Intubation and Ventilation amid the COVID-19 Outbreak

Abstract

The COVID-19 outbreak has led to 80,409 diagnosed cases and 3,012 deaths in mainland China based on the data released on March 4, 2020. Approximately 3.2% of patients with COVID-19 required intubation and invasive ventilation at some point in the disease course. Providing best practices regarding intubation and ventilation for an overwhelming number of patients with COVID-19 amid an enhanced risk of cross-infection is a daunting undertaking. The authors presented the experience of caring for the critically ill patients with COVID-19 in Wuhan. It is extremely important to follow strict self-protection precautions. Timely, but not premature, intubation is crucial to counter a progressively enlarging oxygen debt despite high-flow oxygen therapy and bilevel positive airway pressure ventilation. Thorough preparation, satisfactory preoxygenation, modified rapid sequence induction, and rapid intubation using a video laryngoscope are widely used intubation strategies in Wuhan. Lung-protective ventilation, prone position ventilation, and adequate sedation and analgesia are essential components of ventilation management.

Rapid evidence summary on SARS-CoV-2 survivorship and disinfection, and a reusable PPE protocol using a double-hit process

“…Two small studies from the same group in Singapore failed to detect SARS-CoV-2 contamination from PPE, but only on the surface of uncovered shoes 3,4 . In the case of SARS-CoV-2, it has been estimated that 3.2% of patients in China required intubation 5 . Evidence from the SARS-CoV-1 epidemic show that doctors and nurses involved in the early critical care period and endotracheal intubation of patients were more than 13 times more likely to acquire SARS-CoV-1 infection themselves 6 .…”

Recomendaciones de «hacer» y «no hacer» en el tratamiento de los pacientes críticos ante la pandemia por coronavirus causante de COVID-19 de los Grupos de Trabajo de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC)

“…También debemos evitar el uso prolongado de opioides y desarrollar estrategias de analgesia multimodal con otro tipo de analgésicos (paracetamol, AINE, metamizol).B-Recomendaciones "No hacer".Recomendación 1: no propagar aerosoles durante la IOT, disminuyendo la ventilación con bolsa de resucitación y realizando una intubación de secuencia rápida.Por la situación clínica de estos pacientes con hipoxemia grave y para disminuir el reflejo de la tos y la dispersión de microgotas, se recomienda IOT de secuencia rápida, para ello uso de rocuronio (1,2 mg/kg) y etomidato (0,2-0,3 mg/Kg) o ketamina (1,5 mg/Kg) de forma casi simultánea. En algunos casos puede ser necesario añadir un inductor del sueño tipo midazolam o propofol a dosis baja(107).…”

The Imperfect Cytokine Storm

“…The maneuver has been effective in improving lung mechanics and gas exchanges, and in some cases, it may prevent the need to escalate to venous-venous extracorporeal membrane oxygenation [7,8]. Though there are no published outcomes, early experience in Wuhan, China indicates prone position was widely used in COVID-19 related severe ARDS with possible benefits [8]. Nonetheless, it may be prohibitive in heart failure patients on LVAD support.…”