The document discusses changes to airway management in the post-COVID pandemic era. It notes that COVID-19 often leads to respiratory complications and sequelae. Some key points discussed include: increased use of protective equipment and infection control measures during airway procedures; adoption of alternative techniques like HFNC and NIV; training on specialized post-COVID airway management protocols; and monitoring patients for long-term effects like pulmonary fibrosis using tests like CT scans and pulmonary function tests. The challenges of potential increased airway injuries and need for multidisciplinary care are also addressed.

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CHANGES IN AIRWAY
MANAGEMENT IN POST
COVID 19 PANDEMIC
DR DAISY GOGOI
PRATIKSHA HOSPITAL
GUWAHATI,ASSAM

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The SARS-CoV-2 (COVID-19) pandemic represents the
infection with the highest lethality.
Most sequelae and multi-organ consequences,
especially respiratory.
Various interventions in the field of respiratory and
intensive care medicine done to reduce mortality and
chronicity.
MULTIDISCIPLINARY -physical, emotional, organizing,
and economic aspects.
Post
INTRODUCTION

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•Introduction to Airway Management in the Post-COVID Era
Preparing for Airway Management in the Post-COVID Era
Innovations in Airway Management Techniques
Training and Education in Post-COVID Airway Management
Challenges and Solutions in Post-COVID Airway Management
Mitigating Risks and Ensuring Patient Safe

5. Most affected
OTHER ORGAN
SYSTEM
RESPIRATORY
SYSTEM

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cough, shortness of
breath from mild, such as
fever,
, to critical disease,
including respiratory
failure, shock
multi-organ system
failure.
SYMPTOMS CAN RANGE

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1.Residual respiratory effect-
2.airway hyperreactivity-airway inflammation
3.delayed presentation –advanced airway complications
4.care of patient anxiety during airway procedures
5.multidisciplinary involvement
6.use and availability of more advance airway devices .

9. LESSONS WE LEARNT
Increased use of
PPE
Emphasis on
infection control
measures
Preoperative care to
manage complications
Use of more
advanced airway
devices
Adoption of
alternative airway,
HFNC, NIV ,prone
Development of
specialized protocol

11. A spectrum of pulmonary manifestations, ranging from
1. dyspnea (with or without chronic oxygen dependence)
2. difficult ventilator weaning
3. fibrotic lung damage.
4. The need for supplemental oxygen due to persistent hypoxemia, or new
requirement for continuous positive airway pressure or other breathing
support

12. Viral-dependent mechanisms (including invasion of alveolar
epithelial and endothelial cells by SARS-CoV-2)
viral-independent mechanisms (such as immunological damage,
including perivascular inflammation) contribute to the breakdown
of the endothelial–epithelial barrier with invasion of monocytes
and neutrophils and extravasation of a protein-rich exudate into
the alveolar space, consistent with other forms of ARDS.
Pulmonary vascular microthrombosis and macrothrombosis
have been observed in 20–30% of patients with COVID-19
PATHOLOGY AND PATHOPHYSIOLOGY

13. COMPLICATIONS
Persistent respiratory
symptoms
Pulmonary embolism
ARDS
Pulmonary fibrosis
pneumonia
Bronchiectasis
Asthma exacerbation

15. LARYNGOTRACHEAL STENOSIS
TUBE SIZE- Use of larger than
normal tubes.
CUFF PRESSURE-
maintenance of excessively high
cuff pressure and delay in
tracheotomy performance . Cuff
pressure of endotracheal tube
above the capillary perfusion
pressure of tracheal mucosa
ranging from 20 to 30 mmHg
leads to mucosal ischemia and
damage.
INSTRUMENTATION -Prolonged
mechanical ventilation , using
high ventilatory pressures, and
consequent high tube cuff
pressure
POSITION-pronation cycles
used in intubated patients with
COVID-19 could have caused
an increase in airway lesions.

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Persistent interstitial lung changes
Most frequent sequele.
Survivors from severe covid19 that required
high-flux nasal cannula (HFNC), non-invasive
ventilation (NIV) or intubation and
mechanical ventilation are more prone.

17. Pulmonary Fibrosis
PF disease is characterized by
scarring of the lungs.
Excessive deposition of
extracellular matrix molecules,
such as collagen, laminin, and
fibronectin, in the parenchymal
lung tissue
thickened alveolar walls, which
hinders gas exchange and
contributes to decreased and/or
declining lung function, dyspnea,
fatigue, and exercise intolerance.

18. ● The higher mortality rate of our ECMO-treated COVID-19 patients admitted after July 1, 2020, was
unexpected.
● strong and dysregulated spontaneous respiratory efforts, associated with wide transpulmonary pressure
swings might heighten the risk of harmful “self-inflicted lung injury” on HFNO or NIV, with more
frequent fibrotic evolution of COVID-19 pneumonia

19. Investigations
,
Forced
spirometry
Plethysmography,
Diffusion lung
capacity of carbon
monoxide (DLCO),
6-minutes
walking test
(6MWT)
for measuring
exercise capacity
and oxygen
saturation
FVC, DLCO and the 6MWT
have been useful for
monitoring patients with
post-covid interstitial syndr

20. Pulmonary function tests
● Pulmonary function tests have always been valuable in assessing
pulmonary diseases and respiratory function.
● MERS and SARS has shown that pulmonary function testing is a
valuable tool to assess for lung damage after recovery.

21. AIRWAY ULTRASOUND
● Airway ultrasound has gained significant
attention in the post COVID era.
● Useful in assessing respiratory
complications, airway management .
● Helpful in diagnosis of airway
stenosis,like airway stenosis , and vocal
cord dysfunction .
● Helpful regarding intubation, extubation
and management of airway issues.

23. PEDIATRIC AIRWAY

25. REHABILITATION
● Low-intensity aerobic exercises followed by the introduction
of strengthening exercises and formal occupational therapy
and psychology evaluation.
● The European Respiratory Society and American Thoracic
Society interim guidance recommended formal assessment
6–8 weeks after acute infection,
● a comprehensive pulmonary rehabilitation programs for
patients with new or persistent respiratory symptoms in
addition to oxygen requirements, persistent radiological
abnormalities, or pulmonary function tests abnormalities.
Telerehabilitation and home-based programs are increasingly
used.

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Labarca et al. conducted a case–control study among patients with acute
respiratory distress syndrome (ARDS) secondary to COVID-19 and mild or
moderate disease, showing that, in surviving patients, the prevalence of
undiagnosed OSA was statistically significant compared to patients with mild
or moderate disease. After adjusting for other confounders, OSA was
independently associated with ARDS. Moreover, undiagnosed OSA
presented more pulmonary sequelae in the medium term, in addition to being
associated with variables such as male gender, ARDS, and total days on
invasive mechanical ventilation

27. CARE OF AIRWAY FOR GENERAL ANAESTHESIA
.
Optimal
Positioning is
important
Aimed at
optimizing lung
function and
prevent
complications
Induction
techniques
Rapid sequence
when risk is
present
Less sedatives
Monitoring. Vital
signs, oxygen
saturation,blood
pressure,heart
rate,EtCO2
Extubation
carefully to
minimize the risk of
aerosol generation
and coughing

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AIRWAY
INSTRUMENTATION

29. VIDEO-LARYNGOSCOPE
DISPOSABLE
EQUIPMENNTS
.9
BARRIER DEVICES
CLOSED SUCTION
SYSTEM
HEPA FILTERS
ENHANCED
CLEANING AND
DISINFECTION
After universal droplet precautions and
standard wearing of N95 masks by
healthcare workers, there was eventual
effective termination of transmission of
SARS within acute healthcare facilities

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VIDEO LARYNGOSCOPE
Reduced aerosol
generation
Minimized exposure
Improved visualization
Documentation
Minimum contact
DISPOSABLE
EQUIPMENNTS
Disposable ETT and supraglottic
airway devices
Disposable blades and handles
Filters and HMEFs
Nasopharyngeal airways
Cricothyrotomy kits
Ventilator circuits
Intubation stylets and bougies

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ETT-. It completely seal the trachea and provides better
protection against aerosol liberation and lowers infection risk for
healthcare providers .
MUSCLE RELAXANT- Use of more rapid inducing agents like
succinylcholine and rocuronium .

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HFNC
It became more available .
The WHO advises that HFNO should be used
for selected adult patients with hypoxaemic
respiratory failure and that HFNO can reduce
the need for intubation.
Use in paediatric population has increased.
Apnoeic oxygenation time has really increased
.
HFNO has been used to prolong the apnoea
phase during tracheal intubation and to reduce
intubation rates in acute respiratory failure

33. CONCLUSION
HIGHLIGHTED THE
AIRWAY CHANGES IN
INDIVIUALS
IMPLICATIONS FOR
HEALTHCARE
Investigations
Monitoring
ADAPTATION AND
RESEARCH
COLLABORATION AND
MULTIDISCIPILARY
APPROACH
FUTURE
PREPAREDNESS

35. THANK YOU