The document outlines airway management strategies for COVID-19 patients, emphasizing the need for proper protective measures and meticulous preparation for intubation. It details indications for mechanical ventilation, including severe respiratory distress and obstructed breathing, and highlights the importance of monitoring and managing potential complications. Protocols for safely managing intubation and mechanical ventilation in a COVID-19 context are outlined to ensure effective treatment while minimizing risk to healthcare workers.

1. Airway management in COVID 19
Dr Tushar Kumar
Asst professor
Trauma – Anaesthesiology
Trauma center and central emergency, RIMS, Ranchi

2. Target patients:
• Suspected cases
• Reportable cases
• Confirmed cases

3. Presentation
• Frequently reported signs and symptoms of
patients admitted to the hospital include
• Fever (77–98%)
• Cough (46%–82%)
• Myalgia or fatigue (11–52%)
• Shortness of breath (3-31%) at illness onset
Huang C, Wang Y, Li X, Ren L,et al. The Lancet. 2020 Jan 24. Wang D, Hu B, Hu C, Zhu F, Liu X et al. Published online February 7, 2020.
Chen N, Zhou M, Dong X, Qu J, Gong F. Lancet. 2020 Jan 30. Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J et al. N Engl J Med.
2020 Huang C, Wang Y, Li X, Ren L, Zhao J, et al. Lancet. 2020 Jan 24.

5. Indications of mechanical ventilation
1. Adults with emergency signs
2. Obstructed or absent breathing,
3. Severe respiratory distress,
4. Central cyanosis, shock, coma, or convulsions

6. Aims of Mechanical Ventilation
• Achieve adequate ventilation - CO2
elimination
• Improve oxygenation
• Relieve respiratory distress - offload
respiratory muscles

7. Mechanical Ventilation
• NI Ventilation
• Inv. Ventilation

9. Intubation:
Before :
1. Staff protection
2. Hand hygiene
3. Full PPE
4. Minimize personnel
5. Keep in isolation room if available.

10. Intubation:
Preparation:
1. Early preparation of drug and equipment
2. Formulate plan early
3. Meticulous airway assessment
4. Connect viral/ bacterial circuits and manual
ventilator
5. Use closed suctioning system
6. Use disposable video laryngoscopy( if available)

11. During
Team dynamics:
1. Clear assigned roles
2. Clear communication of airway plan
3. Through close loop communication
4. Close monitoring by all team members for
potential contamination.

12. During
Technical aspects:
Airway management by most experienced
practitioner.
Lowest gas flows, if possible, to maintain
oxygenation.
Tight fitting mask with two hands to minimise leak.
Rapid sequence induction and avoid bag mask
ventilation when possible.
Ensure paralysis to avoid coughing
Positive pressure ventilation only after cuff
inflation.

13. After
1. Avoid unnecessary circuit disconnection
2. If disconnection needed, wear PPE and put
ventilator on stand by mode and/ or clamp
tube.
3. Strict adherence to proper degowning steps.
4. Hand hygiene
5. Team debriefing

14. Monitoring:
• Vital monitoring
•Sp02
•ECG
•NIBP
•Urine output, sensorium
•Invasive monitoring
Respiratory mechanics
•Paw
•Pplat
•Driving pressures
•Transpulmonary pressures (Inspiration and expiration)

15. Maintenance :
• Suctioning
•Close suction only
•As and when required
•Not hourly basis
•PPE precautions if using open suction.

16. Complications
•Barotrauma
•Acute right ventricle failure
•Hemodynamic instability
•Infections

17. Weaning
•Normalised I:E ratio
•Reducing FiO2 (usually <0.5)
•No requirement for high PEEP
•Appropriate underlying respiratory rate
•Appropriate tidal volume with moderate
airway pressures

18. Discharge from ICU to isolation ward
•Depends upon duration of illness
•<2 weeks consider them as infective use all PPE
•>2 weeks may treat as non COVID patients

19. COVID and Cardiac Arrest
•Secure definitive airway as soon as possible to
avoid aerosol generation
•Use PPE (aerosol generating procedure) at all
time during resuscitation.
•Switch patient from ventilator to AMBU with
viral filter during cardiac arrest.

20. Loosing is not an option……THANKYOU