Podcast 553: Airway Management in the Hypoxic COVID-19 Patient (Recorded 4/3/20)

<p><strong>Contributor: Dylan Luyten, MD</strong></p> <p><strong>Educational pearls:</strong></p> <ul> <li style="font-weight: 400;"><span style= "font-weight: 400;">Clinical management of COVID-19 is rapidly evolving, relying on case reports and clinical experience</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">In just a month, the consensus around management of COVID patients with severe hypoxia has shifted from an early intubation strategy to other, non-invasive means</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Intubating early can quickly consume ventilator resources, require increased intensive care monitoring, and likely leads to longer hospital stays and once COVID patients are intubated, extubation can take days to weeks.</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">In Italy, ventilator supplies were depleted leading to the use of helmet CPAP machines, which appeared to be effective in management of respiratory distress in COVID, though not available for use in the US</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Non-invasive ventilation such as CPAP/BiPAP is thought to increase risk to staff for infection via aerosolization, and has often been avoided in COVID patients</span></li> <li style="font-weight: 400;"><span style="font-weight: 400;">High flow nasal cannulas appear to pose less of a risk of aerosolization of viral particles</span> <em><span style= "font-weight: 400;">(especially when a surgical mask is placed over the patient’s nose, mouth and apparatus)</span></em></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Anecdotal evidence from NYC has shown success allowing conscious patients to maintain hypoxia on HFN, where they will self prone to help with lung recruitment, and seemingly do well despite persistent saturations in the 80s or less</span></li> <li style="font-weight: 400;"><span style= "font-weight: 400;">Hospitals around the country are moving away from