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Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations

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单位： [1]Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science andTechnology, Wuhan, China [2]Department of Anesthesiology, Union Hospital, Tongji Medical College, HuazhongUniversity of Science and Technology, Wuhan, China [3]Department of Anesthesiology and Critical Care, University ofPennsylvania, Philadelphia, PA, USA [4]Department of Anesthesiology, Peking University People’s Hospital, Beijing,China [5]Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK [6]Division ofCardiovascular Surgery and Critical Care, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA [7]AirwayManagement Academy, Amsterdam, the Netherlands [8]Department of Anaesthesia, Toronto Western Hospital,University Health Network, University of Toronto, Toronto, ON, Canada [9]Department of Anaesthesia, Western GeneralHospital, Edinburgh, UK [10]Department of Anaesthesia, Ninewells Hospital, Dundee, UK [11]Department of Anaesthesiaand Intensive Care Medicine, Warrington and Halton Hospitals, Warrington, UK [12]Department of Anesthesiology,Kailash Cancer Hospital and Research Center, Muni Seva Ashram, Goraj, India [13]Department of Anaesthesiology, RoyalNational Throat, Nose and Ear Hospital, London, UK [14]Department of Anesthesiology, Beijing Hospital, National Centerof Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China [15]Department ofAnesthesiology, First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou,China [16]Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China [17]Department ofAnesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center (UPMC) and University of PittsburghSchool of Medicine, Pittsburgh, PA, USA [18]Department of Anesthesiology, Eye, Ear, Nose and Throat Hospital of FudanUniversity, Shanghai, China [19]Department of Anesthesiology and Perioperative Medicine, University of Texas MDAnderson Cancer Center, Houston, TX, USA [20]Department of Anaesthesia and Intensive Care Medicine, St James’sHospital, Dublin, Ireland [21]Department of Critical Care Medicine, Zhongnan Hospital, Wuhan University, Wuhan, China [22]Department of Anesthesiology, Peking University People’s Hospital, Beijing, China [23]Department of Anesthesiology and Operating Room, General Sagami Kosei Hospital, Kanagawa, Japan

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关键词： airway management ARDS COVID-19 critical care infection prevention and control pneumonia respiratory failure tracheal intubation

摘要：

Tracheal intubation in coronavirus disease 2019 (COVID-19) patients creates a risk to physiologically compromised patients and to attending healthcare providers. Clinical information on airway management and expert recommendations in these patients are urgently needed. By analysing a two-centre retrospective observational case series from Wuhan, China, a panel of international airway management experts discussed the results and formulated consensus recommendations for the management of tracheal intubation in COVID-19 patients. Of 202 COVID-19 patients undergoing emergency tracheal intubation, most were males (n=136; 67.3%) and aged 65 yr or more (n=128; 63.4%). Most patients (n=152; 75.2%) were hypoxaemic (SaO2 <90%) before intubation. Personal protective equipment was worn by all intubating healthcare workers. Rapid sequence induction (RSI) or modified RSI was used with an intubation success rate of 89.1% on the first attempt and 100% overall. Hypoxaemia (SaO2 <90%) was common during intubation (n=148; 73.3%). Hypotension (arterial pressure <90/60 mm Hg) occurred in 36 (17.8%) patients during and 45 (22.3%) after intubation with cardiac arrest in four (2.0%). Pneumothorax occurred in 12 (5.9%) patients and death within 24 h in 21 (10.4%). Up to 14 days post-procedure, there was no evidence of cross infection in the anaesthesiologists who intubated the COVID-19 patients. Based on clinical information and expert recommendation, we propose detailed planning, strategy, and methods for tracheal intubation in COVID-19 patients. © 2020 The Author(s)

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出版当年[2019]版：

大类 | 2 区

医学

小类 | 1 区麻醉学

最新[2025]版：

大类 | 1 区

医学

小类 | 1 区麻醉学

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出版当年[2018]版：

Q1 ANESTHESIOLOGY

最新[2023]版：

Q1 ANESTHESIOLOGY

影响因子： 9.1 最新[2023版] 9.5 最新五年平均 6.199 出版当年[2018版] 6.522 出版当年五年平均 6.499 出版前一年[2017版] 6.88 出版后一年[2019版]

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第一作者单位： [1]Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science andTechnology, Wuhan, China

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Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations