Poster: AIRWAY MANAGEMENT Rev. 1.2
ESAIC Academy. Sorbello M. 04/13/20; 293212
Topic: Respiration and Airway Management
Massimiliano Sorbello
Contributions
Contributions
Abstract
Summary
One of the most critical issues regarding 2019 nCoV patients is the transitory phase between initial symptoms and potentially severe evolution requiring critical care, while taking into account the comorbidities. The choice of supplementary oxygen delivery interface and the decision to provide invasive ventilatory support is crucial. These decisions have the potential of impacting outcome and may lead to consequences on saturation of critical care beds. Non-invasive support methods (CPAP, BiPAP, NIV, HFNO) might correct hypoxemia and counterbalance respiratory failure (though univocal data are missing) and may either delay or avoid endotracheal intubation (with potential complications and effects on outcome). Nevertheless, data from the SARS epidemic provide evidence showing that these ventilatory techniques might favor the risk of airborne viral spreading. Given the nature of nCoV 19 in terms of contagiousness, should the patient require, or be expected to necessitate invasive ventilator support, an elective endotracheal intubation should be preferred,or even anticipated, rather than waiting for an emergency procedure (in the precipitating patient) as to minimize complications of intubation itself and also to reduce both the risks of procedural errors and the contamination of healthcare providers. Adoption of early warning scores (EWS), shared and predefined strategies, multidisciplinary team training and simulation of possible scenarios are highly recommended, taking also into account the available levels of care and feasibility of critical care levels of assistance in a non-ICU environment. The decisional elements for airway management, oxygenation and invasive ventilator support thus include competencies and organization and available human and environmental resources. Vigilance in prevention, strict adhesion of donning/doffing of PPE, preparedness for the care of infected patients remain priority and of utmost importance.
One of the most critical issues regarding 2019 nCoV patients is the transitory phase between initial symptoms and potentially severe evolution requiring critical care, while taking into account the comorbidities. The choice of supplementary oxygen delivery interface and the decision to provide invasive ventilatory support is crucial. These decisions have the potential of impacting outcome and may lead to consequences on saturation of critical care beds. Non-invasive support methods (CPAP, BiPAP, NIV, HFNO) might correct hypoxemia and counterbalance respiratory failure (though univocal data are missing) and may either delay or avoid endotracheal intubation (with potential complications and effects on outcome). Nevertheless, data from the SARS epidemic provide evidence showing that these ventilatory techniques might favor the risk of airborne viral spreading. Given the nature of nCoV 19 in terms of contagiousness, should the patient require, or be expected to necessitate invasive ventilator support, an elective endotracheal intubation should be preferred,or even anticipated, rather than waiting for an emergency procedure (in the precipitating patient) as to minimize complications of intubation itself and also to reduce both the risks of procedural errors and the contamination of healthcare providers. Adoption of early warning scores (EWS), shared and predefined strategies, multidisciplinary team training and simulation of possible scenarios are highly recommended, taking also into account the available levels of care and feasibility of critical care levels of assistance in a non-ICU environment. The decisional elements for airway management, oxygenation and invasive ventilator support thus include competencies and organization and available human and environmental resources. Vigilance in prevention, strict adhesion of donning/doffing of PPE, preparedness for the care of infected patients remain priority and of utmost importance.
Summary
One of the most critical issues regarding 2019 nCoV patients is the transitory phase between initial symptoms and potentially severe evolution requiring critical care, while taking into account the comorbidities. The choice of supplementary oxygen delivery interface and the decision to provide invasive ventilatory support is crucial. These decisions have the potential of impacting outcome and may lead to consequences on saturation of critical care beds. Non-invasive support methods (CPAP, BiPAP, NIV, HFNO) might correct hypoxemia and counterbalance respiratory failure (though univocal data are missing) and may either delay or avoid endotracheal intubation (with potential complications and effects on outcome). Nevertheless, data from the SARS epidemic provide evidence showing that these ventilatory techniques might favor the risk of airborne viral spreading. Given the nature of nCoV 19 in terms of contagiousness, should the patient require, or be expected to necessitate invasive ventilator support, an elective endotracheal intubation should be preferred,or even anticipated, rather than waiting for an emergency procedure (in the precipitating patient) as to minimize complications of intubation itself and also to reduce both the risks of procedural errors and the contamination of healthcare providers. Adoption of early warning scores (EWS), shared and predefined strategies, multidisciplinary team training and simulation of possible scenarios are highly recommended, taking also into account the available levels of care and feasibility of critical care levels of assistance in a non-ICU environment. The decisional elements for airway management, oxygenation and invasive ventilator support thus include competencies and organization and available human and environmental resources. Vigilance in prevention, strict adhesion of donning/doffing of PPE, preparedness for the care of infected patients remain priority and of utmost importance.
One of the most critical issues regarding 2019 nCoV patients is the transitory phase between initial symptoms and potentially severe evolution requiring critical care, while taking into account the comorbidities. The choice of supplementary oxygen delivery interface and the decision to provide invasive ventilatory support is crucial. These decisions have the potential of impacting outcome and may lead to consequences on saturation of critical care beds. Non-invasive support methods (CPAP, BiPAP, NIV, HFNO) might correct hypoxemia and counterbalance respiratory failure (though univocal data are missing) and may either delay or avoid endotracheal intubation (with potential complications and effects on outcome). Nevertheless, data from the SARS epidemic provide evidence showing that these ventilatory techniques might favor the risk of airborne viral spreading. Given the nature of nCoV 19 in terms of contagiousness, should the patient require, or be expected to necessitate invasive ventilator support, an elective endotracheal intubation should be preferred,or even anticipated, rather than waiting for an emergency procedure (in the precipitating patient) as to minimize complications of intubation itself and also to reduce both the risks of procedural errors and the contamination of healthcare providers. Adoption of early warning scores (EWS), shared and predefined strategies, multidisciplinary team training and simulation of possible scenarios are highly recommended, taking also into account the available levels of care and feasibility of critical care levels of assistance in a non-ICU environment. The decisional elements for airway management, oxygenation and invasive ventilator support thus include competencies and organization and available human and environmental resources. Vigilance in prevention, strict adhesion of donning/doffing of PPE, preparedness for the care of infected patients remain priority and of utmost importance.
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