Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Salas Cirúrgicas , Inovação Organizacional , Pandemias/prevenção & controle , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/prevenção & controle , Treinamento por Simulação , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Georgia/epidemiologia , Humanos , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Melhoria de Qualidade , SARS-CoV-2RESUMO
Some patients infected with the Coronavirus Disease 2019 (COVID-19) require endotracheal intubation, an aerosol-generating procedure that is believed to result in viral transmission to personnel performing the procedure. Additionally, donning and doffing personal protective equipment can be time consuming. In particular, doffing requires strict protocol adherence to avoid exposure. We describe the Emory Healthcare intubation team approach during the COVID-19 pandemic. This structure resulted in only 1 team member testing positive for COVID-19 despite 253 patient intubations over a 6-week period with 153 anesthesia providers on service.
Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/terapia , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Intubação Intratraqueal/efeitos adversos , Exposição Ocupacional/prevenção & controle , Saúde Ocupacional , Equipe de Assistência ao Paciente , Pneumonia Viral/terapia , COVID-19 , Lista de Checagem , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Descontaminação , Contaminação de Equipamentos/prevenção & controle , Humanos , Intubação Intratraqueal/instrumentação , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Medição de Risco , Fatores de Risco , SARS-CoV-2RESUMO
BACKGROUND: The effect of patient position on the view obtained during laryngoscopy was investigated. METHODS: 60 morbidly obese patients undergoing elective bariatric were studied. Patients were randomly assigned into one of two groups. In Group 1, a conventional "sniff" position was obtained by placing a firm 7-cm cushion underneath the patient's head, thus raising the occiput a standard distance from the operating-table while the patient remained supine. In Group 2, a "ramped" position was achieved by arranging blankets underneath the patient's upper body and head until horizontal alignment was achieved between the external auditory meatus and the sternal notch. Following induction of general anesthesia, tracheal intubation was performed using a Video MacIntosh laryngoscope. The laryngoscopy and intubation sequences were recorded onto videotape. Three independent investigators, unaware as to which position the patient had been in at the time of tracheal intubation, then viewed the videotape and assigned a numerical grade to the best laryngeal view obtained. RESULTS: The "ramped" position improved the laryngeal view when compared to a standard "sniff" position, and this difference was statistically significant (P=0.037). CONCLUSION: The "ramped" position is superior to the standard "sniff" position for direct laryngoscopy in morbidly obese patients.