COVID-19: Intubation Kit, Intubation Team, or Intubation Spots?

Sorbello, Massimiliano; Morello, Gianluigi; Pintaudi, Sergio; Cataldo, Rita

doi:10.1213/ane.0000000000004970

Cited by 36 publications

(23 citation statements)

References 3 publications

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“…Ninth, intubation of COVID-19 patients remains challenging and under debate [ 40 ], with risk for healthcare providers [ 42 , 43 ] and patients [ 44 , 45 , 46 , 47 ]. Consequently, the decision-making for intubation may be delayed until arrival at a high-level care facility with an experienced team member [ 48 , 49 ].…”

Section: Discussionmentioning

confidence: 99%

Hypoxemia Index Associated with Prehospital Intubation in COVID-19 Patients

Jouffroy

Kedzierewicz

Derkenne

et al. 2020

JCM

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Background: There exists a need for prognostic tools for the early identification of COVID-19 patients requiring prehospital intubation. Here we investigated the association between a prehospital Hypoxemia Index (HI) and the need for intubation among COVID-19 patients in the prehospital setting. Methods: We retrospectively analyzed COVID-19 patients initially cared for by a Paris Fire Brigade advanced life support (ALS) team in the prehospital setting between 8th March and 18th April of 2020. We assessed the association between HI and prehospital intubation using receiver operating characteristic (ROC) curve analysis and logistic regression model analysis after propensity score matching. Results are expressed as odds ratio (OR) and 95% confidence interval (CI). Results: We analyzed 300 consecutive COVID-19 patients (166 males (55%); mean age, 64 ± 18 years). Among these patients, 45 (15%) were deceased on the scene, 34 (11%) had an active care restriction, and 18 (6%) were intubated in the prehospital setting. The mean HI value was 3.4 ± 1.9. HI was significantly associated with prehospital intubation (OR, 0.24; 95% CI: 0.12–0.41, p < 10−3) with a corresponding area under curve (AUC) of 0.91 (95% CI: 0.85–0.98). HI significantly differed between patients with and without prehospital intubation (1.0 ± 1.0 vs. 3.6 ± 1.8, respectively; p < 10−3). ROC curve analysis defined the optimal HI threshold as 1.3. Bivariate analysis revealed that HI <1.3 was significantly, positively associated with prehospital intubation (OR, 38.38; 95% CI: 11.57–146.54; p < 10−3). Multivariate logistic regression analysis demonstrated that prehospital intubation was significantly associated with HI (adjusted odds ratio (ORa), 0.20; 95% CI: 0.06–0.45; p < 10−3) and HI <3 (ORa, 51.08; 95% CI: 7.83–645.06; p < 10−3). After adjustment for confounders, the ORa between HI <1.3 and prehospital intubation was 3.6 (95% CI: 1.95–5.08; p < 10−3). Conclusion: An HI of <1.3 was associated with a 3-fold increase in prehospital intubation among COVID-19 patients. HI may be a useful tool to facilitate decision-making regarding prehospital intubation of COVID-19 patients initially cared for by a Paris Fire Brigade ALS team. Further prospective studies are needed to confirm these preliminary results.

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Section: Discussionmentioning

confidence: 99%

Hypoxemia Index Associated with Prehospital Intubation in COVID-19 Patients

Jouffroy

Kedzierewicz

Derkenne

et al. 2020

JCM

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“…It appears more rational to adopt correct individual and social protective behaviours, 82 develop PPE prioritisation strategies, 62,69,78,80,82 establish boundaries for non-clinical working areas, 83 and recommend suitable protection levels of PPE for AGPs. 69,84,85 Limitations and knowledge gaps It must be acknowledged that most data regarding the COVID-19 outbreak should be considered of low-level evidence given that many of the analysed papers were expert opinions, technical reports, small simulation studies, small case series, pre-print proofs, or narrative reviews based on previous SARS and MERS outbreaks. Hence, the expert panel could not perform a systematic review.…”

Section: Can Multi-use Barriers Themselves Be An Infection Hazard?mentioning

confidence: 99%

Section: Narrative Summary Of Evidence Identifiedmentioning

confidence: 99%

Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: a scoping review and narrative synthesis

Sorbello

Rosenblatt

Hofmeyr

et al. 2020

British Journal of Anaesthesia

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113

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Exposure of healthcare providers to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a significant safety concern during the coronavirus disease 2019 (COVID-19) pandemic, requiring contact/droplet/airborne precautions. Because of global shortages, limited availability of personal protective equipment (PPE) has motivated the development of barrier-enclosure systems, such as aerosol boxes, plastic drapes, and similar protective systems. We examined the available evidence and scientific publications about barrier-enclosure systems for airway management in suspected/ confirmed COVID-19 patients. MEDLINE/Embase/Google Scholar databases (from December 1, 2019 to May 27, 2020) were searched for all articles on barrier enclosures for airway management in COVID-19, including references and websites. All sources were reviewed by a panel of experts using a Delphi method with a modified nominal group technique. Fiftytwo articles were reviewed for their results and level of evidence regarding barrier device feasibility, advantages, protection against droplets and aerosols, effectiveness, safety, ergonomics, and cleaning/disposal. The majority of analysed papers were expert opinions, small case series, technical descriptions, small-sample simulation studies, and pre-print proofs. The use of barrier-enclosure devices adds to the complexity of airway procedures with potential adverse consequences, especially during airway emergencies. Concerns include limitations on the ability to perform airway interventions and the aid that can be delivered by an assistant, patient injuries, compromise of PPE integrity, lack of evidence for added protection of healthcare providers (including secondary aerosolisation upon barrier removal), and lack of cleaning standards. Enclosure barriers for airway management are no substitute for adequate PPE, and their use should be avoided until adequate validation studies can be reported.

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“…The overwhelming request of qualified personnel, respirators, medical resource, PPEs and critical care beds deeply influenced the “routine” concept of critical care and patients’ triaging during the pandemic which unveiled the fragility of the health care system, and the fragility of the exhausted personnel as human beings. A crucial priority was and is proper and available PPE [ 21 , 22 ]. People started to invent their own 3D printed PPEs [ 23 ] or reused them [ 24 , 25 ].…”

Section: The Macgyver Effect: Using Better What We Have and Invent Whmentioning

confidence: 99%