Articles: intubation.
-
JAMA internal medicine · Jan 2021
Randomized Controlled TrialEffect of Tocilizumab vs Usual Care in Adults Hospitalized With COVID-19 and Moderate or Severe Pneumonia: A Randomized Clinical Trial.
Severe pneumonia with hyperinflammation and elevated interleukin-6 is a common presentation of coronavirus disease 2019 (COVID-19). ⋯ In this randomized clinical trial of patients with COVID-19 and pneumonia requiring oxygen support but not admitted to the intensive care unit, TCZ did not reduce WHO-CPS scores lower than 5 at day 4 but might have reduced the risk of NIV, MV, or death by day 14. No difference on day 28 mortality was found. Further studies are necessary for confirming these preliminary results.
-
J Coll Physicians Surg Pak · Jan 2021
ReviewAirway Management for Emergent Surgeries during COVID-19 Pandemic.
Aerosol generating procedures (AGPs) performed in the operating room during general anesthesia and surgery can contaminate the operation room environment putting the anesthetist, surgeons and paramedical staff at risk of infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The polymerase chain reaction (PCR) test for SARS-CoV-2 has low sensitivity and is time-bound. ⋯ In this communication, we summarised the modifications required in anesthesia technique during intubation and extubation of a patient's airway that would decrease the risk of virus transmission to the operation theatre staff. Key Words: COVID-19, SARS-CoV-2, Emergent surgeries, Anesthesia technique.
-
Anesthesia and analgesia · Jan 2021
Barrier Devices, Intubation, and Aerosol Mitigation Strategies: Personal Protective Equipment in the Time of Coronavirus Disease 2019.
Numerous barrier devices have recently been developed and rapidly deployed worldwide in an effort to protect health care workers (HCWs) from exposure to coronavirus disease 2019 (COVID-19) during high-risk procedures. However, only a few studies have examined their impact on the dispersion of droplets and aerosols, which are both thought to be significant contributors to the spread of COVID-19. ⋯ Our observations imply that intubation boxes and sheets may reduce HCW exposure to droplets, but they both may merely redirect aerosolized particles, potentially resulting in increased exposure to aerosols in certain circumstances. Aerosols may remain within the barrier device after a cough, and manipulation of the box may release them. Patients should be positioned to facilitate intubation, but slight reverse Trendelenburg may direct infectious aerosols away from the HCW. Novel barrier devices should be used with caution, and further validation studies are necessary.
-
Multicenter Study
Tolerability and safety of awake prone positioning COVID-19 patients with severe hypoxemic respiratory failure.
Prone positioning of non-intubated patients with coronavirus disease (COVID-19) and hypoxemic respiratory failure may prevent intubation and improve outcomes. Nevertheless, there are limited data on its feasibility, safety, and physiologic effects. The objective of our study was to assess the tolerability and safety of awake prone positioning in COVID-19 patients with hypoxemic respiratory failure. ⋯ In a small sample, prone positioning non-intubated COVID-19 patients with severe hypoxemia was safe; however, many patients did not tolerate prolonged durations. Although patients had improved oxygenation and respiratory rate in the prone position, many still required intubation. Future studies are required to determine methods to improve the tolerability of awake prone positioning and whether there is an impact on clinical outcomes.