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Also, in a study conducted in New York, 12.2 to 33.1% of COVID-19 patients needed intubation ( 4, 9). On March 4, 2020, 3.2% of infected cases in China required intubation ( 7). The need for intubation and mechanical ventilation in cases who are critically ill is vary ranging from 30 to 100% ( 8).Ĭurrently, different statistics are provided on the intubation rate of COVID-19 patients in intensive care units (ICUs). Almost 14 - 30% of hospitalized COVID-19 patients develop a respiratory failure at different degrees (moderate to severe) and may need intensive care ( 4- 6) so that less than 5% of COVID-19 patients required intubation and invasive ventilation at some stages of respiratory failure ( 7). Because intubation is an invasive and uncomfortable procedure, it is often performed under general anesthesia and using a neuromuscular-blocking medication.ĭuring the coronavirus disease 2019 (COVID-19) pandemic, because infected patients develop acute respiratory distress and respiratory failure, putting invasive airways can prevent the disease progression ( 1- 3). Some circumstances may require intubation, such as loss of consciousness, major surgeries, decreased oxygen saturation (hypoxemia), airway obstruction (laryngospasm), or respiratory diseases, such as acute respiratory distress syndrome ( 1, 2). Tracheal intubation is a clinical procedure to place a flexible tube into the trachea with the aim of keeping a safe airway and establishing ventilation. Noninvasive ventilation may have survival benefits. There was no association between intubation timing and mortality of the infected patients. Awake-prone positioning in comparison with high-flow nasal oxygen therapy did not reduce the risk of intubation and mechanical ventilation.
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ICU admission mortality following intubation was found to be 15 to 36%. Old age, diabetes mellitus, respiratory rate, increased level of CRP, bicarbonate level, and oxygen saturation are the most valuable predictors of the need for mechanical ventilation. Also, increased levels of C-reactive protein (CRP), ferritin, d-dimer, and lipase in combination with hypoxia are correlated with intubation. Severe respiratory distress, loss of consciousness, and hypoxia had been the most important reasons for intubation. Yet obesity and age (elderly) are the only risk factors of delayed or difficult extubation.Īcute respiratory distress in COVID-19 patients could require endotracheal intubation and mechanical ventilation. It was revealed that 1.4 - 44.5% of patients might be extubated. According to the studies, the rate of intubation was 5 to 88%. ROX index can be utilized as the predictor of the necessity of intubation in COVID-19 patients. Rapid sequence induction had been mostly used for intubation. Most patients had been intubated in the intensive care unit. Studies had been conducted in the USA, China, Spain, South Korea, Italy, Iran, and Brazil.
BJR SUPPLEMENT 25 AAPM REPORT SERIES
We searched PubMed, Embase, and Scopus databases to identify relevant randomized control trials, observational studies, and case series published from April 1, 2021.Ģ4 studies were included in this review. Intubation and mechanical ventilation are strategic treatments for COVID-19 distress or hypoxia. Severe coronavirus disease 2019 (COVID-19) can induce acute respiratory distress, which is characterized by tachypnea, hypoxia, and dyspnea.