Clinical recommendations for in-hospital airway management during aerosol-transmitting procedures in the setting of a viral pandemic

Abstract

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can lead to severe pneumonia and multi-organ failure. While most of the infected patients develop no or only mild symptoms, some need respiratory support or even invasive ventilation. The exact route of transmission is currently under investigation. While droplet exposure and direct contact seem to be the most significant ways of transmitting the disease, aerosol transmission appears to be possible under circumstances favored by high viral load. Despite the use of personal protective equipment (PPE), this situation potentially puts healthcare workers at risk of infection, especially if they are involved in airway management. Various recommendations and international guidelines aim to protect healthcare workers, although evidence-based research confirming the benefits of these approaches is still scarce. In this article, we summarize the current literature and recommendations for airway management of COVID-19 patients.

High flow nasal cannula oxygenation in COVID-19 related acute respiratory distress syndrome: a safe way to avoid endotracheal intubation?

“…In the HFNC-DNIO group, hospital mortality was 54.5% (6/11) (Table 1). Death occurred in a median of 17 [10][11][12][13][14][15][16][17] days from onset of the symptoms, all related to refractory ARDS in ICU.…”

“…9,11 High flow nasal cannula (HFNC) oxygenation emerged to prevent intubation for mild to severe ARDS, [12][13][14][15] but is still subject to debate; in COVID- 19-related ARDS due to potential HFNC induced viral aerosolization which may contaminate healthcare workers. [16][17][18][19][20][21] With regard to conventional pathophysiology of ARDS, COVID-19 has some particularities at the initial stage: a preserved compliance and high oxygen shunt which could sustain the hypothesis of loss of adapted hypoxic vasoconstriction 22 which would be in favor of preserving spontaneous breathing as far as possible. Early guidelines were either against 23 or in favor 24 of HFNC.…”

Attitudes and Practices of Operating Room Nurses toward COVID-19 in Turkey

“…Transmission routes for COVID-19 are coughing, sneezing and spread of large droplets containing viral particles. (20) These droplets can be suspended in the air for a few seconds and can travel a short distance before descending to the ground due to their weight (21,22). However, the droplets may lose their liquid content, diffuse into air and produce aerosols during such procedures as intubation, extubating, tracheal aspiration, use of electrical devices and medical gases and endoscopic examinations (23).…”

Development of an emergency airway response system for COVID-19 at a tertiary care hospital in resource limited country

“…The airway management is aimed at minimizing disconnection, aerosolization and exposure of staff to viral transmission. 7 The decision to make pre-packed PPE kits and intubation baskets along with designated people carrying pagers in day and night have shown a consistent management and positive outcome.…”