Wang Jiafang, Lu Fan, Zhou Mingxing, Qi Zhong, Chen Zhijun
Department of Anesthesiology, Wuhan First Hospital, Wuhan 430022, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2020 Mar 30;40(3):337-341. doi: 10.12122/j.issn.1673-4254.2020.03.07.
To analyze the clinical characteristics of patients with severe or critical coronavirus disease 2019 (COVID-19) receiving tracheal intubation.
We analyzed clinical characteristics of 18 severely or critically ill patients with COVID-19 undergoing tracheal intubation. The general demographic and clinical data of the patients including their age, gender, pre- intubation state of consciousness and the ventilation mode were recorded. The anesthesiologists performing the tracheal intubation procedure evaluated and recorded the tracheal intubation conditions of the patients. The changes in the vital signs of the patients before anesthesia induction and after intubation were recorded.
The average ages of these patients were 70.39±8.02 years. Fifteen patients (83.33%) received non- invasive ventilation before tracheal intubation, and 13 patients (72.22%) were conscious before tracheal intubation. After induction of anesthesia, the blood pressure and heart rate of the patients decreased significantly ( < 0.05). Most of the patients (94.44%) were in excellent or good conditions for tracheal intubation, and the first-attempt success rate of tracheal intubation was 100%. Five patients died within 3 weeks following the intubation. Tracheotomy was performed in one patient. Twelve patients were still on endotracheal mechanical ventilation in the intensive care unit, and one of them received ECMO treatment due to poor oxygenation. A total of 16 experienced anesthesiologists participated in tracheal intubation, all with third-level protection during the operation, and no medical staff infection has been detected so far.
For patients with severe and critical COVID-19 and indications of tracheal intubation, we recommend early intubation with invasive respiratory support to improve the treatment efficacy and reduce the mortality. Anesthetic agents should be used carefully during tracheal intubation to ensure patients' safety. The medical staff should have a high-level protection during the intubation to maximally ensure their safety.
分析2019冠状病毒病（COVID-19）重型或危重型患者气管插管的临床特征。
我们分析了18例接受气管插管的COVID-19重型或危重型患者的临床特征。记录患者的一般人口统计学和临床数据，包括年龄、性别、插管前意识状态及通气模式。实施气管插管操作的麻醉医生对患者的气管插管情况进行评估并记录。记录患者麻醉诱导前及插管后生命体征的变化。
这些患者的平均年龄为70.39±8.02岁。15例患者（83.33%）在气管插管前接受无创通气，13例患者（72.22%）在气管插管前意识清醒。麻醉诱导后，患者的血压和心率显著下降（<0.05）。大多数患者（94.44%）气管插管条件为优或良，气管插管首次成功率为100%。5例患者在插管后3周内死亡。1例患者行气管切开术。12例患者仍在重症监护病房接受气管内机械通气，其中1例因氧合差接受体外膜肺氧合（ECMO）治疗。共有16名经验丰富的麻醉医生参与气管插管，术中均采取三级防护，目前未检测到医务人员感染。
对于有气管插管指征的COVID-19重型和危重型患者，建议早期进行有创呼吸支持插管，以提高治疗效果，降低死亡率。气管插管时应谨慎使用麻醉药物，确保患者安全。医务人员在插管过程中应采取高级别防护，最大程度确保自身安全。
