
| | - L Clifford McDonald
- Division of Healthcare Quality Promotion, Division of Preparedness and Emerging Infections, Atlanta, GA
| | - Preeta K Kutty
- Division of Healthcare Quality Promotion, Division of Preparedness and Emerging Infections, Atlanta, GA
| | - Scott Santibanez
- Division of Preparedness and Emerging Infections, Centers for Disease Control and Prevention, Atlanta, GA
| | - David A Talan
- Department of Emergency Medicine, University of Iowa College of Public Health, Iowa City, IA; Olive View-University of California Los Angeles Education and Research Institute, Los Angeles, CA; University of California Los Angeles, Ronald Reagan Medical Center, Los Angeles, CA
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8
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Trivedi S, Hylton D, Mueller M, Juan I, Mun C, Tzeng E, Guan P, Filipovic M, Mandoorah S, Brezenski A, O'Brien EO, Malhotra A, Schmidt U. A Comparison of Intubation and Airway Complications Between COVID-19 and Non-COVID-19 Critically Ill Subjects. Cureus 2023; 15:e35145. [PMID: 36950006 PMCID: PMC10027016 DOI: 10.7759/cureus.35145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 02/20/2023] Open
Abstract
Introduction The number of subjects infected with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) throughout the western hemisphere increased exponentially in the later months of 2020. With this increase in infection, the number of subjects requiring advanced ventilatory support increased concomitantly. We decided to compare the survival rates between coronavirus disease 2019 (COVID-19) subjects versus non-COVID-19 subjects undergoing intubation in the intensive care unit (ICU). We hypothesized that COVID-19 subjects would have lower rates of survival post-intubation. Methods We screened all subjects admitted to the adult critical care unit between January 2020 and June 2020 to determine if they met the inclusion criteria. These subjects were required to be spontaneously ventilating upon admission and eventually required intubation. Subjects were selected from our electronic health record (EHR) system EPIC© (Epic Systems, Verona, WI) through a retrospective ICU admission analysis. We identified and included 267 non-COVID-19 subjects and 56 COVID-19 subjects. Our primary outcome of interest was intubation-related mortality. We defined intubation mortality as unexpected death (within 48 hours of intubation). Our secondary outcomes were the length of stay in the ICU, length of time requiring ventilator support, and proportion of subjects requiring tracheostomy placement. Results Compared to non-coronavirus disease (COVID) subjects, COVID subjects were more likely to be intubated for acute respiratory distress. COVID subjects had longer stays in the ICU and longer ventilator duration than non-COVID subjects. COVID-positive subjects had a decreased hazard ratio for mortality (HR = 0.42, 95% CI: 0.20-0.87, P < 0.05) and increased chances of survival compared to non-COVID subjects. Conclusions We showed the rates of intubation survival were no different between the COVID and non-COVID groups. We attribute this finding to intubation preparation, a multidisciplinary team approach, and having the most experienced provider lead the intubation process.
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Affiliation(s)
- Suraj Trivedi
- Anesthesia and Critical Care, University of California San Diego School of Medicine, San Diego, USA
| | - Diana Hylton
- Anesthesia and Critical Care, University of California San Diego, San Diego, USA
| | - Matthew Mueller
- Critical Care Medicine, University of California San Diego, Washington, DC, USA
| | - Ilona Juan
- Anesthesiology, Kaiser San Diego, San Diego, USA
| | - Christie Mun
- Anesthesia and Critical Care, University of California San Diego, San Diego, USA
| | - Eric Tzeng
- Anesthesia and Critical Care, University of California San Diego, San Diego, USA
| | - Patricia Guan
- Anesthesiology, University of California San Diego, San Diego, USA
| | - Maya Filipovic
- Anesthesia and Critical Care, University of California San Diego, San Diego, USA
| | - Sohaib Mandoorah
- Critical Care Medicine, University of California San Diego, San Diego, USA
| | - Alyssa Brezenski
- Anesthesiology, University of California San Diego, San Diego, USA
| | - E Orestes O'Brien
- Anesthesia and Critical Care, University of California San Diego, San Diego, USA
| | - Atul Malhotra
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, San Diego, USA
| | - Ulrich Schmidt
- Anesthesiology, University of California San Diego, San Diego, USA
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9
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Grillot N, Lebuffe G, Huet O, Lasocki S, Pichon X, Oudot M, Bruneau N, David JS, Bouzat P, Jobert A, Tching-Sin M, Feuillet F, Cinotti R, Asehnoune K, Roquilly A. Effect of Remifentanil vs Neuromuscular Blockers During Rapid Sequence Intubation on Successful Intubation Without Major Complications Among Patients at Risk of Aspiration: A Randomized Clinical Trial. JAMA 2023; 329:28-38. [PMID: 36594947 PMCID: PMC9856823 DOI: 10.1001/jama.2022.23550] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
IMPORTANCE It is uncertain whether a rapid-onset opioid is noninferior to a rapid-onset neuromuscular blocker during rapid sequence intubation when used in conjunction with a hypnotic agent. OBJECTIVE To determine whether remifentanil is noninferior to rapid-onset neuromuscular blockers for rapid sequence intubation. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized, open-label, noninferiority trial among 1150 adults at risk of aspiration (fasting for <6 hours, bowel occlusion, recent trauma, or severe gastroesophageal reflux) who underwent tracheal intubation in the operating room at 15 hospitals in France from October 2019 to April 2021. Follow-up was completed on May 15, 2021. INTERVENTIONS Patients were randomized to receive neuromuscular blockers (1 mg/kg of succinylcholine or rocuronium; n = 575) or remifentanil (3 to 4 μg/kg; n = 575) immediately after injection of a hypnotic. MAIN OUTCOMES AND MEASURES The primary outcome was assessed in all randomized patients (as-randomized population) and in all eligible patients who received assigned treatment (per-protocol population). The primary outcome was successful tracheal intubation on the first attempt without major complications, defined as lung aspiration of digestive content, oxygen desaturation, major hemodynamic instability, sustained arrhythmia, cardiac arrest, and severe anaphylactic reaction. The prespecified noninferiority margin was 7.0%. RESULTS Among 1150 randomized patients (mean age, 50.7 [SD, 17.4] years; 573 [50%] women), 1130 (98.3%) completed the trial. In the as-randomized population, tracheal intubation on the first attempt without major complications occurred in 374 of 575 patients (66.1%) in the remifentanil group and 408 of 575 (71.6%) in the neuromuscular blocker group (between-group difference adjusted for randomization strata and center, -6.1%; 95% CI, -11.6% to -0.5%; P = .37 for noninferiority), demonstrating inferiority. In the per-protocol population, 374 of 565 patients (66.2%) in the remifentanil group and 403 of 565 (71.3%) in the neuromuscular blocker group had successful intubation without major complications (adjusted difference, -5.7%; 2-sided 95% CI, -11.3% to -0.1%; P = .32 for noninferiority). An adverse event of hemodynamic instability was recorded in 19 of 575 patients (3.3%) with remifentanil and 3 of 575 (0.5%) with neuromuscular blockers (adjusted difference, 2.8%; 95% CI, 1.2%-4.4%). CONCLUSIONS AND RELEVANCE Among adults at risk of aspiration during rapid sequence intubation in the operating room, remifentanil, compared with neuromuscular blockers, did not meet the criterion for noninferiority with regard to successful intubation on first attempt without major complications. Although remifentanil was statistically inferior to neuromuscular blockers, the wide confidence interval around the effect estimate remains compatible with noninferiority and limits conclusions about the clinical relevance of the difference. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03960801.
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Affiliation(s)
- Nicolas Grillot
- Nantes Université, CHU Nantes, Service d’Anesthésie Réanimation Chirurgicale, INSERM CIC 0004 Immunologie et Infectiologie, Nantes, France
| | - Gilles Lebuffe
- Université Lille, CHU Lille, ULR 7354–GRITA Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Pôle Anesthésie Réanimation, Lille, France
| | - Olivier Huet
- Département d’Anesthésie Réanimation et Médecine Péri-opératoire, CHRU Brest, Université de Bretagne occidentale, Brest, France
| | - Sigismond Lasocki
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Angers, Angers, France
| | - Xavier Pichon
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Toulouse, University Toulouse III–Paul–Sabatier, Toulouse, France
| | - Mathieu Oudot
- Department of Anesthesiology, Centre Hospitalier Departemental, La Roche sur Yon, France
| | - Nathalie Bruneau
- Université Lille, CHU Lille, Hopital Salengro, Pôle Anesthésie Réanimation, Lille, France
| | - Jean-Stéphane David
- Service d’Anesthésie Réanimation, Groupe Hospitalier Sud, Hospices Civils de Lyon, Research on Healthcare Performance (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France
| | - Pierre Bouzat
- Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Alexandra Jobert
- Nantes Université, CHU Nantes, DRCI, Departement Promotion, Nantes, France
- Nantes Université, Univerisité Tours, CHU Nantes, CHU Tours, INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, Nantes, France
| | - Martine Tching-Sin
- Nantes Université, CHU Nantes, Service de Pharmacie, Hôtel Dieu, Nantes, France
| | - Fanny Feuillet
- Nantes Université, Univerisité Tours, CHU Nantes, CHU Tours, INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, Nantes, France
- Nantes Université, CHU Nantes, Service de Pharmacie, Hôtel Dieu, Nantes, France
- Nantes Université, CHU Nantes, DRI, Plateforme de Méthodologie et de Biostatistique, Nantes, France
| | - Raphael Cinotti
- Nantes Université, CHU Nantes, Service d’Anesthésie Réanimation Chirurgicale, INSERM CIC 0004 Immunologie et Infectiologie, Nantes, France
| | - Karim Asehnoune
- Nantes Université, CHU Nantes, Service d’Anesthésie Réanimation Chirurgicale, INSERM CIC 0004 Immunologie et Infectiologie, Nantes, France
| | - Antoine Roquilly
- Nantes Université, CHU Nantes, Service d’Anesthésie Réanimation Chirurgicale, INSERM CIC 0004 Immunologie et Infectiologie, Nantes, France
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10
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Black H, Hall T, Hrymak C, Funk D, Siddiqui F, Sokal J, Satoudian J, Foster K, Kowalski S, Dufault B, Leeies M. A prospective observational study comparing outcomes before and after the introduction of an intubation protocol during the COVID-19 pandemic. CAN J EMERG MED 2023; 25:123-133. [PMID: 36542309 PMCID: PMC9768405 DOI: 10.1007/s43678-022-00422-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 11/19/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Orotracheal intubation is a life-saving procedure commonly performed in the Intensive Care unit and Emergency Department as a part of emergency airway management. Prior to the COVID-19 pandemic, our center undertook a prospective observational study to characterize emergency intubation performed in the emergency department and critical care settings at Manitoba's largest tertiary hospital. During this study, a natural experiment emerged when a standardized "COVID-Protected Rapid Sequence Intubation Protocol" was implemented in response to the pandemic. The resultant study aimed to answer the question; in adult ED patients undergoing emergent intubation by EM and CCM teams, does the use of a "COVID-Protected Rapid Sequence Intubation Protocol" impact first-pass success or other intubation-related outcomes? METHODS A single-center prospective quasi-experimental before and after study was conducted. Data were prospectively collected on consecutive emergent intubations. The primary outcome was the difference in first-pass success rates. Secondary outcomes included best Modified Cormack-Lehane view, hypoxemia, hypotension, esophageal intubation, cannot intubate cannot oxygenate scenarios, CPR post intubation, vasopressors required post intubation, Intensive Care Unit (ICU) mortality, ICU length of stay (LOS), and mechanical ventilation days. RESULTS Data were collected on 630 patients, 416 in the pre-protocol period and 214 in the post-protocol period. First-pass success rates in the pre-protocol period were found to be 73.1% (n = 304). Following the introduction of the protocol, first-pass success rates increased to 82.2% (n = 176, p = 0.0105). There was a statistically significant difference in Modified Cormack-Lehane view favoring the protocol (p = 0.0191). Esophageal intubation rates were found to be 5.1% pre-protocol introduction versus 0.5% following the introduction of the protocol (p = 0.0172). CONCLUSION A "COVID-Protected Protocol" implemented by Emergency Medicine and Critical Care teams in response to the COVID-19 pandemic was associated with increased first-pass success rates and decreases in adverse events.
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Affiliation(s)
- Holly Black
- Department of Emergency Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
| | - Thomas Hall
- grid.21613.370000 0004 1936 9609Department of Anaesthesia, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - Carmen Hrymak
- grid.21613.370000 0004 1936 9609Department of Emergency Medicine, Department of Internal Medicine Section of Critical Care, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - Duane Funk
- grid.21613.370000 0004 1936 9609Department of Anaesthesia, Department of Internal Medicine Section of Critical Care, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - Faisal Siddiqui
- grid.21613.370000 0004 1936 9609Department of Anaesthesia, Department of Internal Medicine Section of Critical Care, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - John Sokal
- grid.21613.370000 0004 1936 9609Department of Emergency Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - Jaime Satoudian
- grid.413899.e0000 0004 0633 2743Department of Respiratory Therapy, Health Sciences Center, Winnipeg, MB Canada
| | - Kendra Foster
- grid.413899.e0000 0004 0633 2743Department of Respiratory Therapy, Health Sciences Center, Winnipeg, MB Canada
| | - Stephen Kowalski
- grid.21613.370000 0004 1936 9609Department of Anaesthesia, Department of Internal Medicine Section of Critical Care, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - Brenden Dufault
- George & Fay Yee Center for Healthcare Innovation, Winnipeg, MB Canada
| | - Murdoch Leeies
- grid.21613.370000 0004 1936 9609Department of Emergency Medicine, Department of Internal Medicine Section of Critical Care, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB Canada
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11
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Chau A, Hofmeyr R. Hypothesis-generating procedures and unmasking novel associations in large observational studies: are we doing harm while doing good? Anaesthesia 2023; 78:9-13. [PMID: 36178605 DOI: 10.1111/anae.15877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 12/13/2022]
Affiliation(s)
- A Chau
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.,Department of Anesthesia, BC Women's Hospital, Vancouver, BC, Canada.,Department of Anesthesia, St. Paul's Hospital, Vancouver, BC, Canada
| | - R Hofmeyr
- Department of Anaesthesia and Peri-operative Medicine, Groote Schuur Hospital, Cape Town, South Africa.,Department of Anaesthesia and Peri-operative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
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12
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Potter T, Cronin JN, Kua J, Nurmi E, Wong DJN, Ahmad I, Cook TM, El-Boghdadly K. Aerosol precautions and airway complications: a national prospective multicentre cohort study. Anaesthesia 2023; 78:23-35. [PMID: 36070622 PMCID: PMC10087829 DOI: 10.1111/anae.15851] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 12/13/2022]
Abstract
The perceived risk of transmission of aerosolised viral particles from patients to airway practitioners during the COVID-19 pandemic led to the widespread use of aerosol precautions, including personal protective equipment and modifications to anaesthetic technique. The risk of these aerosol precautions on peri-operative airway complications has not been assessed outside of simulation studies. This prospective, national, multicentre cohort study aimed to quantify this risk. Adult patients undergoing general anaesthesia for elective or emergency procedures over a 96-hour period were included. Data collected included use of aerosol precautions by the airway practitioner, airway complications and potential confounding variables. Mixed-effects logistic regression was used to assess the risk of individual aerosol precautions on overall and specific airway complications. Data from 5905 patients from 70 hospital sites were included. The rate of airway complications was 10.0% (95%CI 9.2-10.8%). Use of filtering facepiece class 2 or class 3 respirators was associated with an increased risk of airway complications (odds ratio 1.38, 95%CI 1.04-1.83), predominantly due to an association with difficult facemask ventilation (odds ratio 1.68, 95%CI 1.09-2.61) and desaturation on pulse oximetry (odds ratio 2.39, 95%CI 1.26-4.54). Use of goggles, powered air-purifying respirators, long-sleeved gowns, double gloves and videolaryngoscopy were not associated with any alteration in the risk of airway complications. Overall, the use of filtering facepiece class 2 or class 3 respirators was associated with an increased risk of airway complications, but most aerosol precautions used during the COVID-19 pandemic were not.
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Affiliation(s)
- T Potter
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - J N Cronin
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - J Kua
- Surgical Outcomes Research Centre, University College London, UK
| | - E Nurmi
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - D J N Wong
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - I Ahmad
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,King's College London, UK
| | - T M Cook
- Department of Anaesthesia, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.,School of Medicine, University of Bristol, UK
| | - K El-Boghdadly
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,King's College London, UK
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13
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Tung A, Dalton A, Hastie J, Jabaley CS, Mittel AM, Nunnally ME, Siddiqui S. The Next Next Wave: How Critical Care Might Learn From COVID in Responding to the Next Pandemic. Anesth Analg 2022; 135:903-910. [PMID: 36269981 DOI: 10.1213/ane.0000000000006204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Avery Tung
- From the Departments of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
| | - Allison Dalton
- From the Departments of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois
| | - Jonathan Hastie
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York
| | - Craig S Jabaley
- Department of Anesthesiology, Emory University Atlanta, Georgia
| | - Aaron M Mittel
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, New York
| | - Mark E Nunnally
- Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Langone Health, New York, New York
| | - Shahla Siddiqui
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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14
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Abstract
Background: Tracheal intubation is a high-risk intervention for exposure to airborne infective pathogens, including the novel coronavirus disease 2019 (COVID-19). During the recent pandemic, personal protective equipment (PPE) was essential to protect staff during intubation but is recognized to make the practical conduct of anesthesia and intubation more difficult. In the early phase of the coronavirus pandemic, some simple alterations were made to the emergency anesthesia standard operating procedure (SOP) of a prehospital critical care service to attempt to maintain high intubation success rates despite the challenges posed by wearing PPE. This retrospective observational cohort study aims to compare first-pass intubation success rates before and after the introduction of PPE and an altered SOP. Methodology: A retrospective observational cohort study was conducted from January 1, 2019 through August 30, 2021. The retrospective analysis used prospectively collected data using prehospital electronic patient records. Anonymized data were held in Excel (v16.54) and analyzed using IBM SPSS Statistics (v28). Patient inclusion criteria were those of all ages who received a primary tracheal intubation attempt outside the hospital by critical care teams. March 27, 2020 was the date from which the SOP changed to mandatory COVID-19 SOP including Level 3 PPE – this date is used to separate the cohort groups. Results: Data were analyzed from 1,266 patients who received primary intubations by the service. The overall first-pass intubation success rate was 89.7% and the overall intubation success rate was 99.9%. There was no statistically significant difference in first-pass success rate between the two groups: 90.3% in the pre-COVID-19 group (n = 546) and 89.3% in the COVID-19 group (n = 720); Pearson chi-square 0.329; P = .566. In addition, there was no statistical difference in overall intubation success rate between groups: 99.8% in the pre-COVID-19 group and 100.0% in the COVID-19 group; Pearson chi-square 1.32; P = .251. Non-drug-assisted intubations were more than twice as likely to require multiple attempts in both the pre-COVID-19 group (n = 546; OR = 2.15; 95% CI, 1.19-3.90; P = .01) and in the COVID-19 group (n = 720; OR = 2.5; 95% CI, 1.5-4.1; P = <.001). Conclusion: This study presents simple changes to a prehospital intubation SOP in response to COVID-19 which included mandatory use of PPE, the first intubator always being the most experienced clinician, and routine first use of video laryngoscopy (VL). These changes allowed protection of the clinical team while successfully maintaining the first-pass and overall success rates for prehospital tracheal intubation.
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15
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Sajayan A, Nair A, McNarry AF, Mir F, Ahmad I, El‐Boghdadly K. Analysis of a national difficult airway database. Anaesthesia 2022; 77:1081-1088. [DOI: 10.1111/anae.15820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 12/30/2022]
Affiliation(s)
- A. Sajayan
- Department of Anaesthesia University Hospitals Birmingham NHS Foundation Trust Birmingham UK
| | - A. Nair
- Department of Anaesthesia University Hospitals Birmingham NHS Foundation Trust Birmingham UK
| | - A. F. McNarry
- Department of Anaesthesia Western General and St John's Hospitals Edinburgh UK
| | - F. Mir
- Department of Anaesthesia St Georges University Hospitals NHS Foundation Trust London UK
| | - I. Ahmad
- Department of Anaesthesia and Peri‐operative Medicine Guy's and St. Thomas' NHS Foundation Trust London UK
- King's College London London UK
| | - K. El‐Boghdadly
- Department of Anaesthesia and Peri‐operative Medicine Guy's and St. Thomas' NHS Foundation Trust London UK
- King's College London London UK
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16
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Qin Z, Sun Y, Zhang J, Zhou L, Chen Y, Huang C. Lessons from SARS‑CoV‑2 and its variants (Review). Mol Med Rep 2022; 26:263. [PMID: 35730623 PMCID: PMC9260876 DOI: 10.3892/mmr.2022.12779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/01/2022] [Indexed: 12/15/2022] Open
Abstract
COVID-19 has swept through mainland China by human-to-human transmission. The rapid spread of SARS-CoV-2 and its variants, including the currently prevalent Omicron strain, pose a serious threat worldwide. The present review summarizes epidemiological investigation and etiological analysis of genomic, epidemiological, and pathological characteristics of the original strain and its variants, as well as progress in diagnosis and treatment. Prevention and control measures used during the current Omicron pandemic are discussed to provide further knowledge of SARS-CoV-2.
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Affiliation(s)
- Ziwen Qin
- Department of Respiratory Diseases, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250013, P.R. China
| | - Yan Sun
- Department of Respiratory Diseases, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Jian Zhang
- Department of Respiratory Diseases, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Ling Zhou
- Department of Respiratory Diseases, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Yujuan Chen
- Department of Respiratory Diseases, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250013, P.R. China
| | - Chuanjun Huang
- Department of Respiratory Diseases, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250013, P.R. China
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17
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Perez D, Murphy G, Wilkes L, Peters K. Being tied down—The experience of being physically restrained while mechanically ventilated in
ICU. J Adv Nurs 2022; 78:3760-3771. [DOI: 10.1111/jan.15354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/29/2022] [Accepted: 06/14/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Dawn Perez
- School of Nursing and Midwifery Western Sydney University Penrith New South Wales Australia
| | - Gillian Murphy
- School of Nursing and Midwifery/Translational Health Research Institute (THRI) Western Sydney University Penrith New South Wales Australia
| | - Lesley Wilkes
- School of Nursing and Midwifery Western Sydney University Penrith New South Wales Australia
| | - Kath Peters
- School of Nursing and Midwifery/Translational Health Research Institute (THRI) Western Sydney University Penrith New South Wales Australia
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18
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Shekhar AC, Effiong A, Mann NC, Blumen IJ. Success of prehospital tracheal intubation during cardiac arrest varies based on race/ethnicity and sex. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2022. [DOI: 10.1016/j.tacc.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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M S, Ross H, KT S, I Z, Robert G. Rapid Sequence Induction/Intubation: What needs to be fast? TRENDS IN ANAESTHESIA AND CRITICAL CARE 2022. [DOI: 10.1016/j.tacc.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Grudzinski AL, Sun B, Zhang M, Crnic A, Djokhdem AH, Hanna M, Montroy J, Duggan LV, Hamilton GM, Fergusson DA, Boet S, McIsaac DI, Lalu MM. Airway recommendations for perioperative patients during the COVID-19 pandemic: a scoping review. Can J Anaesth 2022; 69:644-657. [PMID: 35112304 PMCID: PMC8809630 DOI: 10.1007/s12630-022-02199-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/13/2021] [Accepted: 11/23/2021] [Indexed: 10/31/2022] Open
Abstract
Purpose Source Principal findings Conclusion Study registration Supplementary Information
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21
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Russotto V, Rahmani LS, Parotto M, Bellani G, Laffey JG. Tracheal intubation in the critically ill patient. Eur J Anaesthesiol 2022; 39:463-472. [PMID: 34799497 DOI: 10.1097/eja.0000000000001627] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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.
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Affiliation(s)
- Vincenzo Russotto
- From the Department of Anesthesia and Intensive Care, University Hospital San Luigi Gonzaga, University of Turin, Italy (VR), Department of Emergency and Intensive Care, University Hospital San Gerardo, Monza (GB), University of Milano-Bicocca, Milan, Italy (GB), Department of Anaesthesiology, Critical Care and Pain Medicine, Children's Health Ireland at Temple Street, Dublin, Ireland (LSR), Department of Anesthesiology and Pain Medicine; Interdepartmental Division of Critical Care Medicine, University of Toronto (MP), Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Canada (MP), Regenerative Medicine Institute at CURAM Centre for Medical Devices, School of Medicine, National University of Ireland (JGL) and Anaesthesia and Intensive Care Medicine, University Hospital Galway, Galway, Ireland (JGL) Correspondence to Vincenzo Russotto, Department of Anesthesia and Intensive Care, University Hospital San Luigi Gonzaga, Regione Gonzole, 10, 10043 Orbassano, Turin, Italy
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22
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Fayed M, Nowak K, Angappan S, Patel N, Abdulkarim F, Penning DH, Chhina AK. Emergent Surgical Airway Skills: Time to Re-evaluate the Competencies. Cureus 2022; 14:e23260. [PMID: 35342673 PMCID: PMC8929234 DOI: 10.7759/cureus.23260] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction One of the most challenging scenarios an anesthesia provider can face is treating a can't intubate can't ventilate (CICV) patient. The incidence of CICV is estimated to be around one in 10,000 cases. According to the American Society of Anesthesiology Closed Claims Study, adverse respiratory events are the most common type of injury, with difficult intubation and ventilation contributing to the majority of these cases. The objective of this non-interventional quality improvement project was to evaluate the prior training, exposure, and self-reported confidence in handling the CICV scenario among anesthesia providers at Henry Ford Hospital in Detroit, MI. Methods An online questionnaire was distributed via email to all residents, certified registered nurse anesthetists (CRNAs), and attending anesthesiologists in March 2021. The email contained a link to an online questionnaire via Microsoft Forms (Microsoft Corporation, Redmond, WA). Univariate group comparisons were carried out between the respondents’ role (attending, CRNA, or resident), as well as between the number of years that the respondents were in practice (< 5 years, 5-10 years, > 10 years). Results Out of the total 170 anesthesia providers, 119 participated in the study where 54 (45%) were attendings, 44 (37%) were residents, and 21 (18%) were CRNAs. The majority (75%) did not know the surgical airway kit location, and 87% had not performed the surgical airway procedure before. The vast majority (96.7%) recommended simulation training compared to online training or lecture series, and just over 50% recommended annual training frequency. When looking at the differences in responses based on years of experience as an anesthesia provider, the majority of those with > 10 years in practice knew how to perform the surgical airway technique while respondents with < 5 years did not know how to perform the technique, and 50% of those with five to 10 years experience knew how to perform the surgical airway procedure for a CICV scenario. Conclusion Although there were many significant differences observed between the various provider roles and years in practice, surprisingly, the responses revealed both a lack of experience and confidence in performing the surgical airway procedure in all provider roles. These findings highlight a need for better emergency airway teaching and training. These findings will be used to guide the design and implementation of improved surgical airway training for residents, CRNAs, and attending anesthesiologists with the goal of better preparedness for handling a CICV scenario.
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Affiliation(s)
- Mohamed Fayed
- Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, USA
| | | | - Santhalakshmi Angappan
- Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, USA
| | - Nimesh Patel
- Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, USA
| | - Fawaz Abdulkarim
- Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, USA
| | - Donald H Penning
- Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, USA
| | - Anoop K Chhina
- Anesthesiology, Pain Management and Perioperative Medicine, Henry Ford Health System, Detroit, USA
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23
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Mehta M. Abstract No.: ABS0125: Study of airway management in 50 COVID positive patients in ICU. Indian J Anaesth 2022. [PMCID: PMC9116748 DOI: 10.4103/0019-5049.340674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background & Aims: The aim was to successfully perform airway management by securing definite airway via endotracheal tube in emergency or semi- emergency situation in first attempt without causing any trauma to the patient. Methods: In our ICU, tracheal intubation was done for patients with COVID-19 which was based on clinical criteria as per the institute protocol. Intubation was performed by an expert in airway management using method of rapid sequence intubation anddirect laryngoscope. Propofol or etomidate were used as induction agent and succinylcholine or rocuronium as musclerelaxant, according to the patient profile. Intubation box, acrylic face shield and personal protective equipment were also used for safety. Various pathological factors also contribute to difficulty in airway management such as edema and ulceration ofepiglottis and vocal cords. Results: Despite a multitude of technical and pathological factors contributing to difficult airway management,in this study of total 50 patients, 45 patients were intubated successfully in the first attempt, 4 patients were intubated in second attempt and 1 patient was intubated after 3 attempts using bougie with some trauma to the patient. All the intubations were performed using direct laryngoscope and rapid sequence intubation by an expert airway manager. ![]()
Conclusion: Therefore, to conclude, in the majority of the COVID 19 ICU patients, airway management was done successfully in the first attempt in emergency situation by the expert airway manager.
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24
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Affiliation(s)
| | - Avery Tung
- University of Chicago, Chicago, Illinois (D.S.R.).
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25
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El-Boghdadly K, Wong DJN, Johnstone C, Ahmad I. Emergency Airway Management in COVID-19: Reply. Anesthesiology 2022; 136:395-396. [PMID: 34758058 PMCID: PMC8745884 DOI: 10.1097/aln.0000000000004061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Kariem El-Boghdadly
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom (K.E.-B.).
| | - Danny J. N. Wong
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom (K.E.-B.).
| | - Craig Johnstone
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom (K.E.-B.).
| | - Imran Ahmad
- Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom (K.E.-B.).
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26
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Jarvis N, Schiavo S, Bartoszko J, Ma M, Chin KJ, Parotto M. A specialized airway management team for COVID-19 patients: a retrospective study of the experience of two Canadian hospitals in Toronto. Can J Anaesth 2021; 69:333-342. [PMID: 34881407 PMCID: PMC8654186 DOI: 10.1007/s12630-021-02169-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 10/25/2022] Open
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.
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Affiliation(s)
- Nicola Jarvis
- Department of Anesthesiology and Pain Medicine, University of Toronto, EN 429 - 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Simone Schiavo
- Department of Anesthesiology and Pain Medicine, University of Toronto, EN 429 - 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Department of Anesthesia and Pain Management, Toronto Western Hospital, Toronto, ON, Canada
| | - Justyna Bartoszko
- Department of Anesthesiology and Pain Medicine, University of Toronto, EN 429 - 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Martin Ma
- Department of Anesthesiology and Pain Medicine, University of Toronto, EN 429 - 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Ki Jinn Chin
- Department of Anesthesiology and Pain Medicine, University of Toronto, EN 429 - 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.,Department of Anesthesia and Pain Management, Toronto Western Hospital, Toronto, ON, Canada
| | - Matteo Parotto
- Department of Anesthesiology and Pain Medicine, University of Toronto, EN 429 - 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada. .,Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada. .,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
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27
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Stein ML, Park RS, Afshari A, Disma N, Fiadjoe JE, Matava CT, McNarry AF, von Ungern-Sternberg BS, Kovatsis PG, Peyton JM. Lessons from COVID-19: A reflection on the strengths and weakness of early consensus recommendations for pediatric difficult airway management during a respiratory viral pandemic using a modified Delphi method. Paediatr Anaesth 2021; 31:1074-1088. [PMID: 34387013 DOI: 10.1111/pan.14272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The authors recognized a gap in existing guidelines and convened a modified Delphi process to address novel issues in pediatric difficult airway management raised by the COVID-19 pandemic. METHODS The Pediatric Difficult Intubation Collaborative, a working group of the Society for Pediatric Anesthesia, assembled an international panel to reach consensus recommendations on pediatric difficult airway management during the COVID-19 pandemic using a modified Delphi method. We reflect on the strengths and weaknesses of this process and ways care has changed as knowledge and experience have grown over the course of the pandemic. RECOMMENDATIONS In the setting of the COVID-19 pandemic, the Delphi panel recommends against moving away from the operating room solely for the purpose of having a negative pressure environment. The Delphi panel recommends supplying supplemental oxygen and using videolaryngoscopy during anticipated difficult airway management. Direct laryngoscopy is not recommended. If the patient meets extubation criteria, extubate in the OR, awake, at the end of the procedure. REFLECTION These recommendations remain valuable guidance in caring for children with anticipated difficult airways and infectious respiratory pathology when reviewed in light of our growing knowledge and experience with COVID-19. The panel initially recommended minimizing involvement of additional people and trainees and minimizing techniques associated with aerosolization of viral particles. The demonstrated effectiveness of PPE and vaccination at reducing the risk of exposure and infection to clinicians managing the airway makes these recommendations less relevant for COVID-19. They would likely be important initial steps in the face of novel respiratory viral pathogens. CONCLUSIONS The consensus process cannot and should not replace evidence-based guidelines; however, it is encouraging to see that the panel's recommendations have held up well as scientific knowledge and clinical experience have grown.
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Affiliation(s)
- Mary Lyn Stein
- Department of Anesthesiology, Critical Care, and Pain Management, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Raymond S Park
- Department of Anesthesiology, Critical Care, and Pain Management, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Arash Afshari
- Department of Pediatric and Obstetric Anesthesia, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Nicola Disma
- Unit for Research and Innovation, Department of Paediatric Anaesthesia, Istituto Giannina Gaslini, Genova, Italy
| | - John E Fiadjoe
- Department of Anesthesiology, Critical Care, and Pain Management, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Clyde T Matava
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | | | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia.,Team Perioperative Medicine, Telethon Kids Institute, Perth, WA, Australia
| | - Pete G Kovatsis
- Department of Anesthesiology, Critical Care, and Pain Management, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - James M Peyton
- Department of Anesthesiology, Critical Care, and Pain Management, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
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28
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Şentürk M, El Tahan MR, Shelley B, Szegedi LL, Piccioni F, Licker MJ, Karzai W, Gil MG, Neskovic V, Vanpeteghem C, Pelosi P, Cohen E, Sorbello M, MBChB JB, Stoica R, Mourisse J, Brunelli A, Jimenez MJ, Drnvsek-Globoikar M, Yapici D, Morsy AS, Kawagoe I, Végh T, Navarro-Ripoll R, Marczin N, Paloczi B, Unzueta C, Gregorio GD, Wouters P, Rex S, Mukherjee C, Paternoster G, Guarracino F. Thoracic Anesthesia during the COVID-19 Pandemic: 2021 Updated Recommendations by the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) Thoracic Subspecialty Committee. J Cardiothorac Vasc Anesth 2021; 35:3528-3546. [PMID: 34479782 PMCID: PMC8313821 DOI: 10.1053/j.jvca.2021.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/09/2021] [Accepted: 07/11/2021] [Indexed: 02/07/2023]
Abstract
The novel coronavirus pandemic has radically changed the landscape of normal surgical practice. Lifesaving cancer surgery, however, remains a clinical priority, and there is an increasing need to fully define the optimal oncologic management of patients with varying stages of lung cancer, allowing prioritization of which thoracic procedures should be performed in the current era. Healthcare providers and managers should not ignore the risk of a bimodal peak of mortality in patients with lung cancer; an imminent spike due to mortality from acute coronavirus disease 2019 (COVID-19) infection, and a secondary peak reflecting an excess of cancer-related mortality among patients whose treatments were deemed less urgent, delayed, or cancelled. The European Association of Cardiothoracic Anaesthesiology and Intensive Care Thoracic Anesthesia Subspecialty group has considered these challenges and developed an updated set of expert recommendations concerning the infectious period, timing of surgery, vaccination, preoperative screening and evaluation, airway management, and ventilation of thoracic surgical patients during the COVID-19 pandemic.
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Affiliation(s)
- Mert Şentürk
- Dep. of Anesthesiology & Reanimation, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
| | - Mohamed R El Tahan
- Cardiothoracic Anesthesiology, College of Medicine, Mansoura University, Mansoura, Egypt
| | - Ben Shelley
- Cardiothoracic Anaesthesia and Intensive Care, Golden Jubilee National Hospital/West of Scotland Heart and Lung Centre, University of Glasgow Academic Unit of Anaesthesia, Pain and Critical Care, Scotland
| | - Laszlo L Szegedi
- Department of Anesthesiology, CUB Hôpital Erasme, ULB Université Libre de Bruxelles, Brussels, Belgium
| | - Federico Piccioni
- Anesthesia and Intensive Care Unit, Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marc-Joseph Licker
- Anesthesia, Pharmacology and Intensive Care, University Hospital Geneva, Geneva, Switzerland
| | - Waheedullah Karzai
- Chefarzt, Zentralklinik Bad Berka GmbH, Robert-Koch-Allee, Bad Berka, Germany
| | | | - Vojislava Neskovic
- Anesthesia and Intensive Care, Military Medical Academy Belgrade, Belgrade, Serbia
| | | | - Paolo Pelosi
- Università degli Studi di Genova, UNIGE, Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), Genoa, Italy
| | - Edmond Cohen
- Anesthesiology, Perioperative & Pain Medicine, Thoracic Surgery Specialty, Anesthesiology Icahn School of Medicine at Mount Sinai, New York, NY; Anesthesia and Intensive Care, AOU Policlinico Vittorio Emanuele San Marco, Catania, Italy
| | - Massimiliano Sorbello
- Anesthesia, Pharmacology and Intensive Care, University Hospital Geneva, Geneva, Switzerland
| | - Johan Bence MBChB
- Cardiothoracic Anaesthesiology, University Hospitals of Leicester Glenfield Hospital, Leicester, UK
| | - Radu Stoica
- Faculty of Medicine, Titu Maiorescu, Bucharest; Anesthesia and Intensive Care, Military Medical Academy Belgrade, Belgrade, Serbia
| | - Jo Mourisse
- Anesthesiology and ICU, Monza Oncolgy Hospital, Bucharest; Department of Anesthesia, Pain and Palliative Medicine, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Alex Brunelli
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Maria-José Jimenez
- Anesthesiology, Centro Medico Teknon, Universitat de Barcelona, Barcelona, Spain
| | | | - Davud Yapici
- Anesthesia and Intensive Care, Mersin University School of Medicine, Mersin, Turkey
| | - Ahmed Salaheldin Morsy
- Department of Anesthesia, King Fahd Hospital of the Imam Abdulrahman bin Faisal University, Al Khober, Saudi Arabia
| | - Izumi Kawagoe
- Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, Tokyo, Japan; Outcomes Research Consortium, Cleveland, OH
| | - Tamás Végh
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
| | | | - Nandor Marczin
- Department of Anesthesiology, Ljubjljana University Medical Centre, Ljubljana, Slovenia; Section of Anesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Anesthesia, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, Middlesex, UK
| | - Balazs Paloczi
- Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary
| | - Carmen Unzueta
- Department of Anesthesiology, Hospital de la Santa Creu i San Pau, Barcelona, Spain
| | - Guido Di Gregorio
- Anesthesia and Critical Care Azienda Ospedaliera Università di Padova, Padova, Italy
| | - Patrick Wouters
- Department of Anesthesia and Perioperative Medicine, Ghent University, Ghent, Belgium
| | - Steffen Rex
- Clinic Department of Anesthesiology, University Hospitals Leuven, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Chirojit Mukherjee
- Department of Anaesthesia & Intensive Care, Helios Clinic for Cardiac Surgery, Karlsruhe, Germany
| | - Gianluca Paternoster
- Division of Cardiac Resuscitation, Cardiovascular Anesthesia and Intensive Care San Carlo Hospital (Potenza) Italy Via Potito Petrone, Italy
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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30
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Duggan LV, El-Boghdadly K. The importance of prospective observational studies in airway management: yet only the first step. Anaesthesia 2021; 76:1555-1558. [PMID: 34189730 DOI: 10.1111/anae.15538] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 12/15/2022]
Affiliation(s)
- L V Duggan
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Canada
| | - K El-Boghdadly
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
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31
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Nauka PC, Chen JT, Shiloh AL, Eisen LA, Fein DG. Practice, Outcomes, and Complications of Emergent Endotracheal Intubation by Critical Care Practitioners During the COVID-19 Pandemic. Chest 2021; 160:2112-2122. [PMID: 34139207 PMCID: PMC8204844 DOI: 10.1016/j.chest.2021.06.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 01/15/2023] Open
Abstract
Background For patients with COVID-19 who undergo emergency endotracheal intubation, data are limited regarding the practice, outcomes, and complications of this procedure. Research Question For patients with COVID-19 requiring emergency endotracheal intubation, how do the procedural techniques, the incidence of first-pass success, and the complications associated with the procedure compare with intubations of critically ill patients before the COVID-19 pandemic? Study Design and Methods We conducted a retrospective study of adult patients with COVID-19 at Montefiore Medical Center who underwent first-time endotracheal intubation by critical care physicians between July 19, 2019, and May 1, 2020. The first COVID-19 patient was admitted to our institution on March 11, 2020; patients admitted before this date are designated the prepandemic cohort. Descriptive statistics were used to compare groups. A Fisher exact test was used to compare categorical variables. For continuous variables, a two-tailed Student t test was used for parametric variables or a Wilcoxon rank-sum test was used for nonparametric variables. Results One thousand two hundred sixty intubations met inclusion criteria (782 prepandemic cohort, 478 pandemic cohort). Patients during the pandemic were more likely to be intubated for hypoxemic respiratory failure (72.6% vs 28.1%; P < .01). During the pandemic, operators were more likely to use video laryngoscopy (89.4% vs 53.3%; P < .01) and neuromuscular blocking agents (86.0% vs 46.2%; P < .01). First-pass success was higher during the pandemic period (94.6% vs 82.9%; P < .01). The rate of associated complications was higher during the pandemic (29.5% vs 15.2%; P < .01), a finding driven by a higher rate of hypoxemia during or immediately after the procedure (25.7% vs 8.2%; P < .01). Interpretation Video laryngoscopy and neuromuscular blockade were used increasingly during the COVID-19 pandemic. Despite a higher rate of first-pass success during the pandemic, the incidence of complications associated with the procedure was higher.
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Affiliation(s)
- Peter C Nauka
- Internal Medicine Residency Program, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Jen-Ting Chen
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Ariel L Shiloh
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Lewis A Eisen
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Daniel G Fein
- Division of Pulmonary Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY.
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