Granell Manuel, Sanchis Nerea, Delgado Carlos, Lozano Manuel, Pinho Marcio, Sandoval Cecilia, Romero Carolina S, Aldecoa Cesar, Cata Juan P, Neira Jorge, De Andres Jose, Herreros-Pomares Alejandro, Navarro Guillermo
Department of Surgery (Anesthesiology), Faculty of Medicine, University of València, 46010 Valencia, Spain.
Department of Anesthesia, Critical Care and Pain Medicine, Consortium València General University Hospital of València, 46014 Valencia, Spain.
J Clin Med. 2022 Aug 12;11(16):4731. doi: 10.3390/jcm11164731.
Airway management during the COVID-19 pandemic has been one of the most challenging aspects of care that anesthesiologists and intensivists face. This study was conducted to evaluate the management of tracheal intubation in patients with suspected or confirmed COVID-19 infection. This is a cross-sectional and international multicenter study based on a 37-item questionnaire. The survey was available to physicians who had performed intubations and tracheostomies in patients with suspected or confirmed COVID-19 and had provided informed consent to participate. The primary outcome is the preference to use a specific device for tracheal intubation. Secondary outcomes are clinical practice variables, use of video laryngoscopes, difficult airway management, and safety features to prevent cross-infection. This study included 2411 physicians who performed an average of 11.90 and 20.67 tracheal intubations in patients diagnosed or suspected of having COVID-19 disease, respectively. Physicians were mainly from the specialties of Anesthesiology (61.2%) and Intensive Care (7.4%). COVID-19 infection diagnosed by positive PCR or serology in physicians participating in intubation in this study was 15.1%. Respondents considered preoxygenation for more than three minutes very useful (75.7%). The preferred device for tracheal intubation was the video laryngoscope (64.8%). However, the direct laryngoscope (57.9%) was the most commonly used, followed by the video laryngoscope (37.5%). The preferred device to facilitate intubation was the Eschmann guide (34.2%). Percutaneous tracheostomy was the preferred technique (39.5%) over the open tracheostomy (22%). The predicted or unpredicted difficult airway management in these patients was preferably performed with a video laryngoscope (61.7% or 63.7, respectively). Intubation was mostly performed by two or more expert airway physicians (61.6%). The use of personal protective equipment increased the practitioners' discomfort during intubation maneuvers. The video laryngoscope is the preferred device for intubating patients with COVID-19, combined with the Eschmann guide, flexible stylet within the endotracheal tube, or Frova guide to facilitate intubation. The sub-analysis of the two groups of physicians by the level of intubation experience showed a higher use of the video laryngoscope (63.4%) in the experts group and no significant differences between the two groups in terms of cross-infection rates in physicians, in their preference for the use of the video laryngoscope or in the number of intubations performed in confirmed or suspected COVID-19 patients.
在新型冠状病毒肺炎（COVID-19）大流行期间，气道管理一直是麻醉医生和重症监护医生面临的最具挑战性的护理方面之一。本研究旨在评估疑似或确诊COVID-19感染患者的气管插管管理情况。这是一项基于37项问卷的横断面国际多中心研究。该调查面向那些对疑似或确诊COVID-19患者进行过插管和气管切开术并已签署知情同意书参与的医生。主要结果是气管插管时使用特定设备的偏好。次要结果是临床实践变量、视频喉镜的使用、困难气道管理以及预防交叉感染的安全措施。本研究纳入了2411名医生，他们分别对诊断或疑似患有COVID-19疾病的患者平均进行了11.90次和20.67次气管插管。医生主要来自麻醉科（61.2%）和重症监护科（7.4%）。参与本研究插管的医生中，通过PCR或血清学检测确诊为COVID-19感染的比例为15.1%。受访者认为预充氧超过三分钟非常有用（75.7%）。气管插管的首选设备是视频喉镜（64.8%）。然而，直接喉镜（57.9%）是最常用的，其次是视频喉镜（37.5%）。便于插管的首选设备是埃施曼导芯（34.2%）。经皮气管切开术是首选技术（39.5%），超过开放气管切开术（22%）。这些患者中预测或未预测到的困难气道管理最好使用视频喉镜进行（分别为61.7%或63.7%）。插管大多由两名或更多专家气道医生进行（61.6%）。使用个人防护设备增加了从业者在插管操作过程中的不适感。视频喉镜是为COVID-19患者插管的首选设备，可结合埃施曼导芯、气管内导管内的可弯曲管芯或弗罗瓦导丝以便于插管。根据插管经验水平对两组医生进行的亚组分析显示，专家组中视频喉镜的使用率更高（63.4%），两组医生在交叉感染率、对视频喉镜使用的偏好或对确诊或疑似COVID-19患者进行插管的次数方面无显著差异。
