key: cord-0884967-34wvro7u
authors: Xia, Haifa; Huang, Shiqian; Xiao, Weimin; Lin, Yun; Hu, Xiaomin; Nie, Binqing; Lin, Ken; Lu, Dongshi; Chen, Xueyin; Song, Linmin; Wang, Li; Zhang, Yuhong; Yao, Shanglong; Chen, Xiangdong
title: Practical workflow recommendations for emergency endotracheal intubation in csritically ill patients with COVID-19 based on the experience of Wuhan Union Hospital
date: 2020-05-28
journal: J Clin Anesth
DOI: 10.1016/j.jclinane.2020.109940
sha: e54a041f92bb5e4e789a9f35d51c7d8b6eedd55c
doc_id: 884967
cord_uid: 34wvro7u

• The condition of some patients with COVID-19 progress rapidly and require aggressive treatments and intensive care, and most of them required endotracheal intubation for mechanical ventilation. • Emergency endotracheal intubation in critically ill patients with COVID-19 has posed a huge challenge to the expertise and self-protection of anesthesiologists. • Anesthesiologists from the frontline of Wuhan, China, of fighting against the epidemic brought first-hand experience about emergency endotracheal intubation in critically ill patients with COVID-19 to colleagues.

J o u r n a l P r e -p r o o f 2 avoiding the cross-infection by SARS-CoV-2. We have recorded more than 100 critically ill patients with COVID-19 receiving emergency endotracheal intubation in Wuhan Union hospital, from Feb 1, 2020 to April 1, 2020, and the success rate of intubation was 100% with no medical staff infected by SARS-CoV-2. Here, we summarized Chinese experience about practical workflow for emergency endotracheal intubation in critically ill patients with COVID-19.

1) Under high-flow nasal catheter oxygen (HFNC) therapy, non-invasive mechanical ventilation (NIV), or 10-15 L/min via a face mask with reservoir bag, the patient's respiratory rate> 30 beats/min or hypoxemia (SpO2<90%), if oxygenation index (PaO2 / FiO2)< 200 mmHg, endotracheal intubation can be considered; PaO2 / FiO2 ≤ 150mmHg, endotracheal intubation must be performed [2] .

2) Respiratory and cardiac arrest patients. iii.

Monitor vital signs (ECG, respiratory rate, SpO2 and blood pressure); iv. Well connected threaded tube, oxygen, power supply, and invasive ventilator with properly adjusted ventilator parameters;

v.

Oxygen pack filled with oxygen;

vi. Connect the suction device;

vii. Prescribe in advance and prepare related drugs. 2) Pre-oxygenated with 100% FiO2 for 5 minutes through a mask via a face mask with reservoir bag, or breathing mask, or BIPAP ventilator, etc. Avoiding pressure-assisted ventilation before the patient's consciousness disappears [4] . to re-intubate again.

2) Routine sedation is recommended to prevent the tube from being bitten, collapsed or even prolapsed by the patient's struggle, and avoid unnecessary secondary intubation. If necessary, using muscle relaxants to eliminate spontaneous breathing.

Clinical features of patients infected with 2019 Novel Coronavirus in Wuhan

Acute respiratory distress syndrome: advances in diagnosis and treatment

Perioperative Management of Patients Infected with the Novel Coronavirus: Recommendation from the Joint Task Force of the Chinese Society of Anesthesiology and the Chinese Association of Anesthesiologists

Comparison of pre-oxygenation using spontaneous breathing through face mask and high-flow nasal oxygen: a randomised controlled crossover study in healthy volunteers

Ultrasound-guided lung sliding sign to confirm optimal depth of tracheal tube insertion in young children