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Original article
Available online 23 September 2022
Airways management in SARS-COV-2 acute respiratory failure: A prospective observational multi-center study
Manejo de las vías respiratorias en la insuficiencia respiratoria aguda SARS-COV-2: un estudio observacional prospectivo multicéntrico
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L. Cattina,d, F. Ferrarib, S. Mongodib, E. Parianic, G. Bettinic, F. Daverioc, K. Donadellod, E. Polatid, F. Mojolib,c, V. Danzia, S. De Rosaa,
Corresponding author
derosa.silvia@ymail.com

Corresponding author.
a Department of Anesthesia and Intensive Care Unit, St. Bortolo Hospital, Vicenza, Italy
b Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
c Department of clinical-surgical, diagnostic and paediatric sciences, Unit of anaesthesia and intensive care, University of Pavia, Pavia, Italy
d Anaesthesia and Intensive Care Unit B, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, University Hospital Integrated Trust of Verona, Verona, Italy
Received 21 April 2022. Accepted 06 July 2022
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Abstract
Objective

Few studies have reported the implications and adverse events of performing endotracheal intubation for critically ill COVID-19 patients admitted to intensive care units. The aim of the present study was to determine the adverse events related to tracheal intubation in COVID-19 patients, defined as the onset of hemodynamic instability, severe hypoxemia, and cardiac arrest.

Setting

Tertiary care medical hospitals, dual-centre study performed in Northern Italy from November 2020 to May 2021.

Patients

Adult patients with positive SARS-CoV-2 PCR test, admitted for respiratory failure and need of advanced invasive airways management.

Interventions

Endotracheal Intubation Adverse Events.

Main variables of interests

The primary endpoint was to determine the occurrence of at least 1 of the following events within 30 minutes from the start of the intubation procedure and to describe the types of major adverse peri-intubation events: severe hypoxemia defined as an oxygen saturation as measured by pulse-oximetry <80%; hemodynamic instability defined as a SBP 65 mmHg recoded at least once or SBP < 90 mmHg for 30 minutes, a new requirement or increase of vasopressors, fluid bolus >15 mL/kg to maintain the target blood pressure; cardiac arrest.

Results

Among 142 patients, 73.94% experienced at least one major adverse peri-intubation event. The predominant event was cardiovascular instability, observed in 65.49% of all patients undergoing emergency intubation, followed by severe hypoxemia (43.54%). 2.82% of the patients had a cardiac arrest.

Conclusion

In this study of intubation practices in critically ill patients with COVID-19, major adverse peri-intubation events were frequent.

Clinical Trial registration

www.clinicaltrials.gov identifier: NCT04909476

Keywords:
Airway management
Critical care
Respiratory failure
SARS-CoV infection
Tracheal intubation
Abbreviations:
ETT
COVID-19
SARS-Cov2
ARDS
HR
ICU
SpO2
SBP
DBP
RR
PaO2/FiO2
HFNO
CPAP
NIV
PCR
ECG
EtCO2
OR
CI
Resumen
Objetivo

Pocos estudios han informado las implicaciones y los eventos adversos de realizar una intubación endotraqueal para pacientes críticos con COVID-19 ingresados ​​en unidades de cuidados intensivos. El objetivo del presente estudio fue determinar los eventos adversos relacionados con la intubación traqueal en pacientes con COVID-19, definidos como la aparición de inestabilidad hemodinámica, hipoxemia severa y paro cardíaco.

Ámbito

Hospitales médicos de atención terciaria, estudio de doble centro realizado en el norte de Italia desde noviembre de 2020 hasta mayo de 2021.

Pacientes

Pacientes adultos con prueba PCR SARS-CoV-2 positiva, ingresados por insuficiencia respiratoria y necesidad de manejo avanzado de vías aéreas invasivas.

Intervenciones

Eventos adversos de la intubación endotraqueal.

Principales variables de interés

El punto final primario fue determinar la ocurrencia de al menos 1 de los siguientes eventos dentro de los 30 minutos posteriores al inicio del procedimiento de intubación y describir los tipos de eventos adversos periintubación mayores. : hipoxemia severa definida como una saturación de oxígeno medida por pulsioximetría <80%; inestabilidad hemodinámica definida como PAS 65 mmHg registrada al menos una vez o PAS < 90 mmHg durante 30 minutos, nuevo requerimiento o aumento de vasopresores, bolo de líquidos > 15 mL/kg para mantener la presión arterial objetivo; paro cardiaco.

Resultados

Entre 142 pacientes, el 73,94% experimentó al menos un evento periintubación adverso importante. El evento predominante fue la inestabilidad cardiovascular, observada en el 65,49% de todos los pacientes sometidos a intubación de urgencia, seguido de la hipoxemia severa (43,54%). El 2,82% de los pacientes tuvo un paro cardíaco.

Conclusión

En este estudio de prácticas de intubación en pacientes críticos con COVID-19, los eventos adversos periintubación mayores fueron frecuentes.

Registro de ensayos clínicos

www.clinicaltrials.gov identificador: NCT04909476

Palabras clave:
Manejo de la vía aérea
Cuidado crítico
Insuficiencia respiratoria
Infección por SARS-CoV
Intubación traqueal

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