Consensus guidelines for managing the airway in patients with COVID‐19

Abstract

Summary Severe acute respiratory syndrome‐corona virus‐2, which causes coronavirus disease 2019 (COVID‐19), is highly contagious. Airway management of patients with COVID‐19 is high risk to staff and patients. We aimed to develop principles for airway management of patients with COVID‐19 to encourage safe, accurate and swift performance. This consensus statement has been brought together at short notice to advise on airway management for patients with COVID‐19, drawing on published literature and immediately available information from clinicians and experts. Recommendations on the prevention of contamination of healthcare workers, the choice of staff involved in airway management, the training required and the selection of equipment are discussed. The fundamental principles of airway management in these settings are described for: emergency tracheal intubation; predicted or unexpected difficult tracheal intubation; cardiac arrest; anaesthetic care; and tracheal extubation. We provide figures to support clinicians in safe airway management of patients with COVID‐19. The advice in this document is designed to be adapted in line with local workplace policies.

Tracheal intubation in patients with COVID-19

“…Ketamine may maintain cardiovascular stability compared with other induction agents. 2 Have inotropes and vasopressors in line or immediately available. Use high-dose rocuronium (1.2-1.5 mg/kg) and ensure full neuromuscular blockade before attempting endotracheal intubation.…”

“…Use high-dose rocuronium (1.2-1.5 mg/kg) and ensure full neuromuscular blockade before attempting endotracheal intubation. 2 Owing to aerosol generation, avoid bag-valve-mask ventilation despite desaturation. 2,4 Use a styleted endotracheal tube and avoid floppy bougies to minimize contamination.…”

“…2 Owing to aerosol generation, avoid bag-valve-mask ventilation despite desaturation. 2,4 Use a styleted endotracheal tube and avoid floppy bougies to minimize contamination. After intubation, place a viral filter on the endotracheal tube and inflate the endotracheal tube cuff to ensure no leak occurs with positive-pressure ventilation.…”

Safe bronchodilator treatment in mechanically ventilated COVID-19 patients: A single center experience

“…Due to concerns regarding the aerosol spread and medical team contamination, guidelines recommend using closed ventilation circuit and mandates extreme safety precautions whenever interruption of the ventilator's tubing continuity is undertaken [5]. Bronchodilators delivery in either intubated or non-invasively ventilated patients is usually done using standard nebulizers or metered-dose inhalers, which have an equal effect on lung function [6].…”

Sometimes Less Is Worse: A Recommendation Against Nonintubated Video-Assisted Thoracoscopy During the COVID-19 Pandemic

“…Indeed, the importance of targeting a fast and easy intubation in diagnosed or suspected COVID patients is recommended by several scientific societies. 8,9,10,11 Finally, the current lack of strenght evidence supporting the advantage of NIVATS over standard thoracotomy or VATS procedures must kept in mind before deciding to perform thoracic surgery without intubation. 12,13,14 Thus, generally speaking, considering that airway management for thoracic surgery includes more aerosol generating procedures than other surgeries (i.e.…”