Chinese Medical Sciences Journal ›› 2020, Vol. 35 ›› Issue (2): 105-109.doi: 10.24920/003724

• Guideline & Consensus •     Next Articles

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

Zuo Mingzhang1, *(), Huang Yuguang2, *(), Ma Wuhua3, Xue Zhanggang4, Zhang Jiaqiang5, Gong Yahong2, Che Lu5, 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 & Peking Union Medical College, Beijing 100730, China
    2. Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 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 Accepted:2020-02-26 Online:2020-02-21 Published:2020-02-27
  • Contact: Zuo Mingzhang,Huang Yuguang E-mail:zuomz@163.com;garybeijing@163.com
The expert panel of airway management in Chinese Society of Anaesthesiology deliberated and drafted feasible recommendations for frontline anesthesiologists and critical care physicians to performance of endotracheal intubation for critically ill patients with COVID-19.

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 into 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, 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 personal protective equitment (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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