Airway management and ventilation considerations in the critically-ill patient with COVID-19
Keywords:
COVID-19, CORONAVIRUS, MECHANICAL VENTILATION, TRACHEOTOMY, INTENSIVE CARE UNIT, OXYGEN THERAPY.Abstract
Introduction: airway management and artificial ventilation play an indispensable role in maintaining vital functions in the critically-ill patient, in those infected with COVID-19 this management has specific particularities.
Objective: to describe airway management in the critically-ill patient with COVID -19
Methods: a medical literature review was conducted, using articles retrieved from MEDLINE, Scopus, ClinicalKey and ScienceDirect published up to May 2020.
Development: oxygen therapy is useful for maintaining oxygen saturation levels above 96% in the less advanced stages; using conventional oxygenation systems and high frequency nasal cannula. Early tracheostomy should be performed in stable patients with low oxygen demand where prolonged mechanical ventilation is expected; and in patients with confirmed COVID-19, 14 days after the starting of orotracheal intubation. Non-invasive mechanical ventilation showed a lower intubation rate than other oxygenation variants. Optimal parameters should be set, taking into account the different characteristics of the patient.
Conclusions: intubation should be performed through a rapid induction sequence, minimizing exposure time, tracheostomy is preferably performed late in the infected patient, and non-invasive mechanical ventilation should be performed avoiding aerosolization as much as possible. In invasive mechanical ventilation, strategies for lung protection, reduction of tidal volumes individualized to the characteristics and phenotypes of the patient, desired plateau pressure and distension pressure along with the use of prone ventilation are useful.
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