COVID-19 / 冠状病毒爆发:保护气道 - 气管内管插管
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Q1: Why is early intubation recommended for COVID-19 patients with respiratory failure?
Early intubation prevents aerosolization of respiratory tract fluids and avoids emergency intubation under crisis conditions. A low threshold for early intubation should be maintained, utilizing modified rapid sequence induction with videolaryngoscopic intubation to minimize infection risk while securing the airway safely.
Q2: What equipment and personnel setup is required before starting endotracheal intubation in COVID-19 patients?
All intubation equipment is prepared outside the patient's room on an airway trolley. The team consists of an intubating doctor, oversight doctor managing cardiovascular function, a nurse operating the ventilator, a second nurse supplying anesthetic agents, and a runner waiting outside. An HME filter connects the Y-piece to the respiratory mask, and the ventilator connections are tested beforehand.
Q3: How should the patient be prepared and positioned before intubation?
The patient is positioned head-up with the pillow removed to optimize the working environment. Minimal two intravenous cannulas are inserted and tested. Complete vital sign monitoring and ECG are established. The suction system is fully functional with the catheter within reach. A 10-second briefing clarifies facts, procedural planning, complications, and team roles before proceeding.
Q4: What is the purpose of the pre-oxygenation phase and how long does it last?
Pre-oxygenation prepares the patient for rapid sequence induction by maximizing oxygen reserves. The respiratory mask is held with a C-grip technique, and oxygen flows through the nasal cannula at 3 liters per minute with CPAP mode, PEEP of 5, and FIO2 of 1. Pre-oxygenation continues for three to five minutes while monitoring cardiovascular status.
Q5: What precautions minimize aerosolization during the intubation attempt?
The intubating doctor maintains maximum distance from the patient during videolaryngoscopic intubation using an endotracheal tube with a pre-positioned bougie. After bougie removal, the endotracheal tube cuff is blocked immediately to prevent aerosolization. A closed suction system is attached to the breathing circuit, and the ventilator is paused during the intubation attempt.
Q6: How is tube position confirmed and what follows after successful intubation?
Tube position is confirmed through capnography and auscultation using a dedicated stethoscope left at the patient's bedside. The endotracheal tube is then fixed, and the first pair of gloves is removed. A nasogastric tube is inserted, positioned, and fixed. The nasal cannula is cut and removed to complete the procedure.
Q7: What is the protocol for managing difficult airways and extubation in COVID-19 patients?
Difficult airway algorithms are pre-established with an emergency trolley placed outside the patient room. Supraglottic airways like laryngeal tubes are used early, and cricothyroid pressure is applied if needed. For extubation, a two-person team with full personal protective equipment performs continuous suctioning while carefully removing the endotracheal tube, then immediately applies a tight-fitting respiratory mask.