Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations

Yao, Wenlong; Wang, Tingting; Jiang, Bailin; Gao, Feng; Wang, Li; Zheng, Hongbo; Xiao, Weimin; Yao, Shanglong; Mei, Wei; Chen, Xiangdong; Luo, Ailin; Sun, Libing; Cook, Tim; Behringer, Elizabeth C.; Huitink, Johannes M.; Wong, David T.; Lane‐Fall, Meghan; McNarry, Alistair F.; McGuire, Barry; Higgs, A.; Shah, Amit; Patel, Anil; Zuo, Mingzhang; Ma, Wuhua; Xue, Zhanggang; Zhang, Liming; Li, Wenxian; Wang, Yong; Hagberg, Carin A.; O’Sullivan, E.; Fleisher, Lee A.; Wei, Huafeng; Peng, Zhiyong; Liang, Hansheng; Nishikawa, Koji

doi:10.1016/j.bja.2020.03.026

Cited by 313 publications

(478 citation statements)

References 58 publications

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“…In addition to its usage as an infection control measure, early intubation could also serve as a means to prevent both emergent intubation and patient self-in icting lung injury. Regarding emergent intubation, its avoidance could improve outcomes, including mortality [15], by reducing incidence of hypoxemia [16]. Regarding patient self-in icted lung injury, its prevention and the subsequent pulmonary-renal crosstalk [17] might explain our nding that need for continuous renal replacement therapy was lower (albeit statistically non-signi cant) in the early versus the delayed or no intubation group (29% versus 50%).…”

Section: Discussionmentioning

confidence: 83%

Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19 

Siempos

Xourgia

Ntaidou

et al. 2020

Preprint

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Background: Optimal timing of initiation of invasive mechanical ventilation in patients with acute hypoxemic respiratory failure due to COVID-19 is unknown. Thanks to early flattening of the epidemiological curve, ventilator demand in Greece was kept lower than supply throughout the pandemic, allowing for unbiased comparison of the outcomes of patients undergoing early intubation versus delayed or no intubation.Methods: We conducted an observational study including all adult patients with laboratory-confirmed COVID-19 consecutively admitted in Evangelismos Hospital, Athens, Greece between March 11, 2020 and April 15, 2020. Patients subsequently admitted in the intensive care unit (ICU) were categorized into the “early intubation” versus the “delayed or no intubation” group.Results: During the study period, a total of 101 patients (37% female, median age 65 years) were admitted in the hospital. Fifty-nine patients (58% of the entire cohort) were exclusively hospitalized in general wards with a mortality of 3% and median length of stay of 7 days. Forty-two patients (19% female, median age 65 years, 62% with at least one comorbidity, 14% never intubated) were admitted in the ICU; all with acute hypoxemic respiratory failure. Early intubation was not associated with higher ICU-mortality (21% versus 33%), fewer ventilator-free days (3 versus 2 days) or fewer ICU-free days than delayed or no intubation.Conclusions: A strategy of early intubation was not associated with worse clinical outcomes compared to delayed or no intubation. Given that early intubation may presumably reduce virus aerosolization, these results may justify further research with a randomized controlled trial.

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Section: Discussionmentioning

confidence: 83%

Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19 

Siempos

Xourgia

Ntaidou

et al. 2020

Preprint

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“…An estimated 2.3% of these patients need tracheal intubation. Despite all adequate support reported mortality rate is still very high 3,4 .…”

Section: Introductionmentioning

confidence: 99%

“…Even with ongoing research worldwide, to date there are no speci c proven treatments. The main goal is to provide rational and effective respiratory support to achieve appropriate oxygenation 3 . Mechanical ventilation is the standard treatment of care for critically ill patients infected with SARS-CoV-2 4 .…”

Section: Introductionmentioning

confidence: 99%

“…High mortality rates are predominantly due to severity and rapid spread of the illness associated with the virus 3 . Signi cant differences have been noted in the clinical and demographic features of COVID-19 patients in many regions of the world 6 .…”

Section: Introductionmentioning

confidence: 99%

“…There is a lack of data despite increased incidence, in high population density areas 3 . Detailed data on demographic characteristics, underlying medical conditions, and potential interventions for hospitalized patients with COVID-19 are needed to conjugate prevention strategies and community speci c interventions 5,9 .…”

Section: Introductionmentioning

confidence: 99%

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Mortality Data in Mechanically Ventilated COVID-19 patients admitted to ICU: A Retrospective Study in Brooklyn

Patti

Duarte

Dalsania

et al. 2020

Preprint

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Background: High mortality rates are predominant even in COVID-19 patients requiring minimal supportive therapy, with a short-coming of data on COVID-19 patients requiring mechanical ventilation.Objectives/Design: We performed a single-center, retrospective, cohort study at a tertiary care, community-based teaching hospital with patient who required invasive mechanical ventilatory support and were COVID-19 positive. All patients were treated according to the ARDSnet protocol. The primary outcome was overall mortality, and secondary outcome was successful extubation.Results: A total of 72 COVID-19 positive intubated patients were included. Twenty-six (66.6%) patients died within the first 15 days of hospital admission; thirty-eight (52.7%) died within 28 days, and thirty-nine (54.2%) died within 29 days. A total of 22 patients (30.5%) were successfully extubated. 15 patients (20.8%) who required reintubation or could not be extubated further underwent tracheostomy.Conclusions: Mortality of critically ill COVID-19 patients requiring mechanical ventilatory support is high, our observed mortality rate (54.2%) was significantly lower than currently published reports. We believe our rate to be a consequence of early intubation in conjunction with adherence to ARDSnet protocol. We also observed patients with hyperlipidemia, higher CRP, renal failure, or those requiring vasopressor use had worse outcomes.

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Stretchable Anti‐Fogging Tapes for Diverse Transparent Materials

Lin

Yang

et al. 2021

Adv Funct Materials

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Surface wetting prevents surface fogging on transparent materials by facilitating filmwise condensation with specific chemistry, but suffers from material and geometry selectivity. Extreme environments associated with high humidity and mechanical loading further limit their anti‐fogging persistence. Here, a stretchable anti‐fogging tape (SAT) that can be applied to diverse transparent materials with varied curvatures for persistent fogging prevention is reported. The SAT consists of three synergistically combined transparent layers: i) a stretchable and tough layer with large elastic recovery, ii) an endurant anti‐fogging layer insensitive to ambient humidity, and iii) a robustly and reversibly adhesive layer. The SAT maintains high total transmittance (>90%) and low diffuse transmittance (<5%) in high‐humidity environments, under various modes of mechanical deformations, and over a prolonged lifetime (193 days tested so far). Two applications are demonstrated, including the SAT‐adhered eyeglasses and goggles for clear fog‐free vision, and the SAT‐adhered condensation cover for efficient solar‐powered freshwater production.

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Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations

Cited by 313 publications

References 58 publications

Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19

Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19

Mortality Data in Mechanically Ventilated COVID-19 patients admitted to ICU: A Retrospective Study in Brooklyn

Stretchable Anti‐Fogging Tapes for Diverse Transparent Materials

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Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations

Cited by 313 publications

References 58 publications

Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19&nbsp;

Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19&nbsp;

Mortality Data in Mechanically Ventilated COVID-19 patients admitted to ICU: A Retrospective Study in Brooklyn

Stretchable Anti‐Fogging Tapes for Diverse Transparent Materials

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Product

Resources

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Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19

Effect of early versus delayed or no intubation on clinical outcomes of patients with COVID-19