Endotracheal intubation in COVID-19 patients in Brazil: a nationwide survey

P. Mendes, B. A. Besen, F. H. Lacerda, J. Ramos, L. Taniguchi
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Abstract

Endotracheal intubation is a life-saving procedure in acute respiratory distress syndrome. However, complications such as hypoxia, hypotension and cardiovascular collapse may occur in almost 40% of the procedures in the intensive care unit (ICU).(1) Evidence regarding the best practice of endotracheal intubation in this context is scarce, and most data have been extrapolated from the operating room. In a survey published in Revista Brasileira de Terapia Intensiva before the COVID-19 pandemic, neuromuscular blockade was infrequently used in Brazilian ICUs.(2) During the COVID-19 pandemic, the fear of staff contamination may have modified usual practice and contributed to increasing the procedure risk.(3,4) Therefore, in this study, we sought to survey ICU physicians about their practices during airway management in COVID-19 patients. Additionally, we aimed to assess whether the pandemic changed physicians’ strategies regarding the use of neuromuscular blockade and sedation. A questionnaire was designed using an informal Delphi process among all authors. After ethics approval, we sent an electronic survey to adult ICU physicians. This study was conducted with logistics support from AMIBnet (the Brazilian network of research in ICUs), and the survey was sent to the AMIBnet mailing list. Continuous data are reported as the mean (standard deviation) and median (25th percentile, 75th percentile) as appropriate. Categorical variables are presented as absolute numbers and percentages. From February 2021 to May 2021, there were 406 respondents from all Brazilian regions, of which 46% were board certified in critical care. The median time from graduation was 10 [6,19] years. Other characteristics of the respondents are provided in table 1. Almost 80% of respondents reported working in an institution with a specific protocol for the intubation of COVID-19 patients. Of the physicians, 41% reported that changes in their usual practice hindered the performance of the procedure and potentially increased the risk of complications (Figure 1). The main differences from previous practice to prevent aerosol dispersion included a direct connection to the mechanical ventilator after endotracheal intubation and the use of devices to occlude the orotracheal tube, which were referred by 56 and 62.5% of the respondents, respectively. The use of personal protective equipment varied among physicians (Table 1). Of the physicians, 91% reported the use of neuromuscular blockade during all or more than 75% of endotracheal intubations, which is much higher than previously reported in our survey.(2) Sedation strategies varied under patient hemodynamic status, and responses did not change with the COVID-19 pandemic. Pedro Vitale Mendes1 , Bruno Adler Maccagnan Pinheiro Besen1 , Fábio Holanda Lacerda2 , João Gabriel Rosa Ramos3 , Leandro Utino Taniguchi4
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巴西COVID-19患者的气管插管:一项全国性调查
气管内插管是急性呼吸窘迫综合征的救命手段。然而,重症监护病房(ICU)近40%的手术可能会出现缺氧、低血压和心血管衰竭等并发症。(1)在这种情况下,关于气管插管最佳实践的证据很少,大多数数据都是从手术室推断出来的。在2019冠状病毒病大流行前发表在《revsta Brasileira de Terapia Intensiva》上的一项调查显示,巴西ICU中很少使用神经肌肉阻断术。(2)在2019冠状病毒病大流行期间,对工作人员污染的恐惧可能改变了常规做法,并增加了手术风险。(3,4)因此,在本研究中,我们试图调查ICU医生在COVID-19患者气道管理中的做法。此外,我们的目的是评估大流行是否改变了医生使用神经肌肉阻断和镇静的策略。采用非正式德尔菲法对所有作者进行问卷调查。伦理批准后,我们向成人ICU医生发送了一份电子调查。这项研究是在AMIBnet(巴西icu研究网络)的后勤支持下进行的,调查结果被发送到AMIBnet的邮件列表。连续数据以适当的平均值(标准差)和中位数(第25百分位,第75百分位)报告。分类变量以绝对数字和百分比表示。从2021年2月到2021年5月,来自巴西所有地区的406名受访者,其中46%获得了重症监护委员会认证。毕业后的中位时间为10年[6,19]。受访者的其他特征列于表1。近80%的受访者报告说,他们所在的机构对COVID-19患者的插管有特定的方案。在这些医生中,41%的人报告说,他们的常规做法的改变阻碍了手术的执行,并可能增加并发症的风险(图1)。与以前防止气溶胶扩散的做法的主要区别包括:在气管插管后直接连接机械呼吸机,以及使用设备阻塞口气管管,分别有56%和62.5%的受访者提到了这一点。医生使用个人防护装备的情况各不相同(表1)。在这些医生中,91%的医生报告在所有或超过75%的气管插管中使用神经肌肉阻断,这远远高于我们之前的调查报告。(2)镇静策略因患者血流动力学状态而异,反应不随COVID-19大流行而改变。Pedro Vitale Mendes1, Bruno Adler, macagnan Pinheiro Besen1, Fábio Holanda Lacerda2, jo o Gabriel Rosa Ramos3, Leandro Utino Taniguchi4
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来源期刊
Revista Brasileira de Terapia Intensiva
Revista Brasileira de Terapia Intensiva Medicine-Critical Care and Intensive Care Medicine
自引率
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发文量
114
审稿时长
15 weeks
期刊最新文献
Patient-level costs of central line-associated bloodstream infections caused by multidrug-resistant microorganisms in a public intensive care unit in Brazil: a retrospective cohort study Critical COVID-19 and neurological dysfunction - a direct comparative analysis between SARS-CoV-2 and other infectious pathogens. Reply to: Epistaxis as a complication of high-flow nasal cannula therapy in adults. Robust, maintainable, emergency invasive mechanical ventilator. Erratum.
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