Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID ‐19 adult patient group (original) (raw)
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Airway Management in COVID-19 as Aerosol Generating Procedure
IntechOpen eBooks, 2021
2020 has seen the whole world battling a pandemic. Coronavirus Disease 2019 (COVID-19) is primarily transmitted through respiratory droplets when in close contact with an infected person, by direct contact, or by contact with contaminated objects and surfaces. Aerosol generating procedures (AGPs) like intubation have a high chance of generating large concentrations of infectious aerosols. AGPs potentially put healthcare workers at an increased risk of contracting the infection, and therefore special precautions are necessary during intubation. The procedure has to be performed by an expert operator who uses appropriate personal protective equipment (PPE). Modifications of known techniques have helped to reduce the chances of contracting the infection from patients. The use of checklists has become standard safe practice. This chapter looks at the current knowledge we have regarding this illness and how we should modify our practice to make managing the airway both safer for the patient and the healthcare workers involved. It addresses the preparation, staff protection, technical aspects and aftercare of patients who need airway intervention. It recommends simulation training to familiarize staff with modifications to routine airway management.
Journal of Aerosol Medicine and Pulmonary Drug Delivery, 2020
National and international guidelines recommend droplet/airborne transmission and contact precautions for those caring for coronavirus disease 2019 (COVID-19) patients in ambulatory and acute care settings. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, an acute respiratory infectious agent, is primarily transmitted between people through respiratory droplets and contact routes. A recognized key to transmission of COVID-19, and droplet infections generally, is the dispersion of bioaerosols from the patient. Increased risk of transmission has been associated with aerosol generating procedures that include endotracheal intubation, bronchoscopy, open suctioning, administration of nebulized treatment, manual ventilation before intubation, turning the patient to the prone position, disconnecting the patient from the ventilator, noninvasive positive-pressure ventilation, tracheostomy, and cardiopulmonary resuscitation. The knowledge that COVID-19 subjects can be asymptomatic and still shed virus, producing infectious droplets during breathing, suggests that health care workers (HCWs) should assume every patient is potentially infectious during this pandemic. Taking actions to reduce risk of transmission to HCWs is, therefore, a vital consideration for safe delivery of all medical aerosols. Guidelines for use of personal protective equipment (glove, gowns, masks, shield, and/or powered air purifying respiratory) during high-risk procedures are essential and should be considered for use with lower risk procedures such as administration of uncontaminated medical aerosols. Bioaerosols generated by infected patients are a major source of transmission for SARS CoV-2, and other infectious agents. In contrast, therapeutic aerosols do not add to the risk of disease transmission unless contaminated by patients or HCWs.
Antimicrobial Resistance & Infection Control
Background In many jurisdictions healthcare workers (HCWs) are using respirators for aerosol-generating medical procedures (AGMPs) performed on adult and pediatric populations with all suspect/confirmed viral respiratory infections (VRIs). This systematic review assessed the risk of VRIs to HCWs in the presence of AGMPs, the role respirators versus medical/surgical masks have on reducing that risk, and if the risk to HCWs during AGMPs differed when caring for adult or pediatric patient populations. Main text We searched MEDLINE, EMBASE, Cochrane Central, Cochrane SR, CINAHL, COVID-19 specific resources, and MedRxiv for English and French articles from database inception to September 9, 2021. Independent reviewers screened abstracts using pre-defined criteria, reviewed full-text articles, selected relevant studies, abstracted data, and conducted quality assessments of all studies using the ROBINS-I risk of bias tool. Disagreements were resolved by consensus. Thirty-eight studies were...
2021
Since December 2019, the outbreak of coronavirus disease 2019 (COVID-19) has spread worldwide. Although the majority of patients show mild symptoms, the disease can rapidly progress in severe cases and develop acute respiratory distress syndrome (ARDS) that may lead to therapeutic interventions, including oxygenation, tracheal intubation, and mechanical ventilation. It is suggested that the new coronavirus spreads mostly via droplets, surface contact, and natural aerosols. Hence, high-risk aerosol-producing procedures, such as endotracheal intubation, may put the healthcare workers at a high risk of infection. In the course of managing patients with COVID-19, it is essential to prioritize the safety of healthcare workers. Hence, this review study aimed to summarize new guidelines and proper airway management in adult and pediatric COVID-19 patients.
Optimal Preparation for Safe Airway Management During Covid-19
ACTA SCIENTIFIC MEDICAL SCIENCES, 2020
Airway management is the core skill of anesthesiologists, intensive care units, and emergency care providers. Clinicians assured that oxygenation is not possible without an open and safe airway. The Severe Acute Respiratory Syndrome-Corona-2 Virus (SARSCoV-2), which causes COVID-19, is encapsulated with single-stranded ribonucleic acid and is highly contagious. Authors believed that the transfer of the virus occurs primarily through direct contact with the patient or contaminated surfaces or through the spread of droplets (i.e., relatively large particles deposited in the air) and smaller particles staying longer in the air. Any airway management or procedures in emergency, operation theatre, and intensive care departments can produce aerosols to increase the risk of contamination. For the above reason, healthcare professionals who are treating patients with COVID-19 are at risk of developing the disease. The purpose of the current study is to review the methods that reduce the risk of an airborne viral spread, maximize the early attempt success, and encourage the use of indirect glottic visualization with video laryngoscopy (VL). The mentioned measures are approved to reduce personnel exposure in all adult COVID 19 patients who are requiring airway management in all emergency departments, hospital wards, and ICUs. The author highlights the needed measures that require to be taken for the safety of the health care workers associated with the airway procedure while providing high-quality patient care to the COVID-19, suspected, or confirmed patients
Journal of Otolaryngology - Head & Neck Surgery
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for Coronavirus disease 2019 (COVID-19) has a predilection for infecting the mucosa of the upper and lower airways. Otolaryngologists and supporting health care workers (HCWs) are particularly at high risk of becoming infected while treating patients as many in-office procedures and surgeries are Aerosol Generating Medical Procedures (AGMP). Based on a review of the literature and various guidelines, recommendations are made to mitigate the risk to health care workers of becoming infected with SARS-CoV-2 while providing clinical care. Recommendations: During the COVID-19 pandemic all elective and non-time sensitive Otolaryngology procedures should be deferred to mitigate the risk of transmission of infection to HCWs. For non-AGMPs in all patients, even COVID-19 positive patients Level 1 PPE (surgical mask, gown, gloves and face shield or goggles) is sufficient. If local prevalence is favourable and patients are asymptomatic and test negative for SARS-CoV-2, Level 1 PPE can be used during short duration AGMPs, with limited risk of infected aerosol spread. For AGMPs in patients who test positive for SARS-CoV-2 a minimum of Level 2 PPE, with adequate protection of mucosal surfaces, is recommended (N95/FFP2 respirator, gown, double gloves, goggles or face shield and head cover). For long duration AGMPs that are deemed high-risk in COVID-19 positive patients, Level 3 PPE can provide a higher level of protection and be more comfortable during long duration surgeries if surgical hoods or PAPRs are used. It is recommended that these procedures are performed in negative pressure rooms, if available. It is essential to follow strict donning and doffing protocols to minimize the risk of contamination.
Estimation of the risk of COVID-19 transmission through aerosol-generating procedures
Dental and Medical Problems
Background. The outbreak of the coronavirus disease 2019 (COVID-19) pandemic was associated with the provision of multiple guidelines for the dental profession. All elective procedures were restricted, and only emergency procedures were performed. There was fear and anxiety among dentists while performing aerosol-generating procedures (AGPs), as they were considered to pose a high risk of COVID-19 transmission. Objectives. The aim of this study was to assess the risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during AGPs, and to examine the association between risk severity and the number of AGPs performed per day. The efficacy of personal protective equipment (PPE) was also assessed. Material and methods. This cross-sectional cohort study was based on an online questionnaire form completed by 629 general and specialized dentists between January 1 and February 28, 2021. The collected data referred to the sources of COVID-19 infection, the type of PPE used and the number of AGPs performed each day by dental healthcare professionals (DHCPs). For each question, the absolute numbers of responses as well as percentages were calculated. Results. Among the 629 DHCPs, 113 (17.97%) contracted COVID-19. The risk of contracting COVID-19 during AGPs was the same as in the case of non-AGPs, and the infection risk was not associated with the number of AGPs performed per day. The efficacy of a surgical mask with a face shield/eye goggles was higher in comparison with all other types of PPE. Differences in the infection risk across the different types of PPE used were statistically significant (p < 0.001). Conclusions. The risk of COVID-19 transmission during AGPs is the same as in the case of non-AGPs. Thus, restrictions on the performance of elective AGPs should be lifted. On the other hand, the best protection during AGPs is provided by a surgical mask with a face shield/eye goggles.
Expert Review of Medical Devices, 2020
Contributorship statement. Authors that participated in the process of planning, conception of the study design, conducting experiments, acquisition, interpretation and analysis of data: Quadros CA, Leal MB, Baptista-Sobrinho Cd, Nonaka CK, Souza BS, Ferreira AG. Authors that participated in conducting experiments and data acquisition:Milan-Mattos JC, Catai AM, Pires Di Lorenzo VA. All authors participated in writing the manuscript. Acknowledgements. Bhiossuplyprovided logistic support and made some essential items used in the experimentsavailable, which were otherwise difficult to purchase considering the conditions imposed by the ongoing pandemic. Conflict of interest statement The authors deny the existence of any conflicts of interest. Bhiossuplyprovided logistic support and made some essential items used in the experimentsavailable, which were otherwise difficult to purchase considering the conditions imposed by the ongoing pandemic.
Antimicrobial Resistance & Infection Control
Objectives: To determine the risk of SARS-CoV-2 transmission by aerosols, to provide evidence on the rational use of masks, and to discuss additional measures important for the protection of healthcare workers from COVID-19. Methods: Literature review and expert opinion. Short conclusion: SARS-CoV-2, the pathogen causing COVID-19, is considered to be transmitted via droplets rather than aerosols, but droplets with strong directional airflow support may spread further than 2 m. High rates of COVID-19 infections in healthcare-workers (HCWs) have been reported from several countries. Respirators such as filtering face piece (FFP) 2 masks were designed to protect HCWs, while surgical masks were originally intended to protect patients (e.g., during surgery). Nevertheless, high quality standard surgical masks (type II/IIR according to European Norm EN 14683) appear to be as effective as FFP2 masks in preventing droplet-associated viral infections of HCWs as reported from influenza or SARS. So far, no head-to-head trials with these masks have been published for COVID-19. Neither mask type completely prevents transmission, which may be due to inappropriate handling and alternative transmission pathways. Therefore, compliance with a bundle of infection control measures including thorough hand hygiene is key. During high-risk procedures, both droplets and aerosols may be produced, reason why respirators are indicated for these interventions.