Publication: The COVID-19 pandemic: the effect on airway Management in non-COVID emergency patients
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2021-12-01
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1471227X
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2-s2.0-85113681462
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Mahidol University
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SCOPUS
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BMC Emergency Medicine. Vol.21, No.1 (2021)
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Onlak Ruangsomboon, Phetsinee Boonmee, Akarin Nimmannit The COVID-19 pandemic: the effect on airway Management in non-COVID emergency patients. BMC Emergency Medicine. Vol.21, No.1 (2021). doi:10.1186/s12873-021-00491-7 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/77543
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The COVID-19 pandemic: the effect on airway Management in non-COVID emergency patients
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Background: During the COVID-19 outbreak, healthcare providers might have avoided droplet/aerosol-generating procedures, such as non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) due to the concern of themselves being infected. We hypothesized that this change of practice could have also occurred to other non-COVID-infected patients in the Emergency Department (ED). Methods: A retrospective analytic study was conducted in the ED of Siriraj Hospital, Bangkok, Thailand, including adult patients presenting with signs and symptoms of respiratory distress between 1 March and 30 April 2020 (the COVID period). A comparison group using the same inclusion criteria was retrieved from 1 March to 30 April 2019 (the pre-COVID period). The primary outcome was rate of NIV and HFNC use. The secondary outcomes were rate of intubation, failure of NIV and HFNC, complications, and mortality. Results: A total of 360 and 333 patients were included during the pre-COVID and COVID periods, respectively. After adjusting for baseline differences, patients in the COVID period were less likely to receive either NIV or HFNC than the pre-COVID period (adjusted OR 0.52 [95%CI 0.29–0.92]). Overall, intubation rate was similar between the two study periods. However, patients in respiratory distress with pulmonary edema had a relatively higher intubation rate in the COVID period. There were higher failure rates of NIV and HFNC, more infectious complications, and a higher rate of mortality in the pre-COVID period. Conclusion: During the COVID-19 pandemic, the overall usage of NIV and HFNC in emergency non-COVID patients decreased. Although not affecting the overall intubation rate, this change of practice could have affected some groups of patients. Therefore, treatment decisions based on a balance between the benefits to the patients and the safety of healthcare providers should be made.