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MCW Anesthesiology Intranet

Considerations for Extubation of COVID-19 Patients (positive or suspected)

  1. Intubation has been recognized as a time when aerosolization of respiratory secretions increases risk of transmission of SARS-CoV-2.
  2. Extubation may represent an equally significant risk, due to coughing and during removal of endotracheal tubes and supraglottic airways.
  3. The suggestions below may merit consideration not only for known infected patients, but also those with exposure to infected patients.
  4. In order to minimize aerosolization and the risk of transmission during extubation, the following suggestions may be considered:

 

1 Tung A, Fergusson NA, Ng N, Hu V, Dormuth C, Griesdale DEG.  Medications to reduce emergence coughing after general anaesthesia with tracheal intubation: a systematic review and network meta-analysis.  BJA 2020; 124:480-495.

2 Contraindications to deep extubation include aspiration risk, difficult mask ventilation, difficult airway (either due to patient conditions or type of surgery), lack of access to airway.  Patients should have full reversal of neuromuscular blockade and exhibit good spontaneous respiration.

3 https://twitter.com/innov8doc/status/1240455223929458696?s=21 (video showing effectiveness of cover over face).

4 https://twitter.com/innov8doc/status/1241332862235873285?s=21 (video showing dispersal if only a face mask is used, without yellow or surgical mask on patient).