Managing airways in confirmed/suspected COVID-19 patients
Patients infected by SARS-CoV-2 Coronavirus may develop severe pneumonia induced by COVID-19, eventually requiring invasive mechanical ventilation to support gas exchange; in these subjects, endotracheal intubation needs to be performed. Given the potential for aereosol/droplets generation, this procedure is one of the highest-risk moments for spreading the disease, and any effort should be made to minimize this risk, maximizing safety of any of the healthcare providers performing intubation, or involved in, and patients’ safety too. Here a collections of free open access checklists, algorithms & infographics focused on this current & complex topic. All of these are reproduced with permission (random order!). Note: given continuously evolving evidence about this topic, as more data are continuously collected/published, these advices may potentially need to be updated in the near future.
This the algorithm for airways management in COVID-19 patients proposed by SIAARTI, Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (Italian Society of Anesthesia, Analgesia and Intensive Care) available for download, along with other interesting documents on the SIAARTI website. This document include:
double check for indications for endotracheal intubation
tube position control and protective ventilation
Authors: M. Sorbello, I. Di Giacinto, F. Bressan, R. Cataldo, G. Cortese, C. Esposito, S. Falcetta, G. Merli , F. Petrini SIAARTI airways management study group.
Department of Anaesthesia and Intensive Care – The Chinese University of Hong Kong
Here an amazing graphics with principles of airway management in suspected or confirmed COVID-19 patients which may apply to Operative Room, Intensive Care Unit, Emergency Department and, eventually, ward; similar principles may be applied at extubation, by Albert Chan (@gaseousXchange on twitter) realized for the Department of Anaesthesia and Intensive Care – The Chinese University of Hong Kong, and proposed in lot of different languages (English, French, Spanish, Italian, German, Japanese, Portuguese, and simplified Chinese), with the purpose to try helping clinicians around the world; all versions are available for download here (high resolution) .
Criticalcarenorthampton & Propofology
The following represent a proposal of checklists when considering or performing airway intervention in suspected (& confirmed) COVID-19 patients, with pre-intubation, intubation and post-intubation approach , made by a collaborative group including (random order): Dr Jonny Wilkinson, Dr David Lyness, The ICS – Intensive Care Society, and the Midlands Coronavirus ITU Group. Proposed in different styles…
First one by Jonny Wilkinson (follow him on twitter @Wilkinsonjonny) available for download at Criticalcarenorthampton.com, with lot of COVID-19 resources including an intubation COVID trolley set up checklist.
The other two amazing ones by David Lyness: check COVID-19 dedicated page on his blog, Propofology blog (full resolution infographics & tons of other educational stuff related to SARS-CoV-2 infection), and follow him on twitter @Gas_Craic.
An update of the Alfred ICU guidelines for intubation of critically ills to include an appendix with specific considerations for SARS-CoV-2, outlining modifications for suspected COVID19 has been published by Julia Coull & Chris Nickson (follow them on twitter, @julia_coull & @precordialthump) check & download full document on Intensive Blog.
In the last infographics, emerging best practices for performing tracheal intubation in this population, based on current evidence from China and prior understanding of SARS. Focus on what to do/avoid in this setting!
By Patrick Boreskie and published on CanadiEM website!