Anesthesiology. 2021 Aug 1;135(2):292-303. doi: 10.1097/ALN.0000000000003791.
Tracheal intubation for patients with COVID-19 is required for invasive mechanical ventilation. The authors sought to describe practice for emergency intubation, estimate success rates and complications, and determine variation in practice and outcomes between high-income and low- and middle-income countries. The authors hypothesized that successful emergency airway management in patients with COVID-19 is associated with geographical and procedural factors.
The authors performed a prospective observational cohort study between March 23, 2020, and October 24, 2020, which included 4,476 episodes of emergency tracheal intubation performed by 1,722 clinicians from 607 institutions across 32 countries in patients with suspected or confirmed COVID-19 requiring mechanical ventilation. The authors investigated associations between intubation and operator characteristics, and the primary outcome of first-attempt success.
Successful first-attempt tracheal intubation was achieved in 4,017/4,476 (89.7%) episodes, while 23 of 4,476 (0.5%) episodes required four or more attempts. Ten emergency surgical airways were reported-an approximate incidence of 1 in 450 (10 of 4,476). Failed intubation (defined as emergency surgical airway, four or more attempts, or a supraglottic airway as the final device) occurred in approximately 1 of 120 episodes (36 of 4,476). Successful first attempt was more likely during rapid sequence induction versus non-rapid sequence induction (adjusted odds ratio, 1.89 [95% CI, 1.49 to 2.39]; P < 0.001), when operators used powered air-purifying respirators versus nonpowered respirators (adjusted odds ratio, 1.60 [95% CI, 1.16 to 2.20]; P = 0.006), and when performed by operators with more COVID-19 intubations recorded (adjusted odds ratio, 1.03 for each additional previous intubation [95% CI, 1.01 to 1.06]; P = 0.015). Intubations performed in low- or middle-income countries were less likely to be successful at first attempt than in high-income countries (adjusted odds ratio, 0.57 [95% CI, 0.41 to 0.79]; P = 0.001).
The authors report rates of failed tracheal intubation and emergency surgical airway in patients with COVID-19 requiring emergency airway management, and identified factors associated with increased success. Risks of tracheal intubation failure and success should be considered when managing COVID-19.
对于需要有创机械通气的 COVID-19 患者，需要进行气管插管。作者旨在描述紧急插管的实践，估计成功率和并发症，并确定高收入和低收入/中等收入国家之间的实践和结果差异。作者假设 COVID-19 患者的紧急气道管理的成功与地理和程序因素有关。
作者于 2020 年 3 月 23 日至 2020 年 10 月 24 日期间进行了一项前瞻性观察性队列研究，该研究包括 32 个国家/地区的 607 家机构中的 1,722 名临床医生对疑似或确诊 COVID-19 需行机械通气的患者进行的 4,476 例紧急气管插管，调查了插管和操作人员特征与首次尝试成功之间的关系。
4,017/4,476（89.7%）例中成功进行了首次尝试气管插管，而 4,476 例中有 23 例需要 4 次或以上尝试。报告了 10 例紧急外科气道-约每 450 例（4,476 例中的 10 例）中有 1 例。插管失败（定义为紧急外科气道、4 次或更多尝试或最终装置为声门上气道）约占 1/120 例（4,476 例中的 36 例）。与非快速顺序诱导相比，快速顺序诱导（调整后的优势比，1.89 [95%CI，1.49 至 2.39]；P < 0.001）、操作员使用动力空气净化呼吸器与非动力呼吸器（调整后的优势比，1.60 [95%CI，1.16 至 2.20]；P = 0.006）以及具有更多 COVID-19 插管记录的操作员（调整后的优势比，每次额外的先前插管增加 1.03 [95%CI，1.01 至 1.06]；P = 0.015）时，首次尝试的成功率更高。中低收入国家的插管首次尝试成功率低于高收入国家（调整后的优势比，0.57 [95%CI，0.41 至 0.79]；P = 0.001）。
作者报告了 COVID-19 需要紧急气道管理的患者中气管插管失败和紧急外科气道的发生率，并确定了与成功率增加相关的因素。在管理 COVID-19 时，应考虑气管插管失败和成功的风险。
