Safe extubation during the COVID-19 pandemic

Kangas-Dick, Aaron; Swearingen, Bruce; Wan, Elias; Chawla, Kabu; Wiesel, Ory

doi:10.1016/j.rmed.2020.106038

Cited by 17 publications

(14 citation statements)

References 20 publications

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“…Since the beginning of the COVID-19 outbreak, we have implemented precautions regarding laparoscopy, in order to avoid healthcare professional exposure during intubation and extubation, but also during laparoscopy, once the pneumoperitoneum has been created. For intubation and extubation, recently published guidelines were followed by the pediatric anesthesiology team, including the use of protective personal equipment (PPE), rapid sequence induction [16][17][18]. Regarding laparoscopy, care was taken during surgery not to release any pneumoperitoneum, that was safely evacuated via a closed suction system before trocar removal and appendix extraction.…”

Section: Methodsmentioning

confidence: 99%

The role of a pediatric tertiary care center in avoiding collateral damage for children with acute appendicitis during the COVID-19 outbreak

et al. 2020

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Purpose To evaluate the impact of the COVID-19 pandemic-related lockdown on management and outcomes of children with acute appendicitis. Methods A retrospective cohort study was conducted, including children treated for acute appendicitis (January 20th–May 11th, 2020). The data regarding the severity of appendicitis and outcome were collected and compared for two time periods, before and after the nationwide lockdown (March 17th, 2020). Results The number of cases of acute appendicitis increased by 77% during the lockdown ( n = 39 vs. n = 69, p = 0.03). During the lockdown, children treated for appendicitis were older (11.1 vs. 8.9 years, p = 0.003), and were more likely to live more than 5 km away from our institution (77% vs. 52%, p = 0.017). Less children had previously consulted a general practitioner (15% vs. 33%, p = 0.028), whereas more children were transferred from other hospitals (52% vs. 31%, p = 0.043). There was no difference in terms of length of hospital stay, rate of postoperative intra-abdominal abscess, ER visits, and readmissions between both periods. Three children (4%) were diagnosed with COVID-19 and appendicitis. Conclusions Despite an increase in the number of children with appendicitis managed at our hospital during the COVID-19-related lockdown, management, and outcome remained similar. Although our pediatric center was strongly affected by this pandemic, maintaining our prior practice strategies for acute appendicitis avoided the occurrence of collateral damage for those children.

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Section: Methodsmentioning

confidence: 99%

The role of a pediatric tertiary care center in avoiding collateral damage for children with acute appendicitis during the COVID-19 outbreak

et al. 2020

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“…In fact, the concentration of aerosol in the containment box could even be higher than without it, exposing the airway manager to a greater risk of infection [ 91 ]. Reviews published until now therefore suggest avoiding the use of protective aids and focusing more on correct handling of PPE and proper ventilation, which workers are already familiar with in their daily practice [ 91 , 92 , 93 ].…”

Section: Developing New Protection Toolsmentioning

confidence: 99%

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

Fuchs

Lanzi

Beilstein

et al. 2021

Best Practice & Research Clinical Anaesthesiology

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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.

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“…A humidifier with a virus-filtering function should be used if modified T-piece ventilation is needed. Also, several strategies to reduce the aerosolization of SARS-CoV-2 have been adopted in recent months [ 105 ], including portable barrier hood devices, the use of wet gauze, plastic drape covering the patient’s mouth and nose, the use of masks over tube or extubation boxes, which can potentially reduce the risk of exposure [ 106 ].…”

Section: Introductionmentioning

confidence: 99%

Ten things you need to know about intensive care unit management of mechanically ventilated patients with COVID-19

Robba

Battaglini

Ball

et al. 2021

Expert Review of Respiratory Medicine

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Introduction: The ongoing pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has posed important challenges for clinicians and health-care systems worldwide. Areas covered: The aim of this manuscript is to provide brief guidance for intensive care unit management of mechanically ventilated patients with COVID-19 based on the literature and our direct experience with this population. PubMed, EBSCO, and the Cochrane Library were searched up until 15th of January 2021 for relevant literature. Expert opinion: Initially, the respiratory management of COVID-19 relied on the general therapeutic principles for acute respiratory distress syndrome; however, recent findings have suggested that the pathophysiology of hypoxemia in patients with COVID-19 presents specific features and changes over time. Several therapies, including antiviral and anti-inflammatory agents, have been proposed recently. The optimal intensive care unit management of patients with COVID-19 remains unclear; therefore, ongoing and future clinical trials are warranted to clarify the optimal strategies to adopt in this cohort of patients.

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Safe extubation during the COVID-19 pandemic

Cited by 17 publications

References 20 publications

The role of a pediatric tertiary care center in avoiding collateral damage for children with acute appendicitis during the COVID-19 outbreak

The role of a pediatric tertiary care center in avoiding collateral damage for children with acute appendicitis during the COVID-19 outbreak

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

Ten things you need to know about intensive care unit management of mechanically ventilated patients with COVID-19

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