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      Intubation and Ventilation amid the COVID-19 Outbreak : Wuhan’s Experience

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      Author(s): , M.D. 1 , , M.D. 2 , , M.D. 3 , , M.D. 4 , , M.D. 7 , , M.D. 5 , , M.D. 1 , , M.D., Ph.D. 4 , , M.D., Ph.D. 6 , , M.D. 8 , , M.D. 9 , , M.D., Ph.D. 10 ,
      Publication date (Electronic):
      Journal: Anesthesiology
      Publisher: Lippincott Williams & Wilkins

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          Abstract

          The COVID-19 outbreak has led to 80,409 diagnosed cases and 3,012 deaths in mainland China based on the data released on March 4, 2020. Approximately 3.2% of patients with COVID-19 required intubation and invasive ventilation at some point in the disease course. Providing best practices regarding intubation and ventilation for an overwhelming number of patients with COVID-19 amid an enhanced risk of cross-infection is a daunting undertaking. The authors presented the experience of caring for the critically ill patients with COVID-19 in Wuhan. It is extremely important to follow strict self-protection precautions. Timely, but not premature, intubation is crucial to counter a progressively enlarging oxygen debt despite high-flow oxygen therapy and bilevel positive airway pressure ventilation. Thorough preparation, satisfactory preoxygenation, modified rapid sequence induction, and rapid intubation using a video laryngoscope are widely used intubation strategies in Wuhan. Lung-protective ventilation, prone position ventilation, and adequate sedation and analgesia are essential components of ventilation management.

          Abstract

          The authors summarize the experience of managing intubation and ventilation for critically ill patients with COVID-19 in Wuhan. Anesthesiologists and intensivists are mandated to provide the best practices while following strict self-protection precautions.

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Chaolin Huang, Yeming Wang, Xingwang Li … (2020)
          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Clinical Characteristics of Coronavirus Disease 2019 in China

            Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)
            Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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              Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

              Dawei Wang, Bo Hu, Fangfang Zhu … (2020)
              In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
              Article 0 comments Cited 10800 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Anesthesiology
                Journal ID (iso-abbrev): Anesthesiology
                Journal ID (publisher-id): ALN
                Title: Anesthesiology
                Publisher: Lippincott Williams & Wilkins
                ISSN (Print): 0003-3022
                ISSN (Electronic): 1528-1175
                Publication date (Print): 8 April 2020
                Publication date (Electronic): 18 March 2020
                Electronic Location Identifier: 10.1097/ALN.0000000000003296
                Affiliations
                [1 ]From the Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut (L.M., R.D.)
                [2 ]the Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China (H.Q.)
                [3 ]the Department of Anesthesiology, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, Hubei, China (L.W.)
                [4 ]the Departments of Critical Care Medicine (Y.A., L.Z.), Xiangya Hospital, Central South University, Changsha, Hunan Province, China
                [5 ]Anesthesiology (Q.G.), Xiangya Hospital, Central South University, Changsha, Hunan Province, China
                [6 ]Respiratory Medicine (J.M.), Xiangya Hospital, Central South University, Changsha, Hunan Province, China
                [7 ]the Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China (Z.X.)
                [8 ]the Department of Anesthesiology, Wake Forest University, Winston-Salem, North Carolina (C.T.)
                [9 ]the Department of Anesthesiology and Pain Medicine, University of California Davis, Sacramento, California (H.L.)
                [10 ]the Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, Tongji University School of Medicine, Shanghai, China (L.X.).
                Author notes
                Address correspondence to Dr. Xiong: Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, Tongji University School of Medicine, Shanghai 200081, China. mzkxlz@ 123456126.com . Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
                Article
                Accession ID: 00001
                DOI: 10.1097/ALN.0000000000003296
                PMC ID: 7155908
                PubMed ID: 32195705
                SO-VID: 99d790e8-ae90-4985-9fad-663cc101af3d
                Copyright © Copyright © 2020, the American Society of Anesthesiologists, Inc. All Rights Reserved.
                License:

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                Date received : 16 February 2020
                Date accepted : 06 March 2020
                Categories
                Subject: Special Section: COVID-19
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