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Anaesthesiology Intensive Therapy
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4/2020
vol. 52
 
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Letter to the Editor

COVID-19: Airway management considerations

Jared Herman
1
,
Omar Viswanath
2, 3
,
Ivan Urits
4

1.
Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, United States
2.
Valley Anesthesiology and Pain Consultants – Envision Physician Services, Phoenix, AZ, United States
3.
Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, United States
4.
Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, United States
Anaesthesiol Intensive Ther 2020; 52, 4: 339–340
Online publish date: 2020/10/30
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- COVID-19 Airway.pdf  [0.14 MB]
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Dear Editor,
The global pandemic caused by the outbreak of the novel coronavirus SARS-CoV-2 has brought about new concerns for the protection and safety of both patients and the healthcare workers who care for and support them. The protection of healthcare workers is of utmost importance and the Centres for Disease Control, the World Health Organisation, and the Anaesthesia Patient Safety Foundation (APSF) have all developed recommendations to minimise transmission of this pathogen from SARS-CoV-2-infected patients to healthcare providers. This graphic provides a summary of the recommendations of personal protective equipment (PPE), and precautions to be taken during procedures involving the airway, which are considered aerosol-generating procedures (AGPs) [1, 2].
Aerosol-generating procedures, which include intubation, non-invasive ventilation, tracheotomy, cardio-pulmonary resuscitation, manual ventilation prior to intubation, and bronchoscopy, are all associated with increased risk of SARS-CoV-2 transmission. Thus, special precautions must be taken when performing these procedures, which are the focus of this infographic [1–3]. Healthcare providers should wear N95 masks or utilise a Powered Air-Purifying Respirator (PAPR) when performing AGPs, noting that the PAPR provides superior protection and may be warranted for patients with known or suspected SARS-CoV-2 infection. Eye protection (goggles or face shield) and a long-sleeved, waterproof gown should also be worn. In addition, the APSF recommends utilising the double-glove technique, ensuring the performance of proper hand hygiene for donning and doffing of PPE and at any time that contamination may be suspected [2].
Based on the experience of intubating teams in the epicentre of the pandemic in Wuhan, mask ventilation should be avoided if possible due to the aerosolisation potential of the virus [4]. In regard to intubation, early intubation should be considered to avoid a crash intubation, leaving the healthcare team with inadequate time to appropriately don PPE. The most experienced anaesthesia professional should perform intubation, keeping in mind that the number of persons present in the room should be minimised and specific to the number needed to adequately care for and support the patient in need [2]. Proper disposal of intubation equipment should be planned for, and procedure room surfaces should be cleaned and disinfected promptly [1].
ACKNOWLEDGEMENTS
1. Financial support and sponsorship: none.
2. Conflicts of interest: none.
1. Interim infection prevention and control recommendations for patients with suspected or confirmed coronavirus disease 2019 (COVID-19) in healthcare settings. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-faq.html. Published 2020.
2. Kamming D, Gardam M, Chung FI. Anaesthesia and SARS. Br J Anaesth 2003; 90: 715-718. doi:10.1093/bja/aeg173
3. OMS. Infection prevention and control during halth care when novel coronavirus (nCOV) infection is suspected. Oms 2020; 38: 71-86. doi:10.1016/j.ccm.2016.11.007.
4. Luo M, Cao S, Wei L, et al. Precautions for intubating patients with COVID-19. Anesthesiology 2020; 132: 1616-1618. doi:10.1097/aln.0000000000003288.
This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
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