21 Mar GTEIS-SEMICYUC recommendations for initial airway management in patients with suspected coronavirus
Posted at 18: 50h
in COVID-19
This document summarizes the basic guidelines, recommendations, and precautions to be taken when intubating a patient with suspected COVID-19.
- Remember that your personal protection is the priority. It is recommended to minimize the number of people in the room.
- Procedures that can generate aerosols include, among others, any airway procedure such as endotracheal intubation, bronchoalveolar lavage, or manual ventilation.
- Review material and use droplet/contact isolation precautions (PPE – FFP-2 or FFP-3 high-efficiency mask, gown and gloves, with eye protection if necessary) when interacting with patients. In particular, remember: plan ahead, as all barrier precautions need to be applied. Prior to intubation, review and practice donning and doffing the protective mask, gloves, and clothing. Pay close attention to avoid self-contamination.
- Put on a mask, goggles, disposable protective shoes, a gown, and gloves.
- Intubation should be performed by an experienced intensivist.
- Review monitoring, venous access, instruments, medication, ventilator, and suction system.
- Avoid intubation with a fiberoptic bronchoscope unless specifically indicated. The local anesthetic spray will pulverize the virus. Consider the use of a glidescope or other video laryngoscopes.
- Plan for rapid sequence induction and ensure that an experienced assistant can perform the cricoid pressure. Modification of rapid sequence intubation may be necessary if the patient has a very high alveolar-arterial gradient and cannot tolerate 30 seconds of apnea, or has a contraindication to succinylcholine. If the need for manual ventilation is anticipated, small tidal volumes should be applied.
- Perform five minutes of preoxygenation with 100% oxygen and rapid sequence intubation to avoid manual ventilation of patients and possible aerosolization of respiratory tract virus.
- Ensure the placement of a high efficiency hydrophobic filter interposed between the face mask and the breathing circuit or between the face mask and the Laerdal bag.
- Intubate and confirm the correct position of the endotracheal tube.
- Place mechanical ventilation and stabilize the patient.
- All airway equipment should be sealed in a double-zippered plastic bag and removed for decontamination and disinfection.
- The attendant should clean surfaces with the appropriate disinfectant (as directed by the hospital) after leaving the negative pressure room.
- After removing your protective equipment, avoid touching your hair or face before washing your hands.
- It is recommended to use a closed secretion suction system.
- The person in charge of your ICU and hospital will provide you with additional updated information on the management of patients in the different places of the hospital. Likewise, it is advisable to periodically consult the website of the Ministry of Health, Consumption and Social Welfare to be updated with regard to the latest recommendations and protocols.