tetano
Editor, Senior Moderator
Med Intensiva
. 2023 Mar;47(3):131-139.
doi: 10.1016/j.medin.2022.07.002. Epub 2023 Feb 24.
Airways management in SARS-COV-2 acute respiratory failure: A prospective observational multi-center study
L Cattin[SUP] 1 2 [/SUP], F Ferrari[SUP] 3 [/SUP], S Mongodi[SUP] 3 [/SUP], E Pariani[SUP] 4 [/SUP], G Bettini[SUP] 4 [/SUP], F Daverio[SUP] 4 [/SUP], K Donadello[SUP] 2 [/SUP], E Polati[SUP] 2 [/SUP], F Mojoli[SUP] 3 4 [/SUP], V Danzi[SUP] 1 [/SUP], S De Rosa[SUP] 1 [/SUP]
Affiliations
Abstract
in English, Spanish
Objective: Few studies have reported the implications and adverse events of performing endotracheal intubation for critically ill COVID-19 patients admitted to intensive care units. The aim of the present study was to determine the adverse events related to tracheal intubation in COVID-19 patients, defined as the onset of hemodynamic instability, severe hypoxemia, and cardiac arrest.
Setting: Tertiary care medical hospitals, dual-centre study performed in Northern Italy from November 2020 to May 2021.
Patients: Adult patients with positive SARS-CoV-2 PCR test, admitted for respiratory failure and need of advanced invasive airways management.
Interventions: Endotracheal Intubation Adverse Events.
Main variables of interests: The primary endpoint was to determine the occurrence of at least 1 of the following events within 30 minutes from the start of the intubation procedure and to describe the types of major adverse peri-intubation events: severe hypoxemia defined as an oxygen saturation as measured by pulse-oximetry <80%; hemodynamic instability defined as a SBP 65 mmHg recoded at least once or SBP < 90 mmHg for 30 minutes, a new requirement or increase of vasopressors, fluid bolus >15 mL/kg to maintain the target blood pressure; cardiac arrest.
Results: Among 142 patients, 73.94% experienced at least one major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 65.49% of all patients undergoing emergency intubation, followed by severe hypoxemia (43.54%). 2.82% of the patients had a cardiac arrest.
Conclusion: In this study of intubation practices in critically ill patients with COVID-19, major adverse peri-intubation events were frequent.
Clinical trial registration: www.clinicaltrials.gov identifier: NCT04909476.
Keywords: ARDS, acute respiratory distress syndrome; Airway management; CI, confidence interval; COVID-19, Coronavirus disease 2019; CPAP, continuous positive airways pressure; Critical care; DBP, diastolic blood pressure; ECG, electrocardiography; ETT, Emergency Endotracheal intubation; EtCO2, end-tidal carbon dioxide; HFNO, High flow nasal oxygen; HR, heart rate; ICU, intensive care unit; NIV, noninvasive ventilation; OR, odds ratio; PCR, polymerase chain reaction; PaO2/FiO2, arterial partial oxygen pressure / fraction of inspired oxygen; RR, respiratory rate; Respiratory failure; SARS-CoV infection; SARS-Cov2, severe acute respiratory syndrome coronavirus 2; SBP, systolic blood pressure; SpO2, Peripheral oxygen saturation; Tracheal intubation.
. 2023 Mar;47(3):131-139.
doi: 10.1016/j.medin.2022.07.002. Epub 2023 Feb 24.
Airways management in SARS-COV-2 acute respiratory failure: A prospective observational multi-center study
L Cattin[SUP] 1 2 [/SUP], F Ferrari[SUP] 3 [/SUP], S Mongodi[SUP] 3 [/SUP], E Pariani[SUP] 4 [/SUP], G Bettini[SUP] 4 [/SUP], F Daverio[SUP] 4 [/SUP], K Donadello[SUP] 2 [/SUP], E Polati[SUP] 2 [/SUP], F Mojoli[SUP] 3 4 [/SUP], V Danzi[SUP] 1 [/SUP], S De Rosa[SUP] 1 [/SUP]
Affiliations
- PMID: 36855737
- PMCID: PMC9950782
- DOI: 10.1016/j.medin.2022.07.002
Abstract
in English, Spanish
Objective: Few studies have reported the implications and adverse events of performing endotracheal intubation for critically ill COVID-19 patients admitted to intensive care units. The aim of the present study was to determine the adverse events related to tracheal intubation in COVID-19 patients, defined as the onset of hemodynamic instability, severe hypoxemia, and cardiac arrest.
Setting: Tertiary care medical hospitals, dual-centre study performed in Northern Italy from November 2020 to May 2021.
Patients: Adult patients with positive SARS-CoV-2 PCR test, admitted for respiratory failure and need of advanced invasive airways management.
Interventions: Endotracheal Intubation Adverse Events.
Main variables of interests: The primary endpoint was to determine the occurrence of at least 1 of the following events within 30 minutes from the start of the intubation procedure and to describe the types of major adverse peri-intubation events: severe hypoxemia defined as an oxygen saturation as measured by pulse-oximetry <80%; hemodynamic instability defined as a SBP 65 mmHg recoded at least once or SBP < 90 mmHg for 30 minutes, a new requirement or increase of vasopressors, fluid bolus >15 mL/kg to maintain the target blood pressure; cardiac arrest.
Results: Among 142 patients, 73.94% experienced at least one major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 65.49% of all patients undergoing emergency intubation, followed by severe hypoxemia (43.54%). 2.82% of the patients had a cardiac arrest.
Conclusion: In this study of intubation practices in critically ill patients with COVID-19, major adverse peri-intubation events were frequent.
Clinical trial registration: www.clinicaltrials.gov identifier: NCT04909476.
Keywords: ARDS, acute respiratory distress syndrome; Airway management; CI, confidence interval; COVID-19, Coronavirus disease 2019; CPAP, continuous positive airways pressure; Critical care; DBP, diastolic blood pressure; ECG, electrocardiography; ETT, Emergency Endotracheal intubation; EtCO2, end-tidal carbon dioxide; HFNO, High flow nasal oxygen; HR, heart rate; ICU, intensive care unit; NIV, noninvasive ventilation; OR, odds ratio; PCR, polymerase chain reaction; PaO2/FiO2, arterial partial oxygen pressure / fraction of inspired oxygen; RR, respiratory rate; Respiratory failure; SARS-CoV infection; SARS-Cov2, severe acute respiratory syndrome coronavirus 2; SBP, systolic blood pressure; SpO2, Peripheral oxygen saturation; Tracheal intubation.