Chinese Medical Sciences Journal

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Expert Recommendations for Tracheal Intubation in Critically ill Patients with Noval Coronavirus Disease 2019

Mingzhang Zuo1*, Yuguang Huang2*, Wuhua Ma3, Zhanggang Xue4, Jiaqiang Zhang5, Yahong Gong2, Lu Che2. Chinese Society of Anesthesiology Task Force on Airway Management   

  1. 1 Department of Anesthesiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730 China
    2 Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730 China
    3 Department of Anesthesiology, First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, 510405 China
    4. Department of Anesthesiology, Zhongshan Hospital Fudan University, Shanghai, 200032 China
    5. Department of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou, 450003 China
  • Received:2020-02-21 Revised:2020-02-25 Accepted:2020-02-25 Online:2020-02-27 Published:2020-02-27
Coronavirus Disease 2019 (COVID-19) is the disease caused by a novel coronavirus outbreak in 2019. Main manifestations include fever, fatigue, and dry cough. Severe patients often experience dyspnea and/or hypoxemia one week after the onset of illness. As the fact that endotracheal intubation is needed in critically ill patients with novel coronavirus infection, the expert panel of airway management in Chinese Society of Anaesthesiology has deliberated and drafted recommendations on proper practice of tracheal intubation in critically ill patients with Noval Coronavirus Disease 2019. 

Abstract: Coronavirus Disease 2019 (COVID-19), caused by a novel coronavirus (SARS-CoV-2), is a highly contagious disease. It firstly appeared in Wuhan, Hubei province of China in December 2019. During the next two months, it moved rapidly throughout China. Most of the infected patients have mild symptoms including fever, fatigue and cough. But in severe cases, patients can progress rapidly and develop to the acute respiratory distress syndrome, septic shock, metabolic acidosis and coagulopathy. The new coronavirus was reported to spread via droplets, contact and natural aerosols from human-to-human. Therefore, high-risk aerosol-producing procedures such as endotracheal intubation may put the anesthesiologists at high risk of nosocomial infections. In fact, SARS-CoV-2 infection of anesthesiologists after endotracheal intubation for confirmed COVID-19 patients have been reported in hospitals in Wuhan. The expert panel of airway management in Chinese Society of Anaesthesiology has deliberated and drafted this recommendation, by which we hope to guide the performance of endotracheal intubation by frontline anesthesiologists and critical care physicians. During the airway management, enhanced droplet/airborne PPE should be applied to the health care providers. A good airway assessment before airway intervention is of vital importance. For patients with normal airway, awake intubation should be avoided and modified rapid sequence induction is strongly recommended. Sufficient muscle relaxant should be assured before intubation. For patients with difficult airway, good preparation of airway devices and detailed intubation plans should be made.

Key words: COVID-19, SARS-CoV-2, endotracheal intubation, difficult airway, infection control precaution

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