Intubation and Ventilation amid the COVID-19 Outbreak

TLDR

The COVID‑19 outbreak in China has infected over 80,000 people and caused 3,000 deaths, with about 3.2% of patients requiring intubation and invasive ventilation, making the provision of best practices for intubation and ventilation a daunting task amid heightened cross‑infection risk. In Wuhan, clinicians followed strict self‑protection precautions and employed timely, well‑prepared intubation using video laryngoscopy, rapid sequence induction, and thorough pre‑oxygenation, while managing ventilation with lung‑protective strategies, prone positioning, and adequate sedation and analgesia. The authors presented the experience of caring for critically ill COVID‑19 patients in Wuhan.

Abstract

The COVID-19 outbreak has led to 80,409 diagnosed cases and 3,012 deaths in mainland China based on the data released on March 4, 2020. Approximately 3.2% of patients with COVID-19 required intubation and invasive ventilation at some point in the disease course. Providing best practices regarding intubation and ventilation for an overwhelming number of patients with COVID-19 amid an enhanced risk of cross-infection is a daunting undertaking. The authors presented the experience of caring for the critically ill patients with COVID-19 in Wuhan. It is extremely important to follow strict self-protection precautions. Timely, but not premature, intubation is crucial to counter a progressively enlarging oxygen debt despite high-flow oxygen therapy and bilevel positive airway pressure ventilation. Thorough preparation, satisfactory preoxygenation, modified rapid sequence induction, and rapid intubation using a video laryngoscope are widely used intubation strategies in Wuhan. Lung-protective ventilation, prone position ventilation, and adequate sedation and analgesia are essential components of ventilation management.