Making Intubation and Extubation Safe in the Covid Era
Main Article Content
Abstract
The highly infectious COVID-19 pandemic has in a way or the other affected everyone. Health care workers particularly anaesthesists who deal with airway manipulation are at an increased risk of being infected. Invasive procedures such as intubation and extubation performed mostly by anaesthetists are classified as procedures with high risk of aerosol generating particles where respiratory droplets containing the virus can easily spread to the surroundings. Various methods of preoxygenation, intubation and extubation have been further discussed and improvised with the aim of reducing the spread of aerosolization and making intubation safe. The purpose of this review is to identify the new techniques that are safe and effective in reducing aerosolization of respiratory droplets during the process of intubation and extubation. Anaesthetists are often not familiar with these new techniques and protocols. Thus far, no scientific data has been made available to support the superiority of each technique. Further research is needed to investigate each technique in the future.
Downloads
Article Details
References
Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. J Adv Res. 2020; 24:91-98.
WHO. Clinical management of Covid-19: interim guidance.2020.
Nimmagadda, Usharani, Salem, M. Ramez, Crystal, George J. Preoxygenation: Physiologic Basis, Benefits, and Potential Risks, Anesth Analg. 2017;124(2):507-517.
Tanoubi, I., Drolet, P. & Donati, F. Optimizing preoxygenation in adults. Can J Anesth. 2009;56: 449–466.
Nimmagadda, U., Salem, M.R., Joseph, N.J. et al. Efficacy of preoxygenation using tidal volume and deep breathing techniques with and without prior maximal exhalation. Can J Anesth. 2007; 54, 448–452.
Chan MTV, Chow BK, Lo T, et al. Exhaled air dispersion during bag-mask ventilation and sputum suctioning - Implications for infection control. Sci Rep. 2018;8(1):198.
David J Brewster, Nicholas Chrimes, Thy BT Do, Kirstin Fraser, Christopher J Groombridge, Andy Higgs, et al. Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group. Med J Aust. 2020; 212 (10): 472-481
Sally Roberts, N. Kabaliuk, Cjt Spence, Jane O’Donnell, Z. Zulkhairi Abidin, R. Dougherty, et al, Nasal high-flow therapy and dispersion of nasal aerosols in an experimental setting, J Crit Care. 2015;30(4): 842.
Leung CCH, Joynt GM, Gomersall CD, et al. Comparison of high-flow nasal cannula versus oxygen face mask for environmental bacterial contamination in critically ill pneumonia patients: a randomized controlled crossover trial. J Hosp Infect. 2019;101(1):84-87.
Li J, Fink JB, Ehrmann S. High-flow nasal cannula for COVID-19 patients: low risk of bio-aerosol dispersion. Eur Respir J. 2020;55(5):2000892.
Remy KE, Lin JC, Verhoef PA. High-flow nasal cannula may be no safer than non-invasive positive pressure ventilation for COVID-19 patients. Crit Care. 2020;24(1):169.
Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol-Generating Procedures and Risk of Transmission of Acute Respiratory Infections: A Systematic Review. CADTH Technol Overv. 2013;3(1): e3101.
Weissman DN, de Perio MA, Radonovich LJ. COVID-19 and Risks Posed to Personnel During Endotracheal Intubation. JAMA. 2020; 323(20):2027-2028.
Public Health England. Guidance: COVID-19 personal protective equipment (PPE).2020
Wong J, Goh QY, Tan Z, et al. Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore. Can J Anaesth. 2020;67(6):732-745.
Orser, Beverley A. Recommendations for Endotracheal Intubation of COVID-19 Patients, Anesthesia & Analgesia.2020;130(5):1109-1110.
Anaesthesia Patient Safety Foundation: Perioperative Considerations for the 2019 Novel Coronavirus (COVID-19);2020.
Kim HJ, Ko JS, Kim TY. Recommendations for anesthesia in patients suspected of COVID-19 Coronavirus infection. Korean J Anesthesiol. 2020;73(2):89-91.
Sulser, S., Ubmann, D., Brueesch, M. et al. The C-MAC videolaryngoscope compared with conventional laryngoscopy for rapid sequence intubation at the emergency department: study protocol. Scand J Trauma Resusc Emerg Med. 2015; 23:38.
Wylie NW, Phillips EC, Harrington JK, McNarry AF. Videolaryngoscopy utilisation: Facts and opinions. Trends in Anaesthesia and Critical Care. 2019; 29:21-25.
Audrey De Jong, Emmanuel Pardo, Amélie Rolle, Sandra Bodin-Lario, Yvan Pouzeratte, Samir Jaber, Airway management for COVID-19: a move towards universal videolaryngoscope, The Lancet Respiratory Medicine.2020;8(6):555.
Cai-Neng Wu, Lin-Zhi Xia, Kun-Hong Li, Wu-Hua Ma, Dong-Nan Yu, Bo Qu, et al , High-flow nasal-oxygenation-assisted fibreoptic tracheal intubation in critically ill patients with COVID-19 pneumonia: a prospective randomised controlled trial, Br J Anaesth.2020; 125(1):166-168.
Lyons C. Fibreoptic tracheal intubation in COVID-19. Br J Anaesth. 2020; 125(1):170-171.
Wong P, Lim WY, Mok M. Supraglottic airway guided intubation during the COVID-19 pandemic: a closed technique. Anesth Analg. 2020;10.1213/ANE.0000000000004951.
Yang WS, Hou SW, Lee BC, et al. Taipei Azalea - Supraglottic airways (SGA) preassembled with high-efficiency particulate air (HEPA) filters to simplify prehospital airway management for patients with out-of-hospital cardiac arrests (OHCA) during Coronavirus Disease 2019 (COVID-19) pandemic. Resuscitation. 2020; 151:3-5.
Feldman O, Meir M, Shavit D, Idelman R, Shavit I. Exposure to a Surrogate Measure of Contamination From Simulated Patients by Emergency Department Personnel Wearing Personal Protective Equipment. JAMA. 2020;323(20):2091-2093.
Canelli R, Connor CW, Gonzalez M, Nozari A, Ortega R. Barrier Enclosure during Endotracheal Intubation. N Engl J Med. 2020;382(20):1957-1958.
Asenjo, J.F. Safer intubation and extubation of patients with COVID-19. Can J Anesth.2020; 1-3.
Brown S, Patrao F, Verma S, Lean A, Flack S, Polaner D. Barrier System for Airway Management of COVID-19 Patients. Anesth Analg. 2020;10.1213/ANE.0000000000004876.
Yang YL, Huang CH, Luk HN, Tsai PB. Adaptation to the Plastic Barrier Sheet to Facilitate Intubation during the COVID-19 Pandemic. Anesth Analg. 2020 Apr 27:10.1213/ANE.0000000000004923.
Iwasaki N, Sekino M, Egawa T, Yamashita K, Hara T. Use of a plastic barrier curtain to minimize droplet transmission during tracheal extubation in patients with COVID-19. Acute Med Surg. 2020;7(1):529.
Kim ES, Bishop MJ. Cough during emergence from isoflurane anesthesia. Anesth Analg. 1998;87(5):1170-1174.
Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia. 2020;75(6):785-799.
Rani P, Hemanth Kumar VR, Ravishankar M, Sivashanmugam T, Sripriya R, Trilogasundary M. Rapid and reliable smooth extubation - Comparison of fentanyl with dexmedetomidine: A randomized, double-blind clinical trial. Anesth Essays Res. 2016;10(3):597-601.
Aminnejad R, Salimi A, Saeidi M. Lidocaine during intubation and extubation in patients with coronavirus disease (COVID-19). Can J Anaesth. 2020;67(6):759.
Kwon JH, Shin YH, Gil NS, et al. Effect-site concentration of remifentanil for smooth emergence from sevoflurane anesthesia in patients undergoing endovascular neurointervention. PLoS One. 2019;14(6):0218074.
D’Silva DF, McCulloch TJ, Lim JS, Smith SS, Carayannis D. Extubation of patients with COVID-19. Br J Anaesth. 2020; 125(1):192-195.
Endersby RVW, Ho ECY, Schubert E, Spencer AO. Modified tracheal extubation for patients with COVID-19. Br J Anaesth. 2020; 125(1):191-192.
Matava CT, Yu J, Denning S. Clear plastic drapes may be effective at limiting aerosolization and droplet spray during extubation: implications for COVID-19. Can J Anaesth. 2020;67(7):902-904.
Kristensen MS, Thomsen JLD. Minimising droplet and virus spread during and after tracheal extubation. Br J Anaesth. 2020; 125(1):197-198.
Hung O, Hung D, Hung C, Stewart R. A simple negative-pressure protective barrier for extubation of COVID-19 patients. Can J Anaesth. 2020;1-3.
Convissar D, Chang C Y, Choi W E, et al. The Vacuum Assisted Negative Pressure Isolation Hood (VANISH) System: Novel Application of the Stryker Neptune™ Suction Machine to Create COVID-19 Negative Pressure Isolation Environments. Cureus.2020;12(5): 8126.
Ozaki M, Yasuda Y, Jingushi N, Goto Y, Numaguchi A. Reducing Aerosol Generation During Ventilator Weaning in a Coronavirus Disease 2019 Patient Using a Supraglottic Airway: A Case Report. A A Pract. 2020;14(7):01247.
Patino Montoya M, Chitilian HV. Extubation barrier drape to minimise droplet spread. Br J Anaesth. 2020;125(1):e195-e196.