{"title":"COVID-19 重症患者的紧急气管插管：管理和临床特征","authors":"Fuquan Fang, Jing Jin, Yongmin Pi, Shaohui Guo, Yuhong Li, Shengmei Zhu, Xianhui Kang","doi":"10.1007/s44254-023-00003-9","DOIUrl":null,"url":null,"abstract":"<div><h3>Purposes</h3><p>SARS-CoV-2 have become widespread worldwide since the outbreak. Respiratory function deteriorates rapidly in critically ill patients infected with SARS-CoV-2. Endotracheal intubation is an indispensable therapeutic measure during the development of the disease. This study was intended to describe the experience of endotracheal intubation from front-line anesthesiologists and clinical prognosis of patients infected with Coronavirus disease-19 (COVID-19).</p><h3>Methods</h3><p>Fourteen critical patients infected with COVID-19 who underwent endotracheal intubation were included in this study. We collate and analyze the blood gas results before and after tracheal intubation of patients and clinical prognostic indicators such as length of stay and. mortality. The experience of anesthesiologists who intubated patients has also been recorded in detail.</p><h3>Results</h3><p>Patients had a mean time of 10.6 days from initial symptoms to endotracheal intubation. Most intubated patients had one or more underlying conditions: hypertension (8, 57.14%), diabetes (5, 35.71%), and cardiovascular and cerebrovascular diseases (2, 14.29%). The oxygenation index increased significantly after intubation compared with before intubation (148.80 ± 42.25 vs 284.43 ± 60.17 <i>p</i> < 0.001). 85.72% of patients required extra-corporeal membrane oxygenation (ECMO) due to inability to maintain oxygen saturation with standard therapeutic measures. Two patients underwent lung transplantation because their lungs were essentially nonfunctional, and they recovered well after surgery. As of this writing, all patients were discharged after satisfactory recovery.</p><h3>Conclusions</h3><p>Reasonable selection of intubation timing is particularly important. It is crucial to increase the patient's oxygen supply and reduce oxygen consumption as much as possible during endotracheal intubation. In addition, the personal protective measures of medical personnel participating in treatment should be scientific and standardized.</p><h3>Graphical Abstract</h3>\n <div><figure><div><div><picture><source><img></source></picture></div></div></figure></div>\n </div>","PeriodicalId":100082,"journal":{"name":"Anesthesiology and Perioperative Science","volume":"1 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2023-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s44254-023-00003-9.pdf","citationCount":"0","resultStr":"{\"title\":\"Emergency endotracheal intubation in critically ill patients with COVID-19: management and clinical characteristics\",\"authors\":\"Fuquan Fang, Jing Jin, Yongmin Pi, Shaohui Guo, Yuhong Li, Shengmei Zhu, Xianhui Kang\",\"doi\":\"10.1007/s44254-023-00003-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Purposes</h3><p>SARS-CoV-2 have become widespread worldwide since the outbreak. Respiratory function deteriorates rapidly in critically ill patients infected with SARS-CoV-2. Endotracheal intubation is an indispensable therapeutic measure during the development of the disease. This study was intended to describe the experience of endotracheal intubation from front-line anesthesiologists and clinical prognosis of patients infected with Coronavirus disease-19 (COVID-19).</p><h3>Methods</h3><p>Fourteen critical patients infected with COVID-19 who underwent endotracheal intubation were included in this study. We collate and analyze the blood gas results before and after tracheal intubation of patients and clinical prognostic indicators such as length of stay and. mortality. The experience of anesthesiologists who intubated patients has also been recorded in detail.</p><h3>Results</h3><p>Patients had a mean time of 10.6 days from initial symptoms to endotracheal intubation. Most intubated patients had one or more underlying conditions: hypertension (8, 57.14%), diabetes (5, 35.71%), and cardiovascular and cerebrovascular diseases (2, 14.29%). The oxygenation index increased significantly after intubation compared with before intubation (148.80 ± 42.25 vs 284.43 ± 60.17 <i>p</i> < 0.001). 85.72% of patients required extra-corporeal membrane oxygenation (ECMO) due to inability to maintain oxygen saturation with standard therapeutic measures. Two patients underwent lung transplantation because their lungs were essentially nonfunctional, and they recovered well after surgery. As of this writing, all patients were discharged after satisfactory recovery.</p><h3>Conclusions</h3><p>Reasonable selection of intubation timing is particularly important. It is crucial to increase the patient's oxygen supply and reduce oxygen consumption as much as possible during endotracheal intubation. 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引用次数: 0
摘要
目的 严重急性呼吸系统综合症（SARS）--CoV-2 自爆发以来已在全球广泛传播。感染 SARS-CoV-2 的重症患者呼吸功能会迅速恶化。气管插管是疾病发展过程中不可或缺的治疗措施。本研究旨在描述一线麻醉医生对感染冠状病毒病-19（COVID-19）患者进行气管插管的经验和临床预后。我们整理并分析了患者气管插管前后的血气结果以及住院时间和死亡率等临床预后指标。我们还详细记录了为患者插管的麻醉师的经验。大多数插管患者患有一种或多种基础疾病：高血压（8 例，占 57.14%）、糖尿病（5 例，占 35.71%）、心脑血管疾病（2 例，占 14.29%）。与插管前相比，插管后氧合指数明显增加（148.80 ± 42.25 vs 284.43 ± 60.17 p < 0.001）。85.72%的患者因无法通过标准治疗措施维持血氧饱和度而需要体外膜肺氧合（ECMO）。两名患者因肺部基本丧失功能而接受了肺移植手术，术后恢复良好。结论合理选择插管时机尤为重要。合理选择插管时机尤为重要。在气管插管过程中，尽可能增加患者的氧气供应和减少氧气消耗至关重要。此外，参与治疗的医务人员的个人防护措施也应科学化、规范化。
Emergency endotracheal intubation in critically ill patients with COVID-19: management and clinical characteristics
Purposes
SARS-CoV-2 have become widespread worldwide since the outbreak. Respiratory function deteriorates rapidly in critically ill patients infected with SARS-CoV-2. Endotracheal intubation is an indispensable therapeutic measure during the development of the disease. This study was intended to describe the experience of endotracheal intubation from front-line anesthesiologists and clinical prognosis of patients infected with Coronavirus disease-19 (COVID-19).
Methods
Fourteen critical patients infected with COVID-19 who underwent endotracheal intubation were included in this study. We collate and analyze the blood gas results before and after tracheal intubation of patients and clinical prognostic indicators such as length of stay and. mortality. The experience of anesthesiologists who intubated patients has also been recorded in detail.
Results
Patients had a mean time of 10.6 days from initial symptoms to endotracheal intubation. Most intubated patients had one or more underlying conditions: hypertension (8, 57.14%), diabetes (5, 35.71%), and cardiovascular and cerebrovascular diseases (2, 14.29%). The oxygenation index increased significantly after intubation compared with before intubation (148.80 ± 42.25 vs 284.43 ± 60.17 p < 0.001). 85.72% of patients required extra-corporeal membrane oxygenation (ECMO) due to inability to maintain oxygen saturation with standard therapeutic measures. Two patients underwent lung transplantation because their lungs were essentially nonfunctional, and they recovered well after surgery. As of this writing, all patients were discharged after satisfactory recovery.
Conclusions
Reasonable selection of intubation timing is particularly important. It is crucial to increase the patient's oxygen supply and reduce oxygen consumption as much as possible during endotracheal intubation. In addition, the personal protective measures of medical personnel participating in treatment should be scientific and standardized.
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