scholarly journals Risk of Transmission of infection to Healthcare Workers delivering Supportive Care for Coronavirus Pneumonia;A Rapid GRADE Review

2020 ◽  
Author(s):  
TK Luqman Arafath ◽  
Sandeep S Jubbal ◽  
Elakkat D Gireesh ◽  
Jyothi Margapuri ◽  
Hanumantha Rao Jogu ◽  
...  
Keyword(s):  
Healthy Volunteer ◽  
Supportive Care ◽  
Endotracheal Intubation ◽  
Formal Training ◽  
Mask Ventilation ◽  
Mechanistic Studies ◽  
Eye Protection ◽  
Corona Virus ◽  
Evidence Grade ◽  
Bag And Mask Ventilation

Abstract Background: Avenues of treatment currently implemented for Covid-19 pandemic are largely supportive in nature. Non -availability of an effective antiviral treatment makes supportive care for acute hypoxic respiratory failure is the most crucial intervention. Highly contagious nature of Covid-19 had created stress and confusion among front line Health Care Workers (HCWs) regarding infectious risk of supportive interventions and best preventive strategies. Purpose: To analyze and summarize key evidence from published literature exploring the risk of transmission of Covid-19 related to common supportive care interventions in hospitalized patients and effectiveness of currently used preventive measures in hospital setting. Data Sources: Curated Covid-19 literature from NCBI Computational Biology Branch ,Embase and Ovid till May 20,2020.Longitudinal and reference search till June 28,2020 Study Selection: Studies pertaining to risk of infection to HCWs providing standard supportive care of hospitalized Covid-19 mainly focusing on respiratory support interventions.Indirect studies from SARS,MERS or other ARDS pathology caused by infectious agents based on reference tracking and snow ball search . Clinical, Healthy volunteer and mechanistic studies were included. Two authors independently screened studies for traditional respiratory supportive-care (Hypoxia management, ventilatory support and pulmonary toileting) related transmission of viral or bacterial pneumonia to HCWs. Data Extraction: Two authors (TK and SP) independently screened articles and verified for consensus. Quality of studies and level of evidence was assessed using Oxford Center for Evidence Based Medicine (OCEBM) , Newcastle - Ottawa quality assessment Scale for observational studies and Grading of Recommendations Assessment, Development and Evaluation (GRADE) system for grading evidence. Data Synthesis: 21 studies were eligible for inclusion. In 11 mechanistic studies, 7 were manikin based,1 was in the setting of GNB pneumonia ,2 were healthy volunteer study and 1 was heterogenous setting.Out of 10 clinical studies ,5 were case controlled and 6 were cohort studies. Risk of corona virus transmission was significantly high in HCWs performing or assisting endotracheal intubation or contact with respiratory secretion.(Moderate certainty evidence, GRADE B) Safety of nebulization treatment in corona virus pneumonia patients are questionable(Low certainty evidence, GRADE C).Very low certainty evidence exist for risk of transmission with conventional HFNC (GRADE D) and NIV (GRADE D),CPR (GRADE D),Bag and mask ventilation(GRADE D).Moderate certainty evidence exist for protective effect of wearing a multilayered mask, gown , eye protection and formal training for PPE use (GRADE B).Low certainty evidence exist for transmission risk with bag and mask ventilation, suctioning before and after intubation and prolonged exposure (GRADE C).Certainty of evidence for wearing gloves,post exposure hand washing and wearing N 95 mask is low(GRADE C). Limitations: This study was limited to articles with English abstract. Highly dynamic nature of body of literature related to Covid-19, frequent updates were necessary even during preparation of manuscript and longitudinal search was continued even after finalizing initial search. Due to the heterogeneity and broad nature of the search protocol, quantitative comparisons regarding the effectiveness of included management strategies could not be performed. Direct evidence was limited due to poor quality and non-comparative nature of available Covid-19 reporting. Conclusions: Major risk factors for transmission of corona virus infection were, performing or assisting endotracheal intubation and contact with respiratory secretion. Risk of transmission with HFNC or NIV can be significantly decreased by helmet interface, modified exhalation circuit or placing a properly fitting face mask over patient interface of HFNC. Evidence for risk of transmission with CPR, suctioning before or after intubation or bag and mask ventilation of very low certainty. Significant protective factors are Formal training for PPE use, consistently wearing mask, gown and eye protection. Primary Funding Source: None Disclosure: None of the authors have any conflict of interest to disclose.

Predictors of mortality in premature babies with respiratory distress syndrome treated by early rescue surfactant therapy

2021 ◽  
pp. 1-6
Author(s):  
V. Gahlawat ◽  
H. Chellani ◽  
I. Saini ◽  
S. Gupta
Keyword(s):  
Mechanical Ventilation ◽  
Birth Weight ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Surfactant Therapy ◽  
Mask Ventilation ◽  
Predictors Of Mortality ◽  
Antenatal Steroid ◽  
Bag And Mask Ventilation

OBJECTIVE: To determine the predictors of mortality following early rescue surfactant therapy in preterm babies with respiratory distress syndrome. STUDY DESIGN: Prospective cohort study enrolling babies between 28 weeks to 34 weeks with respiratory distress syndrome requiring early rescue surfactant therapy. For statistical analysis babies were further divided into two subgroups: survivors and non-survivors. Maternal and neonatal variables were compared between the two groups to find out the predictors of mortality. RESULTS: Out of total 110 babies, 72 (65.45%) survived. The mean birth weight and mean gestational age of the study population was 1614.36 (±487.86) g and 31.40 (±2.0)1 weeks, respectively. Birth weight <  1500 g, gestational age <  32 weeks, primiparity, vaginal delivery, prolonged rupture of membranes, lack of antenatal steroid cover, bag and mask ventilation at birth, sepsis, apneic episodes and mechanical ventilation were significantly associated with death on univariate analysis. On multivariate analysis, very low birth weight, vaginal delivery, lack of antenatal steroid cover, bag and mask ventilation at birth and mechanical ventilation were found to be independent predictors of mortality. CONCLUSIONS: Some of the identified predictors of mortality are modifiable and can be used to draw up a screening tool to predict the clinical severity and mortality among these babies.

scholarly journals Application of high-flow nasal oxygenation as a rescue therapy in difficult videolaryngoscopic intubation

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110100
Author(s):  
Min Ho Lee ◽  
Hyun Joo Kim
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Endotracheal Intubation ◽  
Difficult Intubation ◽  
Rescue Therapy ◽  
High Flow ◽  
Mask Ventilation ◽  
Induction Process ◽  
Management Method ◽  
Adequate Oxygenation

In difficult airway situations, the next step of the airway management method is selected according to the prior presence of difficulties in mask ventilation and endotracheal intubation. It is important for the practitioner to be calm, quick in judgment, and take action in cases of difficult intubation. Recently, high-flow nasal oxygenation has been rapidly introduced into the anesthesiology field. This technique could extend the safe apnea time to desaturation. Especially, it maintains adequate oxygenation even in apnea and allows time for intubation or alternative airway management. We report two cases in which high-flow nasal oxygenation was implemented in the middle of the induction process after quick judgment by clinicians. High-flow nasal oxygenation was successfully used to assist in prolonging the safe apnea time during delicate airway securing attempts.

scholarly journals Ease in bag and mask ventilation: Is ankyloglossia in a child with micrognathia a blessing in disguise?

2017 ◽  
Vol 11 (3) ◽  
pp. 803
Author(s):  
Vansh Priya ◽  
Rameez Riaz ◽  
Sanjay Dhiraaj ◽  
Puneet Goyal
Keyword(s):  
Mask Ventilation ◽  
Bag And Mask Ventilation

Early-onset pneumonia following bag-mask ventilation versus endotracheal intubation during cardiopulmonary resuscitation: A substudy of the CAAM trial

Resuscitation ◽  
2020 ◽  
Vol 154 ◽  
pp. 12-18 ◽  
Author(s):  
Josefine S. Baekgaard ◽  
Mohamed N. Triba ◽  
Morgane Brandeis ◽  
Jacob Steinmetz ◽  
Yves Cohen ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Endotracheal Intubation ◽  
Early Onset ◽  
Mask Ventilation ◽  
Bag Mask Ventilation

Risk Factors for and Outcomes Associated With Peri-Intubation Hypoxemia: A Multicenter Prospective Cohort Study

2020 ◽  
pp. 088506662096244
Author(s):  
Nathan J. Smischney ◽  
Ashish K. Khanna ◽  
Ernesto Brauer ◽  
Lee E. Morrow ◽  
Uchenna R. Ofoma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Critically Ill ◽  
Endotracheal Intubation ◽  
Point Estimate ◽  
Mask Ventilation ◽  
Factors Associated ◽  
Icu Length Of Stay ◽  
Multicenter Prospective Cohort Study ◽  
Bag Mask Ventilation ◽  
Multicenter Prospective Cohort

Background: Little is known about hypoxemia surrounding endotracheal intubation in the critically ill. Thus, we sought to identify risk factors associated with peri-intubation hypoxemia and its effects’ on the critically ill. Methods: Data from a multicenter, prospective, cohort study enrolling 1,033 critically ill adults who underwent endotracheal intubation across 16 medical/surgical ICUs in the United States from July 2015-January 2017 were used to identify risk factors associated with peri-intubation hypoxemia and its effects on patient outcomes. We defined hypoxemia as any pulse oximetry ≤ 88% during and up to 30 minutes following endotracheal intubation. Results: In the full analysis (n = 1,033), 123 (11.9%) patients experienced the primary outcome. Five risk factors independently associated with our outcome were identified on multiple logistic regression: cardiac related reason for endotracheal intubation (OR 1.67, [95% CI 1.04, 2.69]); pre-intubation noninvasive ventilation (OR 1.66, [95% CI 1.09, 2.54]); emergency intubation (OR 1.65, [95% CI 1.06, 2.55]); moderate-severe difficult bag-mask ventilation (OR 2.68, [95% CI 1.72, 4.19]); and crystalloid administration within the preceding 24 hours (OR 1.24, [95% CI 1.07, 1.45]; per liter up to 4 liters). Higher baseline SpO2 was found to be protective (OR 0.93, [95% CI 0.91, 0.96]; per percent up to 97%). Consistent results were seen in a separate analysis on only stable patients (n = 921, 93 [10.1%]) (those without baseline hypoxemia ≤ 88%). Peri-intubation hypoxemia was associated with in-hospital mortality (OR 2.40, [95% CI 1.33, 4.31]; stable patients: OR 2.67, [95% CI 1.38, 5.17]) but not ICU length of stay (point estimate 0.9 days, [95% CI −1.0, 2.8 days]; stable patients: point estimate 1.5 days, [95% CI −0.4, 3.4 days]) after adjusting for age, body mass index, illness severity, airway related reason for intubation (i.e., acute respiratory failure), and baseline SPO2. Conclusions: Patients with pre-existing noninvasive ventilation and volume loading who were intubated emergently in the setting of hemodynamic compromise with bag-mask ventilation described as moderate-severe were at increased risk for peri-intubation hypoxemia. Higher baseline oxygenation was found to be protective against peri-intubation hypoxemia. Peri-intubation hypoxemia was associated with in-hospital mortality but not ICU length of stay. Trial registration: Clinicaltrials.gov identifier: NCT02508948 and Registered Report Identifier: RR2-10.2196/11101.

Sign in / Sign up

Export Citation Format

Share Document