The 2019 novel coronavirus is likely similar to Middle East respiratory syndrome coronavirus and severe acute respiratory syndrome coronavirus. They belong to the Betacoronavirus genus and can cause severe respiratory disease, including acute respiratory distress syndrome, pulmonary oedema, and respiratory failure.Tracheal intubation for invasive mechanical ventilation is the mainstay therapy to correct hypoxaemia. Preoxygenation with the standard bag-valve mask oxygenation followed by rapid-sequence intubation has been proposed in non-severely hypoxaemic critically ill patients requiring tracheal intubation to reduce the risk of aspiration and desaturation. However, a previous study reported that 23% of patients had Spo2 <90% during intubation.Thus far, more than 80000 cases of COVID-19 have been confirmed in China. Person-to-person transmission of COVID-19 has been described, including in many healthcare workers.Rapid-sequence fibreoptic bronchoscopic tracheal intubation in patients with COVID-19 pneumonia may reduce the risk of viral spread. We evaluated the efficacy and safety of high-flow nasal oxygenation (HFNO) during fibreoptic bronchoscopic intubation in critically ill patients with COVID-19 pneumonia compared with standard mask oxygenation (SMO).
A recent study of 138 patients showed that healthcare workers comprised 29% of those infected, and suggested rapid human-to-human transmission of COVID-19.As of February 11, 2020, 1716 medical workers were considered laboratory-confirmed COVID-19 infections in China, with six fatal cases. Direct laryngoscopy, inadequate sedation, coughing during laryngoscopy, and manual ventilation are consistently associated with increased risk of transmission as a result of the generation of natural aerosols.Therefore, tracheal intubation and mask ventilation are considered high-risk procedures as they intensify viral spread.To reduce tracheal-intubation-induced coughing and subsequent spread of virus, we recommended intubation after rapid-sequence intubation of general anaesthesia using visual fibreoptic bronchoscopy. Although we have no evidence that fibreoptic tracheal intubation can prevent airborne viral transmission from patient to healthcare provider, it may increase the distance between the anaesthesiologist and the patient's airway. The six anaesthesiologists in the current study are currently not infected. According to the results of a recent study, HFNO use in patients with bacterial pneumonia was not associated with an increase in air or surface contamination.In contrast, mask ventilation before tracheal intubation can generate more aerosols.
In conclusion, in critically ill patients with COVID-19 pneumonia, HFNO provided a shorter intubation time and less frequent incidence of desaturation during attempts at fibreoptic tracheal intubation compared with preoxygenation by face-mask ventilation. High-flow nasal oxygenation is potentially useful during rapid-sequence induction and intubation in critically ill patients with COVID-19 pneumonia.
Reference & Source information: https://bjanaesthesia.org/
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