Airways management in SARS-COV-2 acute respiratory failure: A prospective observational multi-center study

L Cattin, F Ferrari, S Mongodi, E Pariani, G Bettini, F Daverio, K Donadello, E Polati, F Mojoli, V Danzi, S De Rosa, L Cattin, F Ferrari, S Mongodi, E Pariani, G Bettini, F Daverio, K Donadello, E Polati, F Mojoli, V Danzi, S De Rosa

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; Cuidado crítico; Infección por SARS-CoV; Insuficiencia respiratoria; Intubación traqueal; Manejo de la vía aérea; Respiratory failure; SARS-CoV infection; Tracheal intubation.

Conflict of interest statement

FM received fees for lectures from GE Healthcare, Hamilton Medical, SEDA SpA, outside the present work. SM received fees for lectures from GE Healthcare, outside the present work. A research agreement is active between University of Pavia and Hamilton Medical. The other authors declare no conflict of interest.

Copyright © 2022. Published by Elsevier España, S.L.U.

Figures

Graphical abstract
Graphical abstract
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Figure 1
Flow study population.

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