Ventilatory Support for COVID-19 Patients

Main Article Content

Amer Harky
Tinotenda A Harahwa
Inayat H Khan

Keywords

COVID-19, Critical Care, Anesthesiology, Ventilation, Intubation

Abstract

Coronavirus Disease (COVID-19), first emerged in Wuhan, China, in December 2019 and has now become a worldwide health emergency. The symptoms of Coronavirus vary from anosmia, fever, and cough to severe complications such as acute respiratory distress syndrome, which often require intubation and subsequent ventilation. Procedures such as these are aerosol-generating, and this adds additional challenges due to the risks posed to staff. In this brief article, we discuss the need for ventilation, risks raised to healthcare staff in this context, and ways to potentially mitigate these risks. We also discuss emerging themes, including phenotypes of COVID-19 and the role of prone positioning.

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References

1. World Health Organization. Pneumonia of unknown cause – China. 2020 (https://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en/).
2. Huang C, Wang Y, Li X, et al. Clinical Features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395(10223):497-506.
3. WHO pandemic WHO Director-General's opening remarks at the media briefing on COVID19 -March 2020
4. World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report – 104. 2020 (https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200427-sitrep-98-covid-19.pdf?sfvrsn=90323472_4).
5. Xu J, Zhao S, Teng T, et al. Systematic Comparison of Two Animal-to-Human Transmitted Human Coronaviruses: SARS-CoV-2 and SARS-CoV. Viruses 2020;12(2):244.
6. Flahault A. Has China faced only a herald wave of SARS-CoV-2? Lancet 2020;395:947.
7. Kakodkar P, Kaka N, Baig MN. A Comprehensive Literature Review on the Clinical Presentation, and Management of the Pandemic Coronavirus Disease 2019 (COVID-19). Cureus 2020;12(4):e7560.
8. Guo YR, Cao QD, Hong ZS, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – an update on the status. Military Med Res 2020; 7:11.
9. Fu L, Wang B, Yuan T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect 2020 March 15 (Epub ahead of print). https://doi.org/10.1016/j.jinf.2020.03.041.
10. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020 February 24 (Epub ahead of print). https://doi.org/10.1016/S2213-2600(20)30079-5.
11. Umbrello M, Formenti P, Bolgiaghi L, Chiumello D. Current Concepts of ARDS: A Narrative Review. Int J Mol Sci 2016;18(1):e64.
12 Mahase E. Covid-19: most patients require mechanical ventilation in first 24 hours of critical care. BMJ 2020;368:m1201.
13. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus–infected pneumonia in Wuhan, China. JAMA 2020;323(11):1061-1069.
14. Yang, X, Yu, Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. Lancet Respir Med 2020 February 24 (Epub ahead of print). https://doi.org/10.1016/S2213-2600(20)30079-5.
15. Odor PM, Neun M, Bampoe S, et al. Anaesthesia and COVID-19: infection control. Br J Anaesth 2020 March 30 (Epub ahead of print). https://doi.org/10.1016/j.bja.2020.03.025.
16. Raboud J, Shigayeva A, McGeer A, et al. Risk factors for SARS transmission from patients requiring intubation: a multicentre investigation in Toronto, Canada. PLoS One 2010;5(5):e10717.
17. Fowler RA, Guest CB, Lapinsky SE, et al. Transmission of severe acute respiratory syndrome during intubation and mechanical ventilation. Am J Respir Crit Care Med 2004; 169(11):1198-202.
18. Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review. PLoS One 2012;7(4):e35797.
19. Association of Anaesthetists. Anaesthetic Management of Patients During a COVID-19 Outbreak. 2020 (https://anaesthetists.org/Home/Resources-publications/Anaesthetic-Management-of-Patients-During-a-COVID-19-Outbreak)
20. Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anesth/J Can Anesth 2020;67:568-576.
21. Brewster DJ, Chrimes NC, Do TBT, et al. Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group. Med J Aust 2020 April 1 (Epub ahead of print). https://www.mja.com.au/journal/2020/consensus-statement-safe-airway-society-principles-airway-management-and-tracheal.
22. D’Silva DF, McCulloch TJ, Lim JS, Smith SS, Carayannis D. Extubation of patients with COVID-19. Br J Anaesth 2020 March 16 (Epub ahead of print). https://doi.org/10.1016/j.bja.2020.03.016.
23. Aminnejad R, Salimi A, Saeidi M. Lidocaine during intubation and extubation in patients with coronavirus disease (COVID-19). Can J Anesth/J Can Anesth 2020 March 16 (Epub ahead of print). https://doi.org/10.1007/s12630-020-01627-2.
24. Yang SS, Wang NN, Postonogova T, et al. Intravenous lidocaine to prevent postoperative airway complications in adults: a systematic review and meta-analysis. Br J Anaesth 2020; 124: 314-23.
25. Zuo M, Huang Y, Ma W, et al. Chinese Society of Anesthesiology Task Force on Airway Management: Expert Recommendations for Tracheal Intubation in Critically ill Patients with Noval Coronavirus Disease 2019. Chin Med Sci J 2020 February 27 (Epub ahead of print). https://doi.org/10.24920/003724.
26. Poston JT, Patel BK, Davis AM. Management of Critically Ill Adults With COVID-19. JAMA 2020 March 26 (Epub ahead of print). https://doi.org/10.1001/jama.2020.4914.
27. World Health Organisation (WHO). Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim Guidance. 2020 (https://www.who.int/docs/default-source/coronaviruse/clinical-management-of-novel-cov.pdf).
28. Meng L, Qui H, Wan L, et al. Intubation and Ventilation amid the COVID-19 Outbreak: Wuhan’s Experience. Anesthesiology 2020 March 26 (Epub ahead of print). https://doi.org/10.1097/ALN.0000000000003296.
29. Yao W, Wang T, Jiang B, et al. Emergency tracheal intubation in 202 patients with COVID-19 in Wuhan, China: lessons learnt and international expert recommendations. Br J of Anaesth 2020 March 31 (Epub ahead of print). https://doi.org/10.1016/j.bja.2020.03.026.
30. Mendes JJ, Mergulhão P, Froes F, Paiva JA, Gouveia J. Recommendations from the Sociedade Portuguesa de Cuidados Intensivos and Infection & Sepsis Group for intensive care approach to COVID-19. Rev Bras Ter Intensive 2020;32(1):2-10.
31. Cheung JCH, Ho LT, Cheng JV, Cham EYK, Lam KN. Staff safety during emergency airway management for COVID-19 in Hong Kong. Lancet Respir Med 2020;8(4):e19.
32. Kangelaris KN, Ware LB, Wang CY, et al. Timing of Intubation and Clinical outcomes in Adults with ARDS. Crit Care Med 2016;44(1):120-129.
33. Gattinoni, L., Chiumello, D., Caironi, P. et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes?. Intensive Care Med (2020). https://doi.org/10.1007/s00134-020-06033-2
34. Meng L, Qiu H, Wan L, et al. Intubation and ventilation amid the COVID-19 outbreak: wuhan’s experience. Anesthesiol 2020; published online March 26. DOI:10.1097/ALN.0000000000003296
35. Alraddadi BM, Qushmaq I, Al-Hameed FM et al. Non-invasive ventilation in critically ill patients with the Middle East respiratory syndrome. Influenza Other Respir Viruses. 2019; 13: 382-390
36. McEnery T, Gough C, Costello RW. COVID-19: Respiratory support outside the intensive care unit [published online ahead of print, 2020 Apr 9]. Lancet Respir Med. 2020;S2213-2600(20)30176-4. doi:10.1016/S2213-2600(20)30176-4
37. Grasselli G, Zangrillo A, Zanella A, et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy [published online ahead of print, 2020 Apr 6]. JAMA. 2020;323(16):1574‐1581. doi:10.1001/jama.2020.5394
38. Pan C, Chen L, Lu C, Zhang W, Xia JA, Sklar MC, Du B, Brochard L, Qiu H. Lung Recruitability in SARS-CoV-2 Associated Acute Respiratory Distress Syndrome: A Single-center, Observational Study. Am J Respir Crit Care Med. 2020.
39. Roesthuis, L.; van den Berg, M.; van der Hoeven, H. Advanced Respiratory Monitoring in COVID-19 Patients: Use Less PEEP!. Preprints 2020, 2020040275 (doi: 10.20944/preprints202004.0275.v1).
40. Kallet R. A Comprehensive Review of Prone Position in ARDS. Respiratory Care. 2015;60(11):1660-1687.
41. Mora-Arteaga J, Bernal-Ramírez O, Rodríguez S. The effects of prone position ventilation in patients with acute respiratory distress syndrome A systematic review and metaanalysis. Medicina Intensiva (English Edition) 2015;39(6):359–72.
42. Caputo N, Strayer R, Levitan R. Early Self‐Proning in Awake, Non‐intubated Patients in the Emergency Department: A Single ED’s Experience during the COVID‐19 Pandemic. Academic Emergency Medicine. 2020;. doi:10.1111/acem.13994