The COVID-19 pandemic: the effect on airway Management in non-COVID emergency patients

Ruangsomboon, Onlak; Boonmee, Phetsinee; Nimmannit, Akarin

doi:10.1186/s12873-021-00491-7

Cited by 6 publications

(6 citation statements)

References 21 publications

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“…After the first confirmed case of COVID-19 in Taiwan in January 2020, both personal protective equipment and critical care resources have been impacted by the pandemic. The outbreak has severely impacted the daily practice of public health and palliative care globally, and consequently a balance should be struck between intensive care unit (ICU) utilization and hospice medication [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Prediction of survival time after terminal extubation: the balance between critical care unit utilization and hospice medicine in the COVID-19 pandemic era

et al. 2023

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Background We established 1-h and 1-day survival models after terminal extubation to optimize ventilator use and achieve a balance between critical care for COVID-19 and hospice medicine. Methods Data were obtained from patients with end-of-life status at terminal extubation from 2015 to 2020. The associations between APACHE II scores and parameters with survival time were analyzed. Parameters with a p-value ≤ 0.2 in univariate analysis were included in multivariate models. Cox proportional hazards regression analysis was used for the multivariate analysis of survival time at 1 h and 1 day. Results Of the 140 enrolled patients, 76 (54.3%) died within 1 h and 35 (25%) survived beyond 24 h. No spontaneous breathing trial (SBT) within the past 24 h, minute ventilation (MV) ≥ 12 L/min, and APACHE II score ≥ 25 were associated with shorter survival in the 1 h regression model. Lower MV, SpO2 ≥ 96% and SBT were related to longer survival in the 1-day model. Hospice medications did not influence survival time. Conclusion An APACHE II score of ≥ 25 at 1 h and SpO2 ≥ 96% at 1 day were strong predictors of disposition of patients to intensivists. These factors can help to objectively tailor pathways for post-extubation transition and rapidly allocate intensive care unit resources without sacrificing the quality of palliative care in the era of COVID-19. Trial registration They study was retrospectively registered. IRB No.: 202101929B0.

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Section: Introductionmentioning

confidence: 99%

Prediction of survival time after terminal extubation: the balance between critical care unit utilization and hospice medicine in the COVID-19 pandemic era

et al. 2023

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“…This qualification suggested that these noninvasive respiratory support modalities might increase the risk of SARS-CoV-2 transmission to health care workers and therefore advised limiting their use, preferentially placing patients receiving HFNO or NIV in airborne infection isolation rooms and wearing a respirator rather than a medical mask when entering the room of patients with suspected or confirmed infection . The guidelines provided little or no data supporting the designation of HFNO and NIV as AGPs, however, which may have led to misdirected resources and confusion …”

Section: Introductionmentioning

confidence: 99%

“…6,[8][9][10] The guidelines provided little or no data supporting the designation of HFNO and NIV as AGPs, however, which may have led to misdirected resources and confusion. 7,[11][12][13][14][15] Ideally, risk stratification for respiratory support modalities should be based on randomized clinical trials assessing associations between their use and health care worker infections. However, such studies have not been performed, and it is unlikely that they will be, given the complexity of randomizing critically ill patients and strained health care staff as well as the difficulty of attributing health care worker infections to specific exposures given the high prevalence of SARS-CoV-2 in the general community.…”

Section: Introductionmentioning

confidence: 99%

Generation of Aerosols by Noninvasive Respiratory Support Modalities

Zhang,

Lilien,

van Etten-Jamaludin

et al. 2023

JAMA Netw Open

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ImportanceInfection control guidelines have historically classified high-flow nasal oxygen and noninvasive ventilation as aerosol-generating procedures that require specialized infection prevention and control measures.ObjectiveTo evaluate the current evidence that high-flow nasal oxygen and noninvasive ventilation are associated with pathogen-laden aerosols and aerosol generation.Data SourcesA systematic search of EMBASE and PubMed/MEDLINE up to March 15, 2023, and CINAHL and ClinicalTrials.gov up to August 1, 2023, was performed.Study SelectionObservational and (quasi-)experimental studies of patients or healthy volunteers supported with high-flow nasal oxygen or noninvasive ventilation were selected.Data Extraction and SynthesisThree reviewers were involved in independent study screening, assessment of risk of bias, and data extraction. Data from observational studies were pooled using a random-effects model at both sample and patient levels. Sensitivity analyses were performed to assess the influence of model choice.Main Outcomes and MeasuresThe main outcomes were the detection of pathogens in air samples and the quantity of aerosol particles.ResultsTwenty-four studies were included, of which 12 involved measurements in patients and 15 in healthy volunteers. Five observational studies on SARS-CoV-2 detection in a total of 212 air samples during high-flow nasal oxygen in 152 patients with COVID-19 were pooled for meta-analysis. There was no association between high-flow nasal oxygen and pathogen-laden aerosols (odds ratios for positive samples, 0.73 [95% CI, 0.15-3.55] at the sample level and 0.80 [95% CI, 0.14-4.59] at the patient level). Two studies assessed SARS-CoV-2 detection during noninvasive ventilation (84 air samples from 72 patients). There was no association between noninvasive ventilation and pathogen-laden aerosols (odds ratios for positive samples, 0.38 [95% CI, 0.03-4.63] at the sample level and 0.43 [95% CI, 0.01-27.12] at the patient level). None of the studies in healthy volunteers reported clinically relevant increases in aerosol particle production by high-flow nasal oxygen or noninvasive ventilation.Conclusions and RelevanceThis systematic review and meta-analysis found no association between high-flow nasal oxygen or noninvasive ventilation and increased airborne pathogen detection or aerosol generation. These findings argue against classifying high-flow nasal oxygen or noninvasive ventilation as aerosol-generating procedures or differentiating infection prevention and control practices for patients receiving these modalities.

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“… 12 Many acute care hospitals mandated changes in routine processes of patient care to avoid and reduce in-hospital transmission of COVID-19, including universal masking, 13 , 14 visitor restriction policies, 15 , 16 and extra precautions for aerosol generating medical procedures (AGMP). 17 – 19 Training programs also had to adjust to the increasing numbers of patients while mitigating risk. 20 , 21 At the academic hospitals affiliated with the University of Toronto where the authors practice, this involved redeploying residents to the IM clinical teaching units, establishment of COVID-19 teams, and a restructuring of resident call to separate daytime and nighttime shifts.…”

Section: Introductionmentioning

confidence: 99%

Conducting Goals of Care Conversations: Lessons From the COVID-19 Pandemic

Lai

Abdullah

2023

J Palliat Care

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Objective: Internal medicine (IM) residents discuss a patient's goals of care (GOC) as part of their initial consultation. Residents have described inexperience, general discomfort, limited formal teaching, and prognostic uncertainty as barriers to effective GOC conversations. The early COVID-19 pandemic resulted in rapid changes to the healthcare system on the individual, patient, and systemic level that might exacerbate and/or introduce new barriers to IM residents’ GOC conversations. This qualitative study examines how the early COVID-19 pandemic challenged IM residents’ ability to have effective GOC conversations. Methods: Using a constructivist grounded theory approach, participants (n=11) completed a semi-structured interview. Data collection and analysis occurred simultaneously using an open coding, constant comparison process. Interviews were completed until no new themes were identified. Results: Residents self-described their GOC conversations in 5 steps: normalization of the conversation, introduction of expected clinical course, discussion of possible care plans, exploration of the patient's values, and occasionally providing a recommendation. Residents described limited structured teaching around GOC conversations and instead relied on observed role-modelling and self-practice to hone their skillset. Residents described an increased sense of urgency to have GOC conversations due to the uncertainty of clinical course and potential for rapid deterioration of patients with COVID-19. Residents identified restrictive visitor policies as a significant barrier that contributed to feelings of dehumanization. Residents felt that these limitations affected their GOC conversations and potentially resulted in discordant care plans which contributed to moral distress. Conclusion: The early COVID-19 pandemic resulted in several barriers that challenged residents’ ability to conduct effective GOC conversations. This is on the background of previously reported discomfort and limited formal training in conducting GOC conversations. Based on our findings, we present a conceptual model involving teaching validated GOC frameworks, positive role-modelling, and experiential learning to support GOC conversation education in post-graduate medical education.

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The COVID-19 pandemic: the effect on airway Management in non-COVID emergency patients

Cited by 6 publications

References 21 publications

Prediction of survival time after terminal extubation: the balance between critical care unit utilization and hospice medicine in the COVID-19 pandemic era

Prediction of survival time after terminal extubation: the balance between critical care unit utilization and hospice medicine in the COVID-19 pandemic era

Generation of Aerosols by Noninvasive Respiratory Support Modalities

Conducting Goals of Care Conversations: Lessons From the COVID-19 Pandemic

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