High-flow nasal-oxygenation-assisted fibreoptic tracheal intubation in critically ill patients with COVID-19 pneumonia: a prospective randomised controlled trial

Wu, Caineng; Xia, Lin-Zhi; Li, Kunhong; Ma, Wuhua; Yu, Dongnan; Qu, Bo; Li, Bixi; Cao, Ying

doi:10.1016/j.bja.2020.02.020

Cited by 50 publications

(56 citation statements)

References 11 publications

(11 reference statements)

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“…Two trials compared convalescent plasma added to standard care versus standard care alone [ 40 , 52 ]. The remaining trials and comparisons included hydroxychloroquine with and without azithromycin added to standard care versus standard care alone [ 55 ], hydroxychloroquine versus placebo [ 54 , 68 ], hydroxychloroquine and chloroquine added to standard care versus standard care alone [ 49 ], methylprednisolone added to standard care versus standard care alone [ 57 ], lopinavir–ritonavir versus umifenovir and versus standard care [ 41 ], favipravir versus umifenovir [ 34 ], high-flow nasal oxygenation versus standard mask oxygenation prior to fibreotic tracheal intubation [ 45 ], α-lipoic acid versus placebo [ 47 ], the combination of novaferon plus lopinavir–ritonavir versus novaferon and versus lopinavir–ritonavir [ 46 ], baloxavir marboxil versus favipiravir and versus standard care [ 42 ], 5 versus 10 days of remdesivir [ 38 ], interferon β-1a added to standard care versus standard care alone [ 37 ], colchicine added to standard care versus standard care alone [ 50 ], high-dosage with low-dosage chloroquine diphosphate [ 51 ], intravenous immunoglobulin added to standard care versus standard care alone [ 58 ], ribavirin plus interferon alpha versus lopinavir/ritonavir plus interferon alpha versis ribavirin plus lopinavir/ritonavir plus interferon alpha [ 62 ], darunavir/cobicistat plus interferon alpha-2b versus interferon alpha-2b alone [ 61 ], lincomycin HCl versus azitromycin [ 63 ], 99mTc-methyl diphosphonate (99mTc-MDP) injection added to standard care versus standard care alone [ 64 ], and interferon alpha-2b plus gamma versus interferon alpha-2b alone [ 65 ].…”

Section: Resultsmentioning

confidence: 99%

“…Two trials did not report the results in a usable way; one trial reported results of the experimental group with a proportion of participants being nonrandomized [ 57 ], and the second trial reported the results as per-protocol, and there was participant crossover [ 43 ]. Three trials did not report on our review outcomes [ 45 , 63 , 64 ]. We have contacted all corresponding authors, but we have not been able to obtain outcomes for our analyses from the trialists yet.…”

Section: Resultsmentioning

confidence: 99%

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Interventions for treatment of COVID-19: A living systematic review with meta-analyses and trial sequential analyses (The LIVING Project)

et al. 2020

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Background Coronavirus disease 2019 (COVID-19) is a rapidly spreading disease that has caused extensive burden to individuals, families, countries, and the world. Effective treatments of COVID-19 are urgently needed. Methods and findings This is the first edition of a living systematic review of randomized clinical trials comparing the effects of all treatment interventions for participants in all age groups with COVID-19. We planned to conduct aggregate data meta-analyses, trial sequential analyses, network meta-analysis, and individual patient data meta-analyses. Our systematic review is based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and Cochrane guidelines, and our 8-step procedure for better validation of clinical significance of meta-analysis results. We performed both fixed-effect and random-effects meta-analyses. Primary outcomes were all-cause mortality and serious adverse events. Secondary outcomes were admission to intensive care, mechanical ventilation, renal replacement therapy, quality of life, and nonserious adverse events. We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the certainty of evidence. We searched relevant databases and websites for published and unpublished trials until August 7, 2020. Two reviewers independently extracted data and assessed trial methodology. We included 33 randomized clinical trials enrolling a total of 13,312 participants. All trials were at overall high risk of bias. We identified one trial randomizing 6,425 participants to dexamethasone versus standard care. This trial showed evidence of a beneficial effect of dexamethasone on all-cause mortality (rate ratio 0.83; 95% confidence interval [CI] 0.75–0.93; p < 0.001; low certainty) and on mechanical ventilation (risk ratio [RR] 0.77; 95% CI 0.62–0.95; p = 0.021; low certainty). It was possible to perform meta-analysis of 10 comparisons. Meta-analysis showed no evidence of a difference between remdesivir versus placebo on all-cause mortality (RR 0.74; 95% CI 0.40–1.37; p = 0.34, I 2 = 58%; 2 trials; very low certainty) or nonserious adverse events (RR 0.94; 95% CI 0.80–1.11; p = 0.48, I 2 = 29%; 2 trials; low certainty). Meta-analysis showed evidence of a beneficial effect of remdesivir versus placebo on serious adverse events (RR 0.77; 95% CI 0.63–0.94; p = 0.009, I 2 = 0%; 2 trials; very low certainty) mainly driven by respiratory failure in one trial. Meta-analyses and trial sequential analyses showed that we could exclude the possibility that hydroxychloroquine versus standard care reduced the risk of all-cause mortality (RR 1.07; 95% CI 0.97–1.19; p = 0.17; I 2 = 0%; 7 trials; low certainty) and ...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Interventions for treatment of COVID-19: A living systematic review with meta-analyses and trial sequential analyses (The LIVING Project)

et al. 2020

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“…practice and learned opinion has ranged from nasal highflow being the mainstay of treating COVID-19 pneumonia 9 to its use being recommended against 10 . The use of nasal high-flow in the settings of awake tracheal intubation in COVID-19 patients has been shown to reduce the risk of desaturation and reduce the duration of intubation 11 . The exact risk of cross-infection from the use of nasal highflow in comparison to other interventions is unclear 12 and 13 and in our opinion, provided that the patient is placed in isolation and all staff use full Personal Protective equipment at all times a patient receives nasal high-flow, as a temporary holding intervention the benefits of its use outweigh the risks.…”

Section: Clinical Presentation and Initial Assessmentmentioning

confidence: 99%

A multidisciplinary approach for managing the infraglottic difficult airway in the setting of the Coronavirus pandemic

Nouraei

Girgis

Shorthouse

et al. 2020

Operative Techniques in Otolaryngology-Head and Neck Surgery

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Management of a difficult airway caused by pathology below the glottis is high-risk and requires a shared approach to airway planning and surgical treatment. Access to the trachea requires a careful assessment of the airway since the end-point of laryngoscopy for infraglottic airway management is not visualization of the larynx for tube placement, but access to the laryngotracheal complex in cases where intubation may not be feasible or may preclude surgical access. This work provides a common framework for creating multidisciplinary shared-airway management plans and presents devices and strategies that have in recent years improved airway management safety in this difficult patient group and may prove useful in the setting of the novel Coronavirus Disease 2019 (COVID-19).

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“…Bronchoscope-guided endotracheal intubation in patients with COVID-19 has already been reported[ 4 , 5 ]. In our method, an ultrathin gastrointestinal endoscope was used as an alternative to the bronchoscope.…”

Section: To the Editormentioning

confidence: 99%

Endotracheal intubation in patients with COVID-19 using an ultrathin flexible gastrointestinal endoscope

Masaki¹,

Yamada²,

Kimura³

2020

WJGE

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Pneumonia caused by severe acute respiratory syndrome coronavirus 2 occasionally becomes severe and requires endotracheal intubation. Endotracheal intubation is usually performed using a laryngoscope; however, the operator needs to be in close proximity to the patient’s face during the procedure, which increases the risk of droplet exposure. Therefore, we simulated fiberoptic endotracheal intubation on a mannequin representing the patient, using an ultrathin flexible gastrointestinal endoscope as an alternative to the bronchoscope, in order to maintain distance from the patient during the procedure. We performed this procedure 10 times and measured the time required; the median procedure time was 6.4 s (interquartile range, 5.7-8.1 s). The advantage of this method is the short procedure time and distance maintained from the patients. The flexible tip-steerable control and length of the gastrointestinal endoscope contributed to shortening the procedure time and maintaining distance from the patients. In addition, this method can handle difficult airways without risk of misplacement of the endotracheal tube. However, it is necessary to consider the risk of aerosol generation associated with this procedure. In the pandemic setting of coronavirus disease 2019, this approach may be useful when a gastrointestinal endoscopist is in charge of endotracheal intubation of patients with coronavirus disease 2019.

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High-flow nasal-oxygenation-assisted fibreoptic tracheal intubation in critically ill patients with COVID-19 pneumonia: a prospective randomised controlled trial

Cited by 50 publications

References 11 publications

Interventions for treatment of COVID-19: A living systematic review with meta-analyses and trial sequential analyses (The LIVING Project)

Interventions for treatment of COVID-19: A living systematic review with meta-analyses and trial sequential analyses (The LIVING Project)

A multidisciplinary approach for managing the infraglottic difficult airway in the setting of the Coronavirus pandemic

Endotracheal intubation in patients with COVID-19 using an ultrathin flexible gastrointestinal endoscope

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