Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients - PubMed (original) (raw)

Review

Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients

Randy S Wax et al. Can J Anaesth. 2020 May.

Abstract

in English, French

A global health emergency has been declared by the World Health Organization as the 2019-nCoV outbreak spreads across the world, with confirmed patients in Canada. Patients infected with 2019-nCoV are at risk for developing respiratory failure and requiring admission to critical care units. While providing optimal treatment for these patients, careful execution of infection control measures is necessary to prevent nosocomial transmission to other patients and to healthcare workers providing care. Although the exact mechanisms of transmission are currently unclear, human-to-human transmission can occur, and the risk of airborne spread during aerosol-generating medical procedures remains a concern in specific circumstances. This paper summarizes important considerations regarding patient screening, environmental controls, personal protective equipment, resuscitation measures (including intubation), and critical care unit operations planning as we prepare for the possibility of new imported cases or local outbreaks of 2019-nCoV. Although understanding of the 2019-nCoV virus is evolving, lessons learned from prior infectious disease challenges such as Severe Acute Respiratory Syndrome will hopefully improve our state of readiness regardless of the number of cases we eventually manage in Canada.

RéSUMé: Une urgence sanitaire mondiale a été déclarée par l’Organisation mondiale de la Santé alors que l’épidémie de 2019-nCoV se répand dans le monde et que des cas ont été confirmés au Canada. Les patients infectés par le 2019-nCoV sont à risque d’insuffisance respiratoire et peuvent nécessiter une admission à l’unité de soins intensifs. Lors d’une prise en charge optimale de ces patients, il est indispensable de prendre soin d’exécuter rigoureusement les mesures de contrôle des infections afin de prévenir la transmission nosocomiale aux autres patients et aux travailleurs de la santé prodiguant les soins. Bien que les mécanismes précis de transmission ne soient pas encore connus, la transmission d’humain à humain peut survenir, et le risque de dissémination aérienne pendant les interventions médicales générant des aérosols est préoccupant dans certaines circonstances spécifiques. Cet article résume des considérations importantes en ce qui touche au dépistage des patients, aux contrôles environnementaux, au matériel de protection personnelle, aux mesures de réanimation (y compris l’intubation), et à la planification des activités à l’unité de soins intensifs alors que nous nous préparons à la possibilité de nouveaux cas importés ou d’éclosions locales du 2019-nCoV. Bien que la compréhension du virus 2019-nCoV continue d’évoluer, nous espérons que les leçons retenues des éclosions précédentes de maladies infectieuses telles que le syndrome respiratoire aigu sévère nous permettront d’améliorer notre degré de préparation, indépendamment du nombre de cas que nous traiterons au Canada.

Keywords: COVID-19.

PubMed Disclaimer

Figures

Fig. 1

Fig. 1

Example of enhanced droplet/airborne personal protective equipment for intubation of patient with suspected or confirmed novel coronavirus (2019-nCoV) incorporating fit-tested N95 mask. Healthcare staff preparing to enter a room to intubate a patient with suspected or confirmed 2019-nCoV. Note use of fluid-resistant gown, covering of head and neck plus face shield to minimize skin exposure to droplet contamination. Additional eye protection worn under the face shield may help to avoid conjunctival exposure from spray around the shield. Fit-tested N95 mask is worn to protect against inhalation of airborne virus. Strips of tape securing gloves to the gown help prevent gloves from slipping during patient care and exposing wrists to contamination

Fig. 2

Fig. 2

Example of enhanced droplet/airborne personal protective equipment incorporating use of powered air purifying respirator (PAPR) for intubation of a simulated patient with 2019-nCoV. Healthcare staff wearing PAPR blower unit with incorporated filter on belt (rear view on left), attached to full hood with hose. Gown and gloves used to avoid droplet or contact contamination. Note that in this case, a fit-tested N95 respirator is being worn under the PAPR hood to protect against inhalation of airborne viral particles during removal of personal protective equipment (PPE), helpful in settings without appropriate individual airborne isolation rooms with anterooms

Comment in

Similar articles

Cited by

References

    1. Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia. N Engl J Med. 2020 doi: 10.1056/NEJMoa2001316. - DOI - PMC - PubMed
    1. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020 doi: 10.1056/NEJMoa2001017. - DOI - PMC - PubMed
    1. World Health Organization. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). Available from URL: https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-...) (accessed February 2020).
    1. Government of Canada. Government of Canada evacuating Canadians from Wuhan, China. Available from URL: https://www.canada.ca/en/global-affairs/news/2020/02/government-of-canad... (accessed February 2020).
    1. Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020 doi: 10.1016/s0140-6736(20)30251-8. - DOI - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources