Koronavirüs hastalığı-2019 [Coronavirus diseasse (2019)]'na sebep olan şiddetli akut solunum sendromu-koronavirüs-2 [severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)] son derece bulaşıcıdır. COVID-19 hastalarında, havayolu yönetimi hem sağlık personeli hem de hastalar için yüksek risklidir. Özellikle anestezistler, perioperatif dönemde ve acil havayolu durumlarında hastalara ilk müdahale edenler olarak yüksek bir enfeksiyon riskine sahiptirler. Enfeksiyon riskini değerlendiren sistematik ve entegre bir yaklaşım ile enfekte olma potansiyeli azaltılabilir. Ayrıca kişisel koruma ve diğer hastalarla personele çapraz bulaşın önlenmesi için uygun malzeme ve teknik seçimini sağlar. Havayolu yönetimi için sağlık personeline, damlacık ve havayolu bulaş korumasına uygun kişisel koruyucu ekipmanlar sağlanmalıdır. Endotrakeal entübasyonda hızlı seri indüksiyon önerilmektedir. Havayolu yönetimi sırasında temel amaç, aerosol salınımının minimalize edilmesi olmalıdır.
Anahtar Kelimeler: COVID-19; SARS-CoV-2; havayolu yönetimi; endotrakeal entübasyon
Severe acute respiratory syndrome-coronavirus, which causes coronavirus disease-2019 (COVID-19), is highly contagious. Airway management of patients with COVID-19 is high risk to staff and patients. Anesthesiologists have a high risk of infection with COVID-19 during perioperative care and as first responders to airway emergencies. The potential of becoming infected can be reduced by a systematic and integrated approach that assesses infection risk. The latter leads to an acceptable choice of materials and techniques for personal protection and prevention of cross-contamination to other patients and staff. During the airway management, enhanced droplet/airborne personel protective equipment should be applied to the health care providers. Rapid series induction is recommended for endotracheal intubation. The main goal under airway management is to minimize aerosol release.
Keywords: COVID-19; SARS-CoV-2; airway management; endotracheal intubation
- Hagberg CA, Artime CA. Airway management in the adult. In: Miller RD, ed. Miller's Anesthesia. 8th ed. Philadelphia: Elsevier, Saunder; 2015. p.1647-84.
- Kayhan Z. [Clinical anesthesia]. Havayolu Yönetimi ve Endotrakeal Entübasyon. Geniş-letilmiş 4. Baskı. İstanbul: Logos Yayıncılık; 2019. p.255-85.
- World health Organization. There is a current outbreak of coronavirus (COVID-19) disease. available at: https://www.who.int/health-topics/coronavirus. accessed March 10, 2020.
- Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-3.
- Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA. 2020;323(18): 1843-4. [Crossref] [PubMed] [PMC]
- van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1. New England Journal of Medicine 2020. Epub ahead of print 13 March. https://doi.org/ 10.1101/2020.03.09.20033217. [Crossref]
- Yin Y, Wunderink RG. MERS, SARS and other coronaviruses as causes of pneumonia. Respirology. 2018;23(2):130-7. [Crossref] [PubMed] [PMC]
- de Wit E, van Doremalen N, Falzarano D, Munster VJ. SARS and MERS: recent insights into emerging coronaviruses. Nat Rev Microbiol. 2016;14(8):523-34. [Crossref] [PubMed] [PMC]
- Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al; China Novel Coronavirus Investigating and Research Team. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33. [Crossref] [PubMed] [PMC]
- Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223): 470-3. [Crossref]
- Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. [Crossref]
- Tang B, Bragazzi NL, Li Q, Tang S, Xiao Y, Wu J. An updated estimation of the risk of transmission of the novel coronavirus (2019-nCov). Infect Dis Model. 2020;5:248-55. [Crossref] [PubMed] [PMC]
- Sohrabi C, Alsafi Z, O'Neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: a review of the 2019 novel coronavirus (COVID-19). Int J Surg. 2020;76:71-6. [Crossref] [PubMed] [PMC]
- Bai Y, Yao L, Wei T, Tian F, Jin DY, Chen L, et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA. 2020;323(14): 1406-7. [Crossref] [PubMed] [PMC]
- Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The incubation period of coronavirus disease 2019 (COVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med. 2020;172(9): 577-82. [Crossref] [PubMed] [PMC]
- Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020. 2020;323(11):1061-9. [Crossref] [PubMed] [PMC]
- Kamei J, Nakanishi Y, Asato M, Ikeda H. Fentanyl enhances the excitability of rapidly adapting receptors to cause cough via the enhancement of histamine release in the airways. Cough. 2013;9(1):3. [Crossref] [PubMed] [PMC]
- Güldner A, Kiss T, Neto AS, Hemmes SNT, Canet J, Spieth PM, et al. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers. Anesthesiology. 2015;123(3):692-713. [Crossref] [PubMed]
- CDC. Guideline for Disinfection and Sterilization in Healthcare Facilities (2008). Available at: https://www.cdc.gov/infectioncontrol/guidelines/disinfection/index.html. Accessed May 24, 2019.
- Zeraatkari K, Soltani H, Veisy A, Soleimani B. Disinfection effect of cidex, savlon and H2O2 on ventilator tubes. Can J Anesth. 2005;52: A163. [Crossref]
- Berry AJ, Nolte FS. An alternative strategy for infection control of anesthesia breathing circuits: A laboratory assessment of the Pall HME Filter. Anesth Analg. 1991;72(5):651-5. [Crossref] [PubMed]
- Perioperative infection control branch of Chinese society of cardiothoracic and vascular anesthesia. Recommendations for disinfection and sterilization of breathing circuit in anesthesia machine. Chin J Anesthesiol. 2018; 38(12):1417-20. https://doi.org/10.3760/ cma.j.issn.0254-1416.2018.12.003.
- Royal College of Anaesthetists. Capnography: No trace =Wrong place. 2018. https://www.youtube.com/watch?v=t97G65bignQ (accessed 13/03/2020).
- Cook TM, Harrop-Griffiths W. Capnography prevents avoidable deaths. BMJ. 2019;364: l439. [Crossref] [PubMed]
- Resuscitation Council. Resuscitation Council UK Statement on COVID-19 in relation to CPR and resuscitation in healthcare settings. 2020. https://www.resus.org.uk/media/statements/resuscitation-council-uk-statements-on-covid-19- coronavirus-cpr-and-resuscitation/covid-healthcare (accessed 13/03/2020).
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